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

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 nonAboriginal 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.

Geographic Inequalities of Respiratory Health Services Utilization during Childhood in Edmonton and Calgary, Canada: A Tale of Two Cities

“…In Canada, respiratory health inequalities across socioeconomic groups have been identified for a variety of respiratory outcomes in adult populations, including smoking [10] and chronic obstructive pulmonary disease [11][12][13]. Inequalities in paediatric respiratory health have been described for asthma hospitalizations across the urban/rural divide [14], asthma emergency department visits across (large) health zones in Alberta [15], respiratory infections among First Nations and Inuit children [16], and differences in influenza hospitalizations between First Nations populations living on and off reserves [17].…”

Prevalence and associated factors of COPD among Aboriginal peoples in Canada: a cross-sectional study

“…Furthermore, COPD is the most common cause of chronic disease hospitalization in Canada 7. Studies suggest that the Aboriginal population of Canada has a higher incidence of COPD and a greater burden of disease compared to the non-Aboriginal Canadian population 8,9. These differences are likely due to disparities in smoking, demographic, socioeconomic and environmental risk factors between the Aboriginal and non-Aboriginal population of Canada.…”

Acute health care among Indigenous patients in Canada: a scoping review

“…Two articles reported higher visit rates for LRTI [ 98 , 99 ]. Ospina’s article showed increased visit rates for all Indigenous communities except for Métis people for whom no difference was reported [ 92 ]. In articles discussing multiple acute health conditions, 2 articles found higher visit rates [ 31 , 40 ] while 4 articles reported no difference [ 26 , 27 , 43 , 100 ].…”

“…For Indigenous patients with pneumonia or COPD, three studies revealed an increased length of hospital stay [ 55 , 56 , 114 ], two studies found no difference [ 54 , 115 ] and five studies showed decreased length of stay when compared to non-Indigenous patients [ 22 , 49 , 50 , 92 , 93 ]. Two articles mentioned longer hospitalisations for burn injuries [ 58 , 116 ].…”