1
|
de-Miguel-Yanes JM, Jimenez-Garcia R, Hernandez-Barrera V, de-Miguel-Diez J, Jimenez-Sierra A, Zamorano-León JJ, Cuadrado-Corrales N, Lopez-de-Andres A. An observational study of therapeutic procedures and in-hospital outcomes among patients admitted for acute myocardial infarction in Spain, 2016-2022: the role of diabetes mellitus. Cardiovasc Diabetol 2024; 23:313. [PMID: 39182091 PMCID: PMC11344913 DOI: 10.1186/s12933-024-02403-y] [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: 07/08/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND We used the Spanish national hospital discharge data from 2016 to 2022 to analyze procedures and hospital outcomes among patients aged ≥ 18 years admitted for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) according to diabetes mellitus (DM) status (non-diabetic, type 1-DM or type 2-DM). METHODS We built logistic regression models for STEMI/NSTEMI stratified by DM status to identify variables associated with in-hospital mortality (IHM). We analyzed the effect of DM on IHM. RESULTS Spanish hospitals reported 201,950 STEMIs (72.7% non-diabetic, 0.5% type 1-DM, and 26.8% type 2-DM; 26.3% female) and 167,285 NSTEMIs (61.6% non-diabetic, 0.6% type 1-DM, and 37.8% type 2-DM; 30.9% female). In STEMI, the frequency of percutaneous coronary intervention (PCI) increased among non-diabetic people (60.4% vs. 68.6%; p < 0.001) and people with type 2-DM (53.6% vs. 66.1%; p < 0.001). In NSTEMI, the frequency of PCI increased among non-diabetic people (43.7% vs. 45.7%; p < 0.001) and people with type 2-DM (39.1% vs. 42.8%; p < 0.001). In NSTEMI, the frequency of coronary artery by-pass grafting (CABG) increased among non-diabetic people (2.8% vs. 3.5%; p < 0.001) and people with type 2-DM (3.7% vs. 5.0%; p < 0.001). In the entire population, lower IHM was associated with undergoing PCI (odds ratio [OR] [95% confidence interval] = 0.34 [0.32-0.35] in STEMI; 0.24 [0.23-0.26] in NSTEMI) or CABG (0.33 [0.27-0.40] in STEMI; 0.45 [0.38-0.53] in NSTEMI). IHM decreased over time in STEMI (OR = 0.86 [0.80-0.93]). Type 2-DM was associated with higher IHM in STEMI (OR = 1.06 [1.01-1.11]). CONCLUSIONS PCI and CABG were associated with lower IHM in people admitted for STEMI/NSTEMI. Type 2-DM was associated with IHM in STEMI.
Collapse
MESH Headings
- Humans
- Female
- ST Elevation Myocardial Infarction/therapy
- ST Elevation Myocardial Infarction/mortality
- ST Elevation Myocardial Infarction/diagnosis
- ST Elevation Myocardial Infarction/epidemiology
- Male
- Spain/epidemiology
- Hospital Mortality
- Percutaneous Coronary Intervention/mortality
- Percutaneous Coronary Intervention/adverse effects
- Percutaneous Coronary Intervention/trends
- Aged
- Middle Aged
- Non-ST Elevated Myocardial Infarction/therapy
- Non-ST Elevated Myocardial Infarction/mortality
- Non-ST Elevated Myocardial Infarction/diagnosis
- Non-ST Elevated Myocardial Infarction/epidemiology
- Treatment Outcome
- Risk Factors
- Time Factors
- Risk Assessment
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/mortality
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/mortality
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/therapy
- Patient Admission
- Aged, 80 and over
- Databases, Factual
- Diabetes Mellitus/epidemiology
- Diabetes Mellitus/diagnosis
- Diabetes Mellitus/mortality
- Diabetes Mellitus/therapy
- Adult
- Coronary Artery Bypass/mortality
- Coronary Artery Bypass/adverse effects
- Coronary Artery Bypass/trends
Collapse
Affiliation(s)
- Jose M de-Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Javier de-Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid,, Madrid, Spain
| | | | - Jose J Zamorano-León
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| |
Collapse
|
2
|
Claessen H, Narres M, Heier M, Kvitkina T, Linkohr B, Wolff G, Roden M, Icks A, Peters A. Sex-specific trends in incidence of first myocardial infarction among people with and without diabetes between 1985 and 2016 in a German region. Cardiovasc Diabetol 2024; 23:110. [PMID: 38555466 PMCID: PMC10981819 DOI: 10.1186/s12933-024-02179-1] [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: 09/25/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The reduction of myocardial infarction (MI) and narrowing the gap between the populations with and without diabetes are important goals of diabetes care. We analyzed time trends for sex-specific incidence rates (IR) of first MI (both non-fatal MI and fatal MI) as well as separately for first non-fatal MI and fatal MI in the population with and without diabetes. METHODS Using data from the KORA myocardial infarction registry (Augsburg, Germany), we estimated age-adjusted IR in people with and without diabetes, corresponding