title: Emergency Department Visits after Diagnosed Chronic Obstructive Pulmonary Disease in Aboriginal People in Alberta, Canada.
abstract: OBJECTIVE
  This retrospective cohort study compared rates of emergency department (ED) visits after a diagnosis of chronic obstructive pulmonary disease (COPD) in the three Aboriginal groups (Registered First Nations, Métis and Inuit) relative to a non-Aboriginal cohort.
  
  
  METHODS
  We linked eight years of administrative health data from Alberta and calculated age- and sex-standardized ED visit rates in cohorts of Aboriginal and non-Aboriginal individuals diagnosed with COPD. Rate ratios (RR) with 95% confidence intervals (CIs) were calculated in a Poisson regression model that adjusted for important sociodemographic factors and comorbidities. Differences in ED length of stay (LOS) and disposition status were also evaluated.
  
  
  RESULTS
  A total of 2,274 Aboriginal people and 1,611 non-Aboriginals were newly diagnosed with COPD during the study period. After adjusting for important sociodemographic and clinical factors, the rate of all-cause ED visits in all Aboriginal people (RR=1.72, 95% CI: 1.67, 1.77), particularly among Registered First Nations people (RR=2.02; 95% CI: 1.97, 2.08) and Inuit (RR=1.28; 95% CI: 1.22, 1.35), were significantly higher than that in non-Aboriginals, while ED visit rates were significantly lower in the Métis (RR=0.94; 95% CI: 0.90, 0.98). The ED LOS in all Aboriginal groups were significantly lower than that of the non-Aboriginal group.
  
  
  CONCLUSIONS
  Aboriginal people with COPD use almost twice the amount of ED services compared to their non-Aboriginal counterparts. There are also important variations in patterns of ED services use among different Aboriginal groups with COPD in Alberta.
authors.affiliation: *School of Public Health University of Alberta,Edmonton,AB.
authors.forename: Maria B
authors.initials: MB
authors.lastname: Ospina
authors.affiliation: *School of Public Health University of Alberta,Edmonton,AB.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.affiliation: *School of Public Health University of Alberta,Edmonton,AB.
authors.forename: Donald
authors.initials: D
authors.lastname: Voaklander
authors.affiliation: *School of Public Health University of Alberta,Edmonton,AB.
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
authors.affiliation: †Alberta Health Services,Edmonton,AB.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Stickland
authors.affiliation: ¶Faculty of Health Sciences,Simon Fraser University,Vancouver,BC.
authors.forename: Malcolm
authors.initials: M
authors.lastname: King
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000416:Alberta; D000465:Algorithms; D002170:Canada; D015331:Cohort Studies; D016208:Databases, Factual; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data; D004930:Inuit / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000208:ethnology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors
keywords: Aboriginal people; COPD; Emergency Visits