Is geographical isolation associated with poorer outcomes for Northern Manitoba First Nation communities?

Abstract

Background: For First Nations, geographical isolation is often simultaneously presented as protective (less direct exposure racism, colonial encroachment on land, dispossession, and colonial imposition) and as a risk factor (lack of opportunities to participate in the formal economy, poorer access to services including healthcare). Our study sought to test the assumption that geographical isolation is associated with poorer population health outcomes among First Nations in Manitoba. Methods: We conducted a population-based retrospective time-trend analysis using administrative data housed at the Manitoba Centre for Health Policy. The study included all Manitoba residents eligible under the Manitoba Health Services Plan (1984-2014). We measured premature mortality rates (PMR), and trends in hospitalization rates and length of stay (LOS) for Ambulatory Care Sensitive Conditions (ACSC) in northern and southern First Nations (FN) communities in Manitoba.Results: The PMR was significantly higher in northern FN compared to southern FN. Hospitalization rates for mental health-related conditions were significantly higher in the northern First Nation communities compared to all Manitoba, and rising (southern, change=1.52%, P=0.015; northern, change=5.49%, P<0.0001), and significantly higher in northern compared to southern FN communities. The LOS for all ACSC increased significantly for all Manitoba (change=0.63%, P=0.0011) but not for FN communities. The LOS for mental health-related conditions increased only for the southern FN communities (% change=1.67, P=0.0032). Conclusions: Our results show higher PMR in northern communities, declining slower than for any other Manitoba communities. Our results also show lower hospitalization rate for ACSC in the north, suggesting barriers to prevention and early diagnosis. There remains a large gap in ACSC hospitalization rates between FN and all Manitobans. Further research is warranted to understand the relationship between the changes in the rates of ACSC and the difference in the rates between northern and southern communities.

First Nations’ hospital readmission ending in death: a potential sentinel indicator of inequity?

“…The overall objective of this innovative, strength-based programme of research is to learn from FN and rural and remote communities that have developed effective community-based PHC. Numerous papers have already been published from this programme of research [23,26,27,[46][47][48][49], as well as presentations at many national and international conferences.…”

“…As an indicator, readmissions ending in death can provide invaluable insights. Indicators that can inform the performance of the whole system, especially for populations that have historically been underserved or poorly served, are critical and have been the focus of much of our empirical work to date [ 3 , 25 ; 26 , 27 , Lavoie, Phillips-Beck, Kinew, 11 , 28 , 29 ]. Expanding on the set of indicators that can be used to inform the provisions of more responsive care is important.…”