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Livergant RJ, Stefanyk K, Binda C, Fraulin G, Maleki S, Sibbeston S, Joharifard S, Hillier T, Joos E. Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001805. [PMID: 37585444 PMCID: PMC10431673 DOI: 10.1371/journal.pgph.0001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/28/2023] [Indexed: 08/18/2023]
Abstract
Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative outcomes between Indigenous and non-Indigenous populations. This systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n = 31, North America n = 36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients had 1.26 times odds of post-operative morbidity (OR = 1.26, 95% CI: 1.10-1.44, p<0.01) and 1.34 times odds of post-operative infection (OR = 1.34, 95% CI: 1.12-1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times odds of reoperation (OR = 1.33, 95% CI: 1.02-1.74, p = 0.04). In conclusion, we found that Indigenous patients in North American and Oceania experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there is a low proportion of high-quality research focusing on assessing surgical equity for Indigenous patients in these regions, despite multiple international and national calls to action for reconciliation and decolonization to improve quality surgical care for Indigenous populations.
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Affiliation(s)
- Rachel J. Livergant
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kelsey Stefanyk
- Faculty of Medicine, University of British Columbia, Prince George, British Columbia, Canada
| | - Catherine Binda
- Faculty of Medicine, University of British Columbia, Terrace, British Columbia, Canada
| | - Georgia Fraulin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sasha Maleki
- Faculty of Pharmaceutical Sciences, Lower Mainland Pharmacy Services, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Sibbeston
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Northwest Territory Métis Nation, Yellowknife, Northwest Territories, Canada
| | - Shahrzad Joharifard
- Department of Pediatric and Thoracic Surgery, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Tracey Hillier
- Mi’kmaq Qalipu First Nation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Emilie Joos
- Division of General Surgery, Branch for Global Surgical Care, Trauma and Acute Care Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Blanchette V, Patry J, Brousseau-Foley M, Todkar S, Libier S, Leclerc AM, Armstrong DG, Tremblay MC. Diabetic foot complications among Indigenous peoples in Canada: a scoping review through the PROGRESS-PLUS equity lens. Front Endocrinol (Lausanne) 2023; 14:1177020. [PMID: 37645408 PMCID: PMC10461566 DOI: 10.3389/fendo.2023.1177020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Indigenous peoples in Canada face a disproportionate burden of diabetes-related foot complications (DRFC), such as foot ulcers, lower extremity amputations (LEA), and peripheral arterial disease. This scoping review aimed to provide a comprehensive understanding of DRFC among First Nations, Métis, and Inuit peoples in Canada, incorporating an equity lens. Methods A scoping review was conducted based on Arksey and O'Malley refined by the Joanna Briggs Institute. The PROGRESS-Plus framework was utilized to extract data and incorporate an equity lens. A critical appraisal was performed, and Indigenous stakeholders were consulted for feedback. We identified the incorporation of patient-oriented/centered research (POR). Results Of 5,323 records identified, 40 studies were included in the review. The majority of studies focused on First Nations (92%), while representation of the Inuit population was very limited populations (< 3% of studies). LEA was the most studied outcome (76%). Age, gender, ethnicity, and place of residence were the most commonly included variables. Patient-oriented/centered research was mainly included in recent studies (16%). The overall quality of the studies was average. Data synthesis showed a high burden of DRFC among Indigenous populations compared to non-Indigenous populations. Indigenous identity and rural/remote communities were associated with the worse outcomes, particularly major LEA. Discussion This study provides a comprehensive understanding of DRFC in Indigenous peoples in Canada of published studies in database. It not only incorporates an equity lens and patient-oriented/centered research but also demonstrates that we need to change our approach. More data is needed to fully understand the burden of DRFC among Indigenous peoples, particularly in the Northern region in Canada where no data are previously available. Western research methods are insufficient to understand the unique situation of Indigenous peoples and it is essential to promote culturally safe and quality healthcare. Conclusion Efforts have been made to manage DRFC, but continued attention and support are necessary to address this population's needs and ensure equitable prevention, access and care that embraces their ways of knowing, being and acting. Systematic review registration Open Science Framework https://osf.io/j9pu7, identifier j9pu7.
