CMAJ • November 4, 2008; 179 (10). doi:10.1503/cmaj.080063.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Research

Access to health care among status Aboriginal people with chronic kidney disease

Song Gao, MSc, Braden J. Manns, MD MSc, Bruce F. Culleton, MD, Marcello Tonelli, MD SM, Hude Quan, PhD, Lynden Crowshoe, MD, William A. Ghali, MD MPH, Lawrence W. Svenson, BSc, Sofia Ahmed, MD MMSc, Brenda R. Hemmelgarn, PhD MD for the Alberta Kidney Disease Network

From the Departments of Medicine, Division of Nephrology (Gao, Manns, Culleton, Ahmed, Hemmelgarn), Community Health Services (Manns, Quan, Ghali, Svenson, Hemmelgarn), Family Medicine (Crowshoe) and General Internal Medicine (Ghali), and the Centre for Health and Policy Studies (Quan, Ghali), University of Calgary, Calgary, Alta.; The Department of Medicine, Division of Nephrology (Tonelli), University of Alberta; and Public Health Surveillance and Environmental Health, Alberta Health and Wellness (Svenson), Edmonton, Alta.

Correspondence to: Dr. Brenda Hemmelgarn, Division of Nephrology, Foothills Hospital, 1403 29th St. NW, Calgary AB T2N 2T9; fax 403 944-2876; brenda.hemmelgarn{at}calgaryhealthregion.ca

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 m2). 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 m2) 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.


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