PT  - JOURNAL ARTICLE
AU  - Song Gao, MSc
AU  - Braden J. Manns, MD MSc
AU  - Bruce F. Culleton MD
AU  - Marcello Tonelli, MD SM
AU  - Hude Quan, PhD
AU  - Lynden Crowshoe MD
AU  - William A. Ghali, MD MPH
AU  - Lawrence W. Svenson, BSc
AU  - Sofia Ahmed, MD MMSc
AU  - Brenda R. Hemmelgarn, PhD MD
ED  - ,
TI  - Access to health care among status Aboriginal people with chronic kidney disease
AID  - 10.1503/cmaj.080063
DP  - 2008 Nov 04
TA  - Canadian Medical Association Journal
PG  - 1007--1012
VI  - 179
IP  - 10
4099  - http://www.cmaj.ca/content/179/10/1007.short
4100  - http://www.cmaj.ca/content/179/10/1007.full
SO  - CMAJ2008 Nov 04; 179
AB  - 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.