ORIGINAL RESEARCH
End Stage Renal Disease Among People with Diabetes: A Comparison of First Nations People and Other Saskatchewan Residents from 1981 to 2005

https://doi.org/10.1016/S1499-2671(10)44006-XGet rights and content

ABSTRACT

OBJECTIVE:

Since First Nations people (FN) with diabetes experience higher rates of end-stage renal disease (ESRD) than others, we aimed to better understand these disparities by comparing the epidemiology of ESRD between FN and other Saskatchewan residents (OSK) with diabetes over a prolonged period.

METHODS:

We used healthcare system administrative databases to determine ESRD rates, distribution and mortality by ethnicity, age and sex among total diabetes populations in Saskatchewan from 1981 to 2005.

RESULTS:

Although similar initially, ESRD incidence among FN with diabetes peaked at levels 3 to 4 times higher than OSK with diabetes by 1991 to 1996. Differences in ESRD prevalence between diabetes populations were less pronounced. OSK men with diabetes experienced higher ESRD rates than OSK women with diabetes, while sex differences among FN were variable. FN with diabetes and ESRD were younger than OSK at diabetes diagnosis and experienced a longer time from diabetes to ESRD diagnosis. However, survival of FN adults with diabetes after ESRD diagnosis was reduced compared to others.

CONCLUSIONS:

Ethnicity-based disparities in ESRD incidence among people with diabetes remain pronounced, particularly among women. Differential mortality pre-ESRD may contribute to these differences, because FN are younger at diabetes diagnosis. This favours longer survival and increased exposure to the metabolic consequences of diabetes.

RESUME

OBJECTIF :

Comme l'incidence de l'insuffisance renale au stade ultime (IRSU) est plus elevee chez les membres des Premieres Nations (MPN) qui sont diabetiques, nous avons cherche a expliquer la disparite en comparant, pendant une longue periode, l'epidemiologie de l'IRSU chez les MPN et chez les autres habitants de la Saskatchewan (AHS) atteints de diabete.

METHODES :

Nous avons utilise les bases de donnees administratives du systeme de sante pour determiner l'incidence et la distribution de l'IRSU et les taux de mortalite par IRSU en fonction de l'ethnicite, de l'age et du sexe chez l'ensemble des patients diabetiques de la Saskatchewan de 1981 a 2005.

RESULTATS :

L'incidence de l'IRSU etait semblable au depart, mais entre 1991 et 1996, elle etait de trois a quatre fois plus elevee chez les MPN diabetiques que chez les AHS diabetiques. Les differences entre les populations de diabetiques ont ete moins marquees pour ce qui est de la prevalence de l'IRSU. L'incidence de l'IRSU etait plus elevee chez les AHS diabetiques de sexe masculin que de sexe feminin, mais chez les MPN, les differences entre les sexes etaient variables. Les MPN atteints de diabete et d'IRSU etaient plus jeunes que les AHS au moment du diagnostic de diabete et souffraient de diabete depuis plus longtemps au moment du diagnostic d'IRSU. Toutefois, les MPN diabetiques d'age adulte vivaient moins longtemps que les autres apres le diagnostic d'IRSU.

CONCLUSIONS :

Les disparites ethniques quant a l'incidence de l'IRSU chez les personnes diabetiques demeurent marquees, surtout chez les femmes. La mortalite differentielle avant l'IRSU pourrait contribuer a expliquer ces differences. En effet, comme les MPN sont plus jeunes au moment du diagnostic de diabete, leur survie est plus longue et ils sont davantage exposes aux repercussions metaboliques du diabete.

Section snippets

INTRODUCTION

Diabetes mellitus is the most common cause of end-stage renal disease (ESRD) in Canada (1), and the burden of diabetes-related ESRD on indigenous peoples is of particular concern. In 1994, we reported a disproportionate incidence of ESRD among Saskatchewan First Nations people (FN) with diabetes (2), and recent data show that this disparity persists (3). Although the reasons remain unclear, we have suggested 2 possible underlying mechanisms: first, FN with diabetes might be more prone to the

Study populations

This was a University of Saskatchewan Ethics Review Board-approved, population-based study of ESRD among people with diabetes in Saskatchewan from 1980 to 2005. Saskatchewan is a midwestern province with a stable population of approximately 1 million people. About 99% (both FN and OSK) are beneficiaries of a universal healthcare system and recorded in the Ministry of Health's insurance registry (5). They comprised the total annual populations for this study. We subdivided annual provincial

RESULTS

From 1980 to 2005 there were 90 581 incident cases of diabetes in Saskatchewan adults aged ≥ 20 years, in addition to 14 389 people who were prevalent cases of diabetes in 1980 (8). Of those, 1378 subjects with diabetes met the ESRD incident case definition. Since 143 subjects met the ESRD case definition before developing diabetes and since no ESRD incident cases occurred among FN with diabetes in 1980, the final analyses were carried out on 1226 ESRD incident cases from 1981 to 2005 (Table 1).

DISCUSSION

This study compared rates, distribution and outcomes of ESRD between Saskatchewan FN and OSK adults with diabetes from 1981 to 2005. Although ESRD incidence was initially similar between these populations, it rose rapidly among FN during the 1980s to peak at rates 3 to 4 times higher than OSK by the early 1990s. OSK men with diabetes consistently experienced higher ESRD incidence and prevalence than OSK women with diabetes, while FN sex differences were more variable. The most unique finding

DISCLAIMER

This study is based in part on non-identifiable data provided by the Saskatchewan Ministry of Health. The interpretations and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan or the Saskatchewan Ministry of Health.

AUTHOR DISCLOSURES

This study was supported through internal funding.

AUTHOR CONTRIBUTIONS

RD conceived and designed the study; acquired, analyzed and interpreted the data; drafted the original and subsequent manuscript and gave final approval of the version to be published. NO analyzed and interpreted the data, revised the manuscript critically for important intellectual content and gave final approval of the version to be published. THL and AG analyzed the data, revised the manuscript critically for important intellectual content and gave final approval of the version to be

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