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Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Centre de Recherche du Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Jérôme Patry
- Centre de Recherche du Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Medicine, Family and Emergency Medicine Department, Université Laval, Québec, QC, Canada
| | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Faculty of Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie et du Centre-du-Québec Affiliated with Université de Montréal, Trois-Rivières Family Medicine University Clinic, Trois-Rivières, QC, Canada
| | - Shweta Todkar
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Solène Libier
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anne-Marie Leclerc
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Marie-Claude Tremblay
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Faculty of Medicine, Family and Emergency Medicine Department, Université Laval, Québec, QC, Canada
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Boyd AJ. Vascular Surgery in Canada: Challenges in the Great White North. Eur J Vasc Endovasc Surg 2021; 62:842-844. [PMID: 34674933 DOI: 10.1016/j.ejvs.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/15/2022]
Affiliation(s)
- April J Boyd
- Department of Surgery, University of Manitoba, Winnipeg, Canada.
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McVicar JA, Poon A, Caron NR, Bould MD, Nickerson JW, Ahmad N, Kimmaliardjuk DM, Sheffield C, Champion C, McIsaac DI. Issues postopératoires chez les Autochtones au Canada: revue systématique. CMAJ 2021; 193:E1310-E1321. [PMID: 34426452 PMCID: PMC8412424 DOI: 10.1503/cmaj.191682-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Contexte: Il existe d’importantes iniquités en matière de santé chez les populations autochtones au Canada. La faible densité de la population canadienne et les populations en région éloignée posent un problème particulier à l’accès et à l’utilisation des soins chirurgicaux. Aucune synthèse des données sur les issues chirurgicales chez les Autochtones au Canada n’avait été publiée jusqu’à maintenant. Méthodes: Nous avons interrogé 4 bases de données pour recenser les études comparant les issues chirurgicales et les taux d’utilisation chez les adultes des Premières Nations, inuits et métis et chez les adultes non autochtones au Canada. Des évaluateurs indépendants ont réalisé toutes les étapes en parallèle. L’issue primaire était la mortalité; les issues secondaires comprenaient le taux d’utilisation des chirurgies, les complications et la durée du séjour à l’hôpital. Nous avons effectué une méta-analyse pour l’issue primaire à l’aide d’un modèle à effets aléatoires. Nous avons évalué les risques de biais à l’aide de l’outil ROBINS-I. Résultats: Vingt-huit études ont été analysées, pour un total de 1 976 258 participants (10,2 % d’Autochtones). Aucune étude ne portait précisément sur les populations inuites et métisses. Quatre études portant sur 7 cohortes ont fourni des données corrigées sur la mortalité pour 7135 participants (5,2 % d’Autochtones); les Autochtones présentaient un risque de décès après une intervention chirurgicale 30 % plus élevé que les patients non autochtones (rapport de risque combiné 1,30; IC à 95 % 1,09–1,54; I2 = 81 %). Les complications étaient aussi plus fréquentes chez le premier groupe, notamment les infections (RC corrigé 1,63; IC à 95 % 1,13–2,34) et les pneumonies (RC 2,24; IC à 95 % 1,58–3,19). Les taux de différentes interventions chirurgicales étaient plus faibles, notamment pour les transplantations rénales, les arthroplasties, les chirurgies cardiaques et les accouchements par césarienne. Interprétation: Les données disponibles sur les issues postopératoires et le taux d’utilisation de la chirurgie chez les Autochtones au Canada sont limitées et de faible qualité. Elles suggèrent que les Autochtones ont de plus hauts taux de décès et d’issues négatives postchirurgicales et qu’ils font face à des obstacles dans l’accès aux interventions chirurgicales. Ces conclusions indiquent qu’il y a un besoin de réévaluer en profondeur les soins chirurgicaux prodigués aux Autochtones au Canada pour leur assurer un accès équitable et améliorer les issues. Numéro d’enregistrement du protocole: PROSPERO-CRD42018098757.
