title: Quality of care for First Nations and non-First Nations People with diabetes.
abstract: OBJECTIVE
  Compared with non-First Nations, First Nations People with diabetes experience higher rates of kidney failure and death, which may be related to disparities in care. This study examined First Nations and non-First Nations People with diabetes for differences in quality indicators and their association with kidney failure and death.
  
  
  METHODS
  Adults with diabetes and an outpatient creatinine in Alberta from 2005 to 2008 were identified. Logistic regression was used to determine the likelihood of process of care indicators (measurement of urine albumin/creatinine ratio [ACR], LDL, and hemoglobin A1C [A1C]) and surrogate outcome indicators (achievement of LDL and A1C targets). Cox regression was used to determine the association between lack of achievement of indicator targets and each of kidney failure and death.
  
  
  RESULTS
  This study identified 140,709 non-First Nations and 6574 First Nations People with diabetes. There was a significant interaction between First Nations status and CKD for the outcomes (P<0.01); therefore, results are stratified by CKD. Among participants without CKD, First Nations People were less likely to receive process of care indicators and achieve target A1C compared with non-First Nations People. For those with CKD, First Nations People were as likely to receive these indicators (other than LDL) and achieve LDL and A1C targets. Lack of LDL and A1C assessment and achievement of targets were associated with increased risk of kidney failure and death similarly for both groups.
  
  
  CONCLUSIONS
  Compared with non-First Nations, First Nations People with diabetes but without CKD experience disparities in assessment of quality indicators and achievement of A1C target.
authors: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Vinay
authors: V
authors: Deved
authors: Nathalie
authors: N
authors: Jette
authors: Hude
authors: H
authors: Quan
authors: Marcello
authors: M
authors: Tonelli
authors: Braden
authors: B
authors: Manns
authors: Andrea
authors: A
authors: Soo
authors: Cheryl
authors: C
authors: Barnabe
authors: Brenda R
authors: BR
authors: Hemmelgarn
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D044467:American Indian or Alaska Native; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003404:Creatinine / Q000097:blood / Q000652:urine; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006303:Health Services, Indigenous; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D019984:Quality Indicators, Health Care; D051437:Renal Insufficiency / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human
chemical_list: D015415:Biomarkers; D003404:Creatinine; D006442:Glycated Hemoglobin; D012709:Serum Albumin; D000075462:Serum Albumin, Human; C422455:ALB protein, human; C517652:hemoglobin A1c protein, human