Asthma and chronic obstructive pulmonary disease (COPD) prevalence and health services use in Ontario Métis: a population-based cohort study.
BACKGROUND
Chronic respiratory diseases cause a significant health and economic burden around the world. In Canada, Aboriginal populations are at increased risk of asthma and chronic obstructive pulmonary disease (COPD). There is little known, however, about these diseases in the Canadian Métis population, who have mixed Aboriginal and European ancestry. A population-based study was conducted to quantify asthma and COPD prevalence and health services use in the Métis population of Ontario, Canada's largest province.


METHODS
The Métis Nation of Ontario Citizenship Registry was linked to provincial health administrative databases to measure and compare burden of asthma and COPD between the Métis and non-Métis populations of Ontario between 2009 and 2012. Asthma and COPD prevalence, health services use (general physician and specialist visits, emergency department visits, hospitalizations), and mortality were measured.


RESULTS
Prevalences of asthma and COPD were 30% and 70% higher, respectively, in the Métis compared to the general Ontario population (p<0.001). General physician and specialist visits were significantly lower in Métis with asthma, while general physician visits for COPD were significantly higher. Emergency department visits and hospitalizations were generally higher for Métis compared to non-Métis with either disease. All-cause mortality in Métis with COPD was 1.3 times higher compared to non-Métis with COPD (p = 0.01).


CONCLUSIONS
There is a high burden of asthma and COPD in Ontario Métis, with significant prevalence and acute health services use related to these diseases. Lower rates of physician visits suggest barriers in access to primary care services.
Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
Andrea S
AS
Gershon
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Saba
S
Khan
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Julie
J
Klein-Geltink
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Drew
D
Wilton
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
Teresa
T
To
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Geography, University of Ottawa, Ottawa, Ontario, Canada.
Eric J
EJ
Crighton
Métis Nation of Ontario, Ontario, Canada.
Lisa
L
Pigeau
Métis Nation of Ontario, Ontario, Canada.
Jo
J
Macquarrie
Métis Nation of Ontario, Ontario, Canada.
Yvon
Y
Allard
Métis Nation of Ontario, Ontario, Canada.
Storm J
SJ
Russell
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
David A
DA
Henry
D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D006296:Health Services; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology / Q000208:ethnology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000208:ethnology; D012042:Registries; D012959:Socioeconomic Factors