title: Hospital admission for community-acquired pneumonia in a First Nations population.
abstract: BACKGROUND
  Northwestern Ontario is a large rural area with a high concentration of remote First Nations communities. In Ontario, the highest hospital admission rates for pneumonia are reported from northern and rural regions. However, data are lacking on the epidemiology of community-acquired pneumonia in northwestern Ontario. We sought to characterize cases of community-acquired pneumonia requiring admission at the Sioux Lookout Meno Ya Win Health Centre, which serves a primarily First Nations population of 28,000.
  
  
  METHODS
  We undertook a 3-year review of cases of community-acquired pneumonia requiring hospital admission at the centre. We used multivariable logistic regression to identify independent variables predictive of adverse outcomes.
  
  
  RESULTS
  The annual incidence of hospital admissions related to community-acquired pneumonia was 3.42 per 1000 population. Of the 287 patients, 87% were First Nations and 52% were female. There was a high prevalence of diabetes, and chronic cardiovascular, renal and pulmonary diseases. Hospital admissions for community-acquired pneumonia were most prevalent among young children and older adults; both age groups had low coverage with recommended pneumococcal vaccines. Adverse outcomes included 10 deaths (3%) and 35 transfers to an intensive care facility (12%). Chronic renal disease and nonreceipt of azithromycin at initial presentation were identified as 2 independent predictors of an adverse outcome; there was a trend toward an increased risk of an adverse outcome in individuals with chronic obstructive pulmonary disease.
  
  
  CONCLUSIONS
  Our findings emphasize the importance of preventing pneumonia in First Nations communities in northwestern Ontario. Research focusing on the distinct epidemiology of community-acquired pneumonia in this population is needed.
authors.affiliation: Northern Ontario School of Medicine, Sioux Lookout, Ont.
authors.forename: Justin
authors.initials: J
authors.lastname: Poling
authors.affiliation: Northern Ontario School of Medicine, Sioux Lookout, Ont.
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
authors.forename: Christina
authors.initials: C
authors.lastname: Chan
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
authors.forename: David
authors.initials: D
authors.lastname: Fisman
authors.affiliation: Northern Ontario School of Medicine, Thunder Bay, Ont.
authors.forename: Marina
authors.initials: M
authors.lastname: Ulanova
mesh_terms: D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000628:therapy*; D011159:Population Surveillance; D012111:Residence Characteristics