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Affiliation(s)
- Jason A McVicar
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont.
| | - Alana Poon
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Nadine R Caron
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - M Dylan Bould
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Jason W Nickerson
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Nora Ahmad
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Donna May Kimmaliardjuk
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Chelsey Sheffield
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Caitlin Champion
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Daniel I McIsaac
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
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McVicar JA, Poon A, Caron NR, Bould MD, Nickerson JW, Ahmad N, Kimmaliardjuk DM, Sheffield C, Champion C, McIsaac DI. Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. CMAJ 2021; 193:E713-E722. [PMID: 34001549 PMCID: PMC8177941 DOI: 10.1503/cmaj.191682] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Substantial health inequities exist for Indigenous Peoples in Canada. The remote and distributed population of Canada presents unique challenges for access to and use of surgery. To date, the surgical outcome data for Indigenous Peoples in Canada have not been synthesized. Methods: We searched 4 databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Métis identity with non-Indigenous people in Canada. Independent reviewers completed all stages in duplicate. Our primary outcome was mortality; secondary outcomes included utilization rates of surgical procedures, complications and hospital length of stay. We performed meta-analysis of the primary outcome using random effects models. We assessed risk of bias using the ROBINS-I tool. Results: Twenty-eight studies were reviewed involving 1 976 258 participants (10.2% Indigenous). No studies specifically addressed Inuit or Métis populations. Four studies, including 7 cohorts, contributed adjusted mortality data for 7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher rate of death after surgery than non-Indigenous patients (pooled hazard ratio 1.30, 95% CI 1.09–1.54; I2 = 81%). Complications were also higher for Indigenous Peoples, including infectious complications (adjusted OR 1.63, 95% CI 1.13–2.34) and pneumonia (OR 2.24, 95% CI 1.58–3.19). Rates of various surgical procedures were lower, including rates of renal transplant, joint replacement, cardiac surgery and cesarean delivery. Interpretation: The currently available data on postoperative outcomes and surgery utilization rates for Indigenous Peoples in Canada are limited and of poor quality. Available data suggest that Indigenous Peoples have higher rates of death and adverse events after surgery, while also encountering barriers accessing surgical procedures. These findings suggest a need for substantial re-evaluation of surgical care for Indigenous Peoples in Canada to ensure equitable access and to improve outcomes. Protocol registration: PROSPERO-CRD42018098757
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Affiliation(s)
- Jason A McVicar
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Alana Poon
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Nadine R Caron
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - M Dylan Bould
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Jason W Nickerson
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
| | - Nora Ahmad
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Donna May Kimmaliardjuk
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Chelsey Sheffield
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Caitlin Champion
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Daniel I McIsaac
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
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Peripheral Artery Disease in Vulnerable Patient Populations: Outcomes of Orbital Atherectomy in Native Americans Compared to Non-Native Americans. A Single-Center Experience in Rural Oklahoma. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:71-77. [PMID: 32651160 DOI: 10.1016/j.carrev.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE Although the incidence of peripheral artery disease (PAD) and amputations is higher in Native Americans (NA) than Caucasians, the study of revascularization NA is limited, resulting in their under representation in clinical studies. Orbital atherectomy (OA) is widely utilized for endovascular revascularization of significantly calcified peripheral arteries and has been shown to improve limb salvage rates. METHODS/MATERIALS A cohort of 74 consecutive PAD subjects undergoing OA treatment was retrospectively analyzed via Kaplan Meier (KM) and Propensity Score Matched (PSM) analysis. RESULTS A significant proportion of the subjects were NA (16.2%). Compared to the non-NA, the NA had higher numerical baseline rates of wounds, dialysis, chronic kidney disease (CKD), and critical limb ischemia, but were numerically less likely to smoke and had similar rates of diabetes. There were very high rates of severe calcification (100% vs. 87%) and pre-procedure diameter stenosis (99% vs. 95%) in both groups. The NA and non-NA had good angiographic outcomes, resulting in low rates of post-procedure residual diameter stenosis (10% vs. 11%). Lastly, KM analysis indicated high freedom from amputation in both groups at 1 year (89% vs. 95%), as well as in the PSM subjects (89% vs. 100%). CONCLUSIONS Despite numerically higher rates of co-morbidities at baseline (e.g., CKD, dialysis, and presence of non-healing wounds), the NA underwent successful revascularization with OA, resulting in high freedom from amputation at 1-year. Given the small sample size of NA, these results may not be generalizable-thus, larger studies on NA are warranted.
