title: Imbalance of prevalence and specialty care for osteoarthritis for first nations people in Alberta, Canada.
abstract: OBJECTIVE
  To estimate the population-based prevalence and healthcare use for osteoarthritis (OA) by First Nations (FN) and non-First Nations (non-FN) in Alberta, Canada.
  
  
  METHODS
  A cohort of adults with OA (≥ 2 physician claims in 2 yrs or 1 hospitalization with ICD-9-Clinical Modification code 715x or ICD-10-Canadian Adaptation code M15-19, 1993-2010) was defined with FN determination by premium payer status. Prevalence rates (2007/8) were estimated from the cohort and the population registered with the Alberta Health Care Insurance Plan. Rates of outpatient primary care and specialist visits (orthopedics, rheumatology, internal medicine), arthroplasty (hip and knee), and all-cause hospitalization were estimated.
  
  
  RESULTS
  OA prevalence in FN was twice that of the non-FN population [16.1 vs 7.8 cases/100 population, standardized rate ratio (SRR) adjusted for age and sex 2.06, 95% CI 2.00-2.12]. The SRR (adjusted for age, sex, and location of residence) for primary care visits for OA was nearly double in FN compared with non-FN (SRR 1.88, 95% CI 1.87-1.89), and internal medicine visits were increased (SRR 1.25, 95% CI 1.25-1.26). Visit rates with an orthopedic surgeon (SRR 0.49, 95% CI 0.48-0.50) or rheumatologist (SRR 0.62, 95% CI 0.62-0.63) were substantially lower in FN with OA. Hip and knee arthroplasties were performed less frequently in FN with OA (SRR 0.48, 95% CI 0.47-0.49), but all-cause hospitalization rates were higher (SRR 1.59, 95% CI 1.58-1.60).
  
  
  CONCLUSIONS
  We estimate a 2-fold higher prevalence of OA in the FN population with differential healthcare use. Reasons for higher use of primary care and lower use of specialty services and arthroplasty compared with the general population are not yet understood.
authors.affiliation: From the Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary; Department of Physical Therapy, and School of Public Health, University of Alberta, Edmonton, Alberta; Department of Medicine, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.C. Barnabe, MD, MSc, FRCPC, Assistant Professor; B. Hemmelgarn, MD, PhD, FRCPC, Professor; D.A. Marshall, PhD, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Calgary; C.A. Jones, MSc(PT), PhD, Associate Professor, Department of Physical Therapy and School of Public Health; D. Voaklander, PhD, Professor, School of Public Health, University of Alberta; C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Manitoba; L. Joseph, PhD, Professor, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; S. Bernatsky, MD, PhD, FRCPC, Associate Professor, Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre; J.M. Esdaile, MD, MPH, FRCPC, Professor, University of British Columbia, Arthritis Research Centre of Canada. ccbarnab@ucalgary.ca.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
authors.affiliation: From the Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary; Department of Physical Therapy, and School of Public Health, University of Alberta, Edmonton, Alberta; Department of Medicine, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.C. Barnabe, MD, MSc, FRCPC, Assistant Professor; B. Hemmelgarn, MD, PhD, FRCPC, Professor; D.A. Marshall, PhD, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Calgary; C.A. Jones, MSc(PT), PhD, Associate Professor, Department of Physical Therapy and School of Public Health; D. Voaklander, PhD, Professor, School of Public Health, University of Alberta; C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Manitoba; L. Joseph, PhD, Professor, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; S. Bernatsky, MD, PhD, FRCPC, Associate Professor, Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre; J.M. Esdaile, MD, MPH, FRCPC, Professor, University of British Columbia, Arthritis Research Centre of Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.affiliation: From the Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary; Department of Physical Therapy, and School of Public Health, University of Alberta, Edmonton, Alberta; Department of Medicine, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.C. Barnabe, MD, MSc, FRCPC, Assistant Professor; B. Hemmelgarn, MD, PhD, FRCPC, Professor; D.A. Marshall, PhD, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Calgary; C.A. Jones, MSc(PT), PhD, Associate Professor, Department of Physical Therapy and School of Public Health; D. Voaklander, PhD, Professor, School of Public Health, University of Alberta; C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Manitoba; L. Joseph, PhD, Professor, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; S. Bernatsky, MD, PhD, FRCPC, Associate Professor, Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre; J.M. Esdaile, MD, MPH, FRCPC, Professor, University of British Columbia, Arthritis Research Centre of Canada.
authors.forename: C Allyson
authors.initials: CA
authors.lastname: Jones
authors.affiliation: From the Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary; Department of Physical Therapy, and School of Public Health, University of Alberta, Edmonton, Alberta; Department of Medicine, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.C. Barnabe, MD, MSc, FRCPC, Assistant Professor; B. Hemmelgarn, MD, PhD, FRCPC, Professor; D.A. Marshall, PhD, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Calgary; C.A. Jones, MSc(PT), PhD, Associate Professor, Department of Physical Therapy and School of Public Health; D. Voaklander, PhD, Professor, School of Public Health, University of Alberta; C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Manitoba; L. Joseph, PhD, Professor, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; S. Bernatsky, MD, PhD, FRCPC, Associate Professor, Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre; J.M. Esdaile, MD, MPH, FRCPC, Professor, University of British Columbia, Arthritis Research Centre of Canada.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Peschken
authors.affiliation: From the Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary; Department of Physical Therapy, and School of Public Health, University of Alberta, Edmonton, Alberta; Department of Medicine, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.C. Barnabe, MD, MSc, FRCPC, Assistant Professor; B. Hemmelgarn, MD, PhD, FRCPC, Professor; D.A. Marshall, PhD, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Calgary; C.A. Jones, MSc(PT), PhD, Associate Professor, Department of Physical Therapy and School of Public Health; D. Voaklander, PhD, Professor, School of Public Health, University of Alberta; C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Manitoba; L. Joseph, PhD, Professor, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; S. Bernatsky, MD, PhD, FRCPC, Associate Professor, Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre; J.M. Esdaile, MD, MPH, FRCPC, Professor, University of British Columbia, Arthritis Research Centre of Canada.
authors.forename: Don
authors.initials: D
authors.lastname: Voaklander
authors.affiliation: From the Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary; Department of Physical Therapy, and School of Public Health, University of Alberta, Edmonton, Alberta; Department of Medicine, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.C. Barnabe, MD, MSc, FRCPC, Assistant Professor; B. Hemmelgarn, MD, PhD, FRCPC, Professor; D.A. Marshall, PhD, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Calgary; C.A. Jones, MSc(PT), PhD, Associate Professor, Department of Physical Therapy and School of Public Health; D. Voaklander, PhD, Professor, School of Public Health, University of Alberta; C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Manitoba; L. Joseph, PhD, Professor, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; S. Bernatsky, MD, PhD, FRCPC, Associate Professor, Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre; J.M. Esdaile, MD, MPH, FRCPC, Professor, University of British Columbia, Arthritis Research Centre of Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.affiliation: From the Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary; Department of Physical Therapy, and School of Public Health, University of Alberta, Edmonton, Alberta; Department of Medicine, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.C. Barnabe, MD, MSc, FRCPC, Assistant Professor; B. Hemmelgarn, MD, PhD, FRCPC, Professor; D.A. Marshall, PhD, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Calgary; C.A. Jones, MSc(PT), PhD, Associate Professor, Department of Physical Therapy and School of Public Health; D. Voaklander, PhD, Professor, School of Public Health, University of Alberta; C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Manitoba; L. Joseph, PhD, Professor, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; S. Bernatsky, MD, PhD, FRCPC, Associate Professor, Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre; J.M. Esdaile, MD, MPH, FRCPC, Professor, University of British Columbia, Arthritis Research Centre of Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: From the Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary; Department of Physical Therapy, and School of Public Health, University of Alberta, Edmonton, Alberta; Department of Medicine, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.C. Barnabe, MD, MSc, FRCPC, Assistant Professor; B. Hemmelgarn, MD, PhD, FRCPC, Professor; D.A. Marshall, PhD, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Calgary; C.A. Jones, MSc(PT), PhD, Associate Professor, Department of Physical Therapy and School of Public Health; D. Voaklander, PhD, Professor, School of Public Health, University of Alberta; C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Manitoba; L. Joseph, PhD, Professor, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; S. Bernatsky, MD, PhD, FRCPC, Associate Professor, Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre; J.M. Esdaile, MD, MPH, FRCPC, Professor, University of British Columbia, Arthritis Research Centre of Canada.
authors.forename: John M
authors.initials: JM
authors.lastname: Esdaile
authors.affiliation: From the Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary; Department of Physical Therapy, and School of Public Health, University of Alberta, Edmonton, Alberta; Department of Medicine, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.C. Barnabe, MD, MSc, FRCPC, Assistant Professor; B. Hemmelgarn, MD, PhD, FRCPC, Professor; D.A. Marshall, PhD, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Calgary; C.A. Jones, MSc(PT), PhD, Associate Professor, Department of Physical Therapy and School of Public Health; D. Voaklander, PhD, Professor, School of Public Health, University of Alberta; C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Medicine and Department of Community Health Sciences, University of Manitoba; L. Joseph, PhD, Professor, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; S. Bernatsky, MD, PhD, FRCPC, Associate Professor, Divisions of Clinical Epidemiology and Rheumatology, Research Institute of the McGill University Health Centre; J.M. Esdaile, MD, MPH, FRCPC, Professor, University of British Columbia, Arthritis Research Centre of Canada.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Marshall
mesh_terms: D002170:Canada / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D010003:Osteoarthritis / Q000453:epidemiology* / Q000208:ethnology; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D013038:Specialization
keywords: AMERICAN NATIVE CONTINENTAL ANCESTRY GROUP; EPIDEMIOLOGY; HEALTH SERVICES RESEARCH; OSTEOARTHRITIS