title: Mortality outcomes among status Aboriginals and whites with heart failure.
abstract: BACKGROUND
  Aboriginals have more cardiovascular risk factors than do non-Aboriginals that predispose them to the development of heart failure (HF). Whether long-term mortality outcomes and health care use differ between Aboriginals and whites with HF is unknown.
  
  
  METHODS
  The population consisted of all Albertans aged ≥ 20 years with an incident HF hospitalization between 2000 and 2008. Aboriginal status is recorded in the Alberta Health Care Insurance Registry and white ethnicity was determined using previously validated surname analysis algorithms. Cox and logistic regression was used to examine mortality outcomes after adjustment for key variables.
  
  
  RESULTS
  Compared with whites (n = 42,288), status aboriginal patients with HF (n = 1158) were significantly younger (mean age, 62.6 vs 75.4 years; P < 0.0001) and had higher rates of diabetes (45% vs 29%; P < 0.0001) and chronic obstructive pulmonary disease (40% vs 36%; P < 0.0001) but lower rates of most other comorbidities. Although crude mortality rates were lower in status Aboriginals than in whites at 1 year (22% vs 31%; P < 0.0001) and at 5 years (48% vs 59%; P < 0.0001), after adjustment, status Aboriginals exhibited increased mortality at 1 year (adjusted odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01-1.38) and 5 years (adjusted OR, 1.39; 95% CI, 1.16-1.67). Compared with whites, status Aboriginals used more health care resources in the years before and after an incident HF hospitalization but less specialist care.
  
  
  CONCLUSIONS
  Although status Aboriginals hospitalized for the first time with HF are > 10 years younger, they use more health care resources and have increased short- and long-term mortality compared with their white counterparts.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Lyons
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada. Electronic address: jae2@ualberta.ca.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.affiliation: Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada; Division of General Internal Medicine and Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Padma
authors.initials: P
authors.lastname: Kaul
mesh_terms: D000367:Age Factors; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002309:Cardiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*