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Gabel JA, Bianchi C, Possagnoli I, Oyoyo UE, Teruya TH, Kiang SC, Abou-Zamzam AM, Bishop V, Eastridge D. A conservative approach to select patients with ischemic wounds is safe and effective in the setting of deferred revascularization. J Vasc Surg 2020; 71:1286-1295. [PMID: 32085957 DOI: 10.1016/j.jvs.2019.06.199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 06/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The Wound, Ischemia, and foot Infection classification system has been validated to predict benefit from inmediate revascularization and major amputation risk among patients with peripheral arterial disease. Our primary goal was to evaluate wound healing, limb salvage, and survival among patients with ischemic wounds undergoing revascularization when intervention was deferred by a trial of conservative wound therapy. METHODS All patients with peripheral arterial disease and tissue loss are prospectively enrolled into our Prevention of Amputation in Veterans Everywhere limb preservation program. Limbs are stratified into a validated pathway of care based on predetermined criteria (immediate revascularization, conservative treatment, primary amputation, and palliative care). Limbs allocated to the conservative strategy that failed to demonstrate adequate wound healing and were candidates, underwent deferred revascularization. Rates of wound healing, freedom from major amputation, and survival were compared between patients who underwent deferred revascularization with those who received immediate revascularization by univariate and multivariate analysis. RESULTS Between January 2008 and December 2017, 855 limbs were prospectively enrolled into the Prevention of Amputation in Veterans Everywhere program. A total of 203 limbs underwent immediate revascularization. Of 236 limbs stratified to a conservative approach, 185 (78.4%) healed and 33 (14.0%) underwent deferred revascularization (mean, 2.7 ± 2.6 months). The mean long-term follow-up was 51.7 ± 37.0 months. Deferred compared with immediate revascularization demonstrated similar rates of wound healing (66.7% vs 57.6%; P = .33), freedom from major amputation (81.8% vs 74.9%; P = .39), and survival (54.5% vs 50.7%; P = .69). After adjustment for overall Wound, Ischemia, and foot Infection stratification stages, deferred revascularization remained similar to immediate revascularization for wound healing (hazard ratio [HR], 1.5; 95% confidence interval [CI], 0.7-3.2), freedom from major amputation (HR, 0.7; 95% CI, 0.3-1.7) and survival (HR, 1.2; 95% CI, 0.6-2.4). CONCLUSIONS Limbs with mild to moderate ischemia that fail a trial of conservative wound therapy and undergo deferred revascularization achieve similar rates of wound healing, limb salvage, and survival compared with limbs undergoing immediate revascularization. A stratified approach to critical limb ischemia is safe and can avoid unnecessary procedures in selected patients.
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Affiliation(s)
- Joshua A Gabel
- Department of Vascular Surgery, Loma Linda University Health, Loma Linda, Calif
| | - Christian Bianchi
- Department of Vascular Surgery, Loma Linda University Health, Loma Linda, Calif; Department of Vascular Surgery, Veterans Affairs Loma Linda Healthcare System, Loma Linda, Calif.
| | - Isabella Possagnoli
- Department of Vascular Surgery, Veterans Affairs Loma Linda Healthcare System, Loma Linda, Calif
| | - Udochukwu E Oyoyo
- Department of Radiology, Loma Linda University Health, Loma Linda, Calif
| | - Theodore H Teruya
- Department of Vascular Surgery, Loma Linda University Health, Loma Linda, Calif; Department of Vascular Surgery, Veterans Affairs Loma Linda Healthcare System, Loma Linda, Calif
| | - Sharon C Kiang
- Department of Vascular Surgery, Loma Linda University Health, Loma Linda, Calif; Department of Vascular Surgery, Veterans Affairs Loma Linda Healthcare System, Loma Linda, Calif
| | - Ahmed M Abou-Zamzam
- Department of Vascular Surgery, Loma Linda University Health, Loma Linda, Calif
| | - Vicki Bishop
- Department of Vascular Surgery, Veterans Affairs Loma Linda Healthcare System, Loma Linda, Calif
| | - Diana Eastridge
- Department of Vascular Surgery, Veterans Affairs Loma Linda Healthcare System, Loma Linda, Calif