relative risks (RR), and time trends from 1985 to 2016 using Poisson regression. RESULTS There were 19,683 people with first MI (34% fatal MI, 71% men, 30% with diabetes) between 1985 and 2016. In the entire study population, the IR of first MI decreased from 359 (95% CI: 345-374) to 236 (226-245) per 100,000 person years. In men with diabetes, IR decreased only in 2013-2016. This was due to first non-fatal MI, where IR in men with diabetes increased until 2009-2012, and slightly decreased in 2013-2016. Overall, fatal MI declined stronger than first non-fatal MI corresponding to IRs. The RR of first MI substantially increased among men from 1.40 (1.22-1.61) in 1985-1988 to 2.60 (2.26-2.99) in 1997-2000 and moderately decreased in 2013-2016: RR: 1.75 (1.47-2.09). Among women no consistent time trend for RR was observed. Time trends for RR were similar regarding first non-fatal MI and fatal MI. CONCLUSIONS Over the study period, we found a decreased incidence of first MI and fatal MI in the entire study population. The initial increase of first non-fatal MI in men with diabetes needs further research. The gap between populations with and without diabetes remained.
Collapse
Affiliation(s)
- Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Auf´m Hennekamp 65, 40225, Düsseldorf, Germany.
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Maria Narres
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Auf´m Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- KORA Study Centre, University Hospital, Augsburg, Germany
| | - Tatjana Kvitkina
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Auf´m Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Georg Wolff
- Clinic of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich, Heine University, Düsseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, University Hospital, Düsseldorf, Germany
- Institute for Clinical Diabetology, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, German Diabetes Center, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Auf´m Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| |
Collapse
|
3
|
Fujita KK, Ye F, Collister D, Klarenbach S, Campbell DJT, Chew DS, Quinn AE, Ronksley P, Lau D. Sodium-glucose co-transporter-2 inhibitors are associated with kidney benefits at all degrees of albuminuria: A retrospective cohort study of adults with diabetes. Diabetes Obes Metab 2024; 26:699-709. [PMID: 37997302 DOI: 10.1111/dom.15361] [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: 07/28/2023] [Revised: 10/15/2023] [Accepted: 10/21/2023] [Indexed: 11/25/2023]
Abstract
AIM To estimate the real-world effectiveness of sodium-glucose co-transporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP4is) at reducing loss of kidney function and adverse kidney events in adults with varying levels of albuminuria. MATERIALS AND METHODS In this retrospective cohort study using administrative data, we matched new SGLT2i users 1:2 to DPP4i users on diabetes therapy, chronic kidney disease (CKD) stage, albuminuria and time-conditional propensity score. Albuminuria was defined by spot urine albumin or equivalent as mild, moderate or severe. Linear regression was used to model the estimated glomerular filtration rate (eGFR), and Poisson regression for a composite kidney outcome (> 40% loss of eGFR, kidney replacement therapy or death from kidney causes) and all-cause mortality. RESULTS SGLT2i users (n = 19 238, median age 57.9 years, female 40.9%) had mostly nil/mild albuminuria (70.7%). SGLT2is were associated with a 1.36 (95% CI 0.98-1.74) mL/min/1.73m2 (P < .001) acute (≤ 60 days) decline in eGFR, relative to DPP4is. Thereafter, SGLT2is were associated with 1.04 (95% CI 0.93-1.15) mL/min/1.73m2 (P < .001) less annual eGFR loss. SGLT2i users had fewer adverse kidney outcomes (incidence rate ratio [IRR] 0.58 [0.47-0.71]; P < .001), but not all-cause mortality (IRR 0.82 [0.66-1.01]; P = .06). Outcomes were similar considering only those with nil/mild albuminuria. CONCLUSIONS SGLT2is may prevent eGFR decline and reduce the risk of adverse kidney events in adults with diabetes and nil or non-severe albuminuria.
Collapse
Affiliation(s)
- Kaden K Fujita
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David Collister
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David J T Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Derek S Chew
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amity E Quinn
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Paul Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Darren Lau
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
4
|
Alexanderson-Rosas E, Antonio-Villa NE, Guerra EC, Gurrola-Luna H, Barajas-Paulin AJ, Espejel-Guzman A, Prieto-Vