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Emergency Department Visits after Diagnosed Chronic Obstructive Pulmonary Disease in Aboriginal People in Alberta, Canada

  • Maria B. Ospina (a1) (a2), Brian H. Rowe (a1) (a2) (a3), Donald Voaklander (a1), Ambikaipakan Senthilselvan (a1), Michael K. Stickland (a2) (a4) and Malcolm King (a5)...

Abstract

Objectives

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.

Objectif

Il s’agit d’une étude rétrospective de cohorte, visant à comparer les taux de consultation au services des urgences (SU) après la pose d’un diagnostic de bronchopneumopathie chronique obstructive (BPCO) dans les trois groupes d’Autochtones au Canada (Indiens inscrits, Métis et Inuits) avec celui dans une cohorte de non-Autochtones.

Méthode

Ont été liées des données administratives sur la santé provenant de l’Alberta et couvrant une période de huit ans, puis calculés les taux de consultation au SU, normalisés selon l’âge et le sexe dans des cohortes d’Autochtones et de non-Autochtones chez qui un diagnostic de BPCO avait été posé. Les auteurs ont ensuite calculé les ratios de taux (RT) selon des intervalles de confiance (IC) à 95 % à l’aide du modèle de régression de Poisson dans lequel ont été pris en considération des facteurs sociodémographiques importants et des maladies concomitantes. La durée du séjour au SU et les suites à donner ont aussi été évaluées.

Résultats

Un diagnostic de BPCO a été posé chez 2274 Autochtones et 1611 non-Autochtones durant la période à l’étude. Après rajustement des données pour tenir compte de facteurs sociodémographiques importants et de facteurs cliniques, le taux de consultations au SU, toutes causes confondues, dans tous les groupes d’Autochtones (RT=1,72; IC à 95 %: 1,67-1,77), en particulier parmi les Indiens inscrits (RT=2,02; IC à 95 % : 1,97-2,08) et les Inuits (RT=1,28; IC à 95 %: 1,22-1,35), était significativement plus élevé que chez les non-Autochtones; par contre celui chez les Métis était sensiblement plus bas (RT=0,94; IC à 95 % : 0,90-0,98). Enfin, la durée du séjour au SU dans tous les groupes d’Autochtones était passablement plus faible que celle enregistrée dans le groupe de non-Autochtones.

Conclusions

Les Autochtones atteints de BPCO utilisent presque deux fois plus les SU que les non-Autochtones. Il existe également des différences importantes dans l’utilisation des SU entre les groupes d’Autochtones souffrant d’une BPCO en Alberta.

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Copyright

Corresponding author

Correspondence to: Maria B. Ospina, Respiratory Health Strategic Clinical Network, Alberta Health Services, 3-105D Clinical Sciences Building; 11350-83 Ave. Edmonton, Alberta; T6G 2G3; Email: mospina@ualberta.ca

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Keywords

Emergency Department Visits after Diagnosed Chronic Obstructive Pulmonary Disease in Aboriginal People in Alberta, Canada

  • Maria B. Ospina (a1) (a2), Brian H. Rowe (a1) (a2) (a3), Donald Voaklander (a1), Ambikaipakan Senthilselvan (a1), Michael K. Stickland (a2) (a4) and Malcolm King (a5)...

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