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Shah BR, Frymire E, Jacklin K, Jones CR, Khan S, Slater M, Walker JD, Green ME. Peripheral arterial disease in Ontario First Nations people with diabetes: a longitudinal population-based cohort study. CMAJ Open 2019; 7:E700-E705. [PMID: 31822500 PMCID: PMC7015673 DOI: 10.9778/cmajo.20190162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Peripheral arterial disease is an important vascular complication of diabetes that may lead to lower-extremity amputation. We aimed to compare the treatment and complications of peripheral arterial disease between First Nations people and other people in Ontario with diabetes. METHODS Using health care administrative databases, we identified annual cohorts, from 1995/96 to 2014/15, of all people aged 20-105 years in Ontario with a diagnosis of diabetes. We used the Indian Register to identify those who were First Nations people and compared them to all other people in Ontario. We identified revascularization procedures (angioplasty or bypass surgery) and lower-extremity amputation procedures in the 2 populations and determined the mortality rate among those who had had lower-extremity amputation. RESULTS First Nations people received revascularization procedures at a rate comparable to that for other people in Ontario. However, they had lower-extremity amputation procedures at 3-5 times the frequency for other Ontario residents. First Nations people had higher mortality than other people in Ontario after lower-extremity amputation (adjusted hazard ratio 1.15, 95% confidence interval 1.05-1.26), with median survival of 3.5 years versus 4.1 years. INTERPRETATION First Nations people in Ontario had a markedly increased risk for lower-extremity amputation compared to other people in Ontario, and their mortality rate after amputation was 15% higher. Future research is needed to understand what barriers First Nations people face to receive adequate peripheral arterial disease care and what interventions are necessary to achieve equitable outcomes of peripheral arterial disease for First Nations people in Ontario.
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Affiliation(s)
- Baiju R Shah
- ICES (Shah, Frymire, Khan, Slater, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Jones), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont.
| | - Eliot Frymire
- ICES (Shah, Frymire, Khan, Slater, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Jones), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Kristen Jacklin
- ICES (Shah, Frymire, Khan, Slater, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Jones), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Carmen R Jones
- ICES (Shah, Frymire, Khan, Slater, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Jones), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Shahriar Khan
- ICES (Shah, Frymire, Khan, Slater, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Jones), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Morgan Slater
- ICES (Shah, Frymire, Khan, Slater, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Jones), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Jennifer D Walker
- ICES (Shah, Frymire, Khan, Slater, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Jones), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Michael E Green
- ICES (Shah, Frymire, Khan, Slater, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Jones), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
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Singh TP, Moxon JV, Healy GN, Cadet-James Y, Golledge J. Presentation and outcomes of indigenous Australians with peripheral artery disease. BMC Cardiovasc Disord 2018; 18:94. [PMID: 29769031 PMCID: PMC5956730 DOI: 10.1186/s12872-018-0835-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/09/2018] [Indexed: 12/01/2022] Open
Abstract
Background The risk factors for peripheral artery disease (PAD) are more common in Indigenous than non-Indigenous Australians, however the presentation and outcome of PAD in Indigenous Australians has not been previously investigated. The aim of this prospective cohort study was to compare the presenting characteristics and clinical outcome of Indigenous and non-Indigenous Australians with PAD. Methods PAD patients were prospectively recruited and followed-up since 2003 from an outpatient vascular clinic in Townsville, Australia. Presenting symptoms and risk factors in Indigenous and non-Indigenous patients were compared using Pearson’s χ2 test and Mann Whitney U test. Kaplan Meier survival analysis and Cox proportional hazard analysis were used to compare the incidence of myocardial infarction (MI), stroke or death (major cardiovascular events) among Indigenous and non-Indigenous patients. Results Four hundred and one PAD patients were recruited, of which 16 were Indigenous and 385 were non-Indigenous Australians. Indigenous Australians were younger at entry (median age 63.3 [54.7–67.8] vs 69.6 [63.3–75.4]), more commonly current smokers (56.3% vs 31.4%), and more frequently had insulin-treated diabetes (18.8% vs 5.2%). During a median follow-up of 2.5 years, five and 45 major cardiovascular events were recorded amongst Indigenous and non-Indigenous Australians, respectively. Indigenous Australians were at ~ 5-fold greater risk of major cardiovascular events (adjusted hazard ratio 4.72 [95% confidence intervals 1.41–15.78], p = 0.012) compared to non-Indigenous Australians. Conclusions These findings suggest that Indigenous Australians with PAD present at a younger age, have higher rates of smoking and insulin-treated diabetes, and poorer clinical outcomes compared to non-Indigenous Australians.
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Affiliation(s)
- Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.,The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia.,The University of Queensland, School of Public Health, Herston, QLD, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Genevieve N Healy
- The University of Queensland, School of Public Health, Herston, QLD, Australia
| | | | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia. .,The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia.
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11
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Tiwari A, Slim H, Edmonds M, Ritter JC, Rashid H. Outcome of Lower Limb Distal Bypass in Afro-Caribbean Populations. Vasc Endovascular Surg 2011; 45:514-8. [DOI: 10.1177/1538574411408350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is little data on outcome following lower limb bypass surgery in ethnic minorities in the United Kingdom. We looked at the results of distal bypass surgery in Afro-Caribbeans (AFCs) and compared it to caucasians (CAs). Patients undergoing distal bypass between 2004 and 2009 were analyzed. Life table analyses and log rank were used to compare graft patency and amputation-free survival. A total of 86 CA and 39 AFC patients, with a median age of 78 years and 73 years, respectively (P = .01), underwent bypass. There were more women in AFC groups (41.1%) compared to CA group (19.2%, P = .01). Tissue loss as indication for surgery was more in AFC than in CA group (92.3% vs73.9%, P = .03). Primary, primary-assisted and secondary patency rates, and amputation-free survival at 12 months for AFCs compared to CAs (51.3 vs 44.6; 85.2 vs 80.9; 91.2 vs 84.4; and 84.9 vs 75.1). Graft patency after lower limb distal revascularization in AFCs is comparable to CAs.
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Affiliation(s)
- Alok Tiwari
- Departments of Vascular Surgery, Kings College Hospital, Denmark Hill, London, UK
| | - Hani Slim
- Departments of Vascular Surgery, Kings College Hospital, Denmark Hill, London, UK
| | - Michael Edmonds
- Internal Medicine, Kings College Hospital, Denmark Hill, London, UK
| | - Jens Carsten Ritter
- Departments of Vascular Surgery, Kings College Hospital, Denmark Hill, London, UK
| | - Hisham Rashid
- 1Departments of Vascular Surgery, Kings College Hospital, Denmark Hill, London, UK,
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12
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Silha JV, Nyomba BLG, Leslie WD, Murphy LJ. Ethnicity, insulin resistance, and inflammatory adipokines in women at high and low risk for vascular disease. Diabetes Care 2007; 30:286-91. [PMID: 17259496 DOI: 10.2337/dc06-1073] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to compare the relationship between body composition, insulin resistance, and inflammatory adipokines in Aboriginal Canadian women, who are at high risk of vascular disease, with white women. RESEARCH DESIGN AND METHODS A subgroup of the First Nations Bone Health Study population, consisting of 131 Aboriginal women and 132 matched white women, was utilized. Body composition was determined by whole-body dual X-ray absorptiometry, and blood analytes were measured after an overnight fast. RESULTS After excluding individuals with diabetes, A1C, BMI, percent trunk fat, and homeostasis model assessment of insulin resistance (HOMA-IR) were greater in First Nation women compared with white women, whereas adiponectin, retinol binding protein (RBP)4, and insulin-like growth factor binding protein-1 (IGFBP-1) were lower. First Nation women had more trunk fat for any given level of total fat than white women. There were no differences in resistin, leptin, tumor necrosis factor (TNF)-alpha, or C-reactive protein (CRP) levels between First Nation and white women. Insulin resistance correlated with leptin and inversely with adiponectin levels in both First Nation and white women. There were weak correlations between insulin resistance and TNF-alpha, interleukin-6, and CRP, but these were not significant after correction for body fat. No correlation was found between RBP4 and insulin resistance. ANCOVA revealed a higher HOMA-IR adjusted for total body fat in First Nation women than in white women (P = 0.015) but not HOMA-IR adjusted for trunk fat (P > 0.2). CONCLUSIONS First Nation women are more insulin resistant than white women, and this is explained by trunk fat but not total fat. Despite the increased insulin resistance, inflammatory adipokines are not significantly increased in First Nation women compared with white women.
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Affiliation(s)
- Josef V Silha
- Department of Internal Medicine, University of Manitoba, 715 McDermot Avenue, Winnipeg, R3E 3P4 Canada
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