title: Incidence, secular trends, and outcomes of cardiac surgery in Aboriginal peoples.
abstract: BACKGROUND
  Canada's Aboriginal people experience a disproportionate burden of comorbid illnesses predisposing them to higher rates of atherosclerotic disease. We set out to investigate secular rates of cardiovascular surgery (CVSx) and postsurgical outcomes in Aboriginals compared with non-Aboriginals.
  
  
  METHODS
  All patients undergoing CVSx in Manitoba, Canada from 1995-2007 (N =12,170 [Aboriginal, 574, 4.7%; non-Aboriginal, 11,596, 95.3%]) were included in our study cohort. Race was self-identified. Age- and sex-adjusted incidence were determined using 2001 and 2006 census data. Multivariable logistic regression models were constructed to determine the association between race and the outcomes of death, infections, and a composite of adverse events.
  
  
  RESULTS
  CVSx rates were significantly lower in Aboriginals compared with non-Aboriginals (all CVSx, 63.6 vs 97.7 per 10,000 population; coronary artery bypass grafting only, 46.2 vs 71.9 per 10,000 population, respectively). The lower CVSx rates were most pronounced among Aboriginals residing in urban areas (21.0 vs 78.0 per 10,000). Postoperatively, Aboriginals experienced significantly higher odds of infections (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.13-2.34; P = 0.008), in particular pneumonia (OR, 2.24; 95% CI, 1.58-3.19; P < 0.0001). There was no increase in risk of death after surgery (OR, 1.15; 95% CI, 0.63-2.08; P = 0.6) or the composite outcome (OR, 1.0; 95% CI, 0.66-1.52; P = 1.0) compared with non-Aboriginals.
  
  
  CONCLUSIONS
  Aboriginal peoples, particularly in the urban setting, are considerably less likely to undergo CVSx. When they do, they have postoperative mortality similar to that of non-Aboriginals. Our findings suggest an urban racial disparity in access to CVSx.
authors.affiliation: Section of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada; St Boniface Hospital, Winnipeg, Manitoba, Canada. Electronic address: Msood99@gmail.com.
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Suhail
authors.initials: S
authors.lastname: Khojah
authors.forename: Brett
authors.initials: B
authors.lastname: Hiebert
authors.forename: Alan
authors.initials: A
authors.lastname: Menkis
authors.forename: James
authors.initials: J
authors.lastname: Tam
authors.forename: Rakesh C
authors.initials: RC
authors.lastname: Arora
mesh_terms: D054058:Acute Coronary Syndrome / Q000208:ethnology / Q000401:mortality; D000368:Aged; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D005544:Forecasting; D006297:Health Services Accessibility / Q000706:statistics & numerical data* / Q000639:trends*; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data / Q000639:trends; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends*; D017052:Hospital Mortality; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011014:Pneumonia / Q000208:ethnology / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000208:ethnology* / Q000401:mortality; D006435:Renal Dialysis / Q000401:mortality / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology / Q000401:mortality; D013530:Surgical Wound Infection / Q000208:ethnology / Q000401:mortality; D015996:Survival Rate; D014505:Urban Population / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data