title: Cardiovascular disease rates, outcomes, and quality of care in Ontario Métis: a population-based cohort study.
abstract: BACKGROUND
  The burden of cardiovascular disease in the Métis, Canada's fastest growing Aboriginal group, is not well studied. We determined rates of five cardiovascular diseases and associated outcomes in Ontario Métis, compared to the general Ontario population.
  
  
  METHODS
  Métis persons were identified using the Métis Nation of Ontario Citizenship Registry. Métis citizens aged 20-105 were linked to Ontario health databases for the period of April 2006 to March 2011. Age- and sex-standardized prevalence and incidence of acute coronary syndromes (ACS), congestive heart failure (CHF), cerebrovascular disease (stroke), atrial fibrillation, and hypertension were compared between the Métis and the general population. Secondary outcome measures included one-year hospitalizations and mortality following the incident cardiovascular diagnosis, as well as quality-of-care measures.
  
  
  RESULTS
  There were 12,550 eligible Métis persons and 10,144,002 in the general population. The adjusted prevalence of each disease was higher (p<0.05) among the Métis compared to the general population: ACS 5.3% vs. 3.0%; CHF 5.1% vs. 3.9%; stroke 1.4% vs. 1.1%; atrial fibrillation 2.1% vs. 1.4%; hypertension 34.9% vs. 29.8%. Incident ACS, stroke, and atrial fibrillation were also higher (p<0.05) among the Métis: ACS 2.4% vs. 1.5%; stroke 0.8% vs. 0.6%; atrial fibrillation 0.6% vs. 0.3%. One-year all-cause and cardiovascular-related mortality were not significantly different. Hospitalizations were higher for Métis persons with CHF (OR 1.93; 95% CI 1.34-2.78) and hypertension (OR 2.27; 95% CI 1.88-2.74). Métis with CHF made more emergency department (ED) visits in the year after diagnosis compared to non-Métis with CHF, while Métis aged ≥65 with ACS were more likely to be on beta-blockers following diagnosis.
  
  
  CONCLUSIONS
  The burden of cardiovascular disease was markedly higher in the Métis compared to the general population: prevalence rates for five cardiovascular conditions were 25% to 77% higher. Métis persons with CHF had more frequent hospitalizations and ED visits following their diagnosis.
authors: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors: Clare L
authors: CL
authors: Atzema
authors: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Saba
authors: S
authors: Khan
authors: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Hong
authors: H
authors: Lu
authors: The Métis Nation of Ontario, Ottawa, Ontario, Canada.
authors: Yvon E
authors: YE
authors: Allard
authors: The Métis Nation of Ontario, Ottawa, Ontario, Canada.
authors: Storm J
authors: SJ
authors: Russell
authors: The Métis Nation of Ontario, Ottawa, Ontario, Canada.
authors: Mario R
authors: MR
authors: Gravelle
authors: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Julie
authors: J
authors: Klein-Geltink
authors: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Peter C
authors: PC
authors: Austin
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D003710:Demography; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D011787:Quality of Health Care; D016896:Treatment Outcome