Access to health care among status Aboriginal people with chronic kidney disease
Access to health care among status Aboriginal people with chronic kidney disease
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DOI：
10.1503/cmaj.080063
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发表时间：
2008-11-04
影响因子：
14.6
通讯作者：
Hemmelgarn, Brenda R.
中科院分区：
文献类型：
--
作者：
Gao, Song;Manns, Braden J.;Hemmelgarn, Brenda R.
背景：在获得医疗保健和健康结果方面的种族差异有充分的记录。目前尚不清楚在加拿大的土著和非土著慢性肾病患者之间是否存在类似的差异。我们确定土著居民（根据联邦印第安人法案登记的土著居民）和患有慢性肾病的非土著居民获得护理的机会是否不同。方法：我们确定了106 511名非原住民和1182名原住民慢性肾病患者（估计肾小球滤过率小于60 mL/min/1.73 m）。我们比较了包括住院在内的结果，这些结果可能是通过适当的门诊治疗（门诊护理敏感的情况）以及使用专家服务（包括访问肾脏科医生和普通内科医生）来预防的。结果：原住民因门诊敏感疾病入院的可能性几乎是非原住民的两倍（比率比1.77,95%可信区间[CI] 1.46-2.13）。患有严重慢性肾病的土著居民（估计肾小球滤过率< 30 mL/min/1.73 m(2)）比患有严重慢性肾病的非土著居民少43%去看肾病科医生（风险比0.57,95% CI 0.39-0.83）。就诊内科医生的可能性没有差异（风险比1.00,95% CI 0.83-1.21）。解释：门诊敏感疾病住院率的增加和肾脏病就诊可能性的降低表明，在患有慢性肾病的土著居民中，护理存在潜在的不平等。这在多大程度上导致了这一人群中较高的肾衰竭发生率，需要进一步探讨。
Background: Ethnic disparities in access to health care and health outcomes are well documented. It is unclear whether similar differences exist between Aboriginal and non-Aboriginal people with chronic kidney disease in Canada. We determined whether access to care differed between status Aboriginal people (Aboriginal people registered under the federal Indian Act) and non-Aboriginal people with chronic kidney disease.Methods: We identified 106 511 non-Aboriginal and 1182 Aboriginal patients with chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m(2)). We compared outcomes, including hospital admissions, that may have been preventable with appropriate outpatient care (ambulatory-care-sensitive conditions) as well as use of specialist services, including visits to nephrologists and general internists.Results: Aboriginal people were almost twice as likely as non-Aboriginal people to be admitted to hospital for an ambulatory-care-sensitive condition (rate ratio 1.77, 95% confidence interval [CI] 1.46-2.13). Aboriginal people with severe chronic kidney disease (estimated glomerular filtration rate < 30 mL/min/1.73 m(2)) were 43% less likely than non-Aboriginal people with severe chronic kidney disease to visit a nephrologist (hazard ratio 0.57, 95% CI 0.39-0.83). There was no difference in the likelihood of visiting a general internist (hazard ratio 1.00, 95% CI 0.83-1.21).Interpretation: Increased rates of hospital admissions for ambulatory-care-sensitive conditions and a reduced likelihood of nephrology visits suggest potential inequities in care among status Aboriginal people with chronic kidney disease. The extent to which this may contribute to the higher rate of kidney failure in this population requires further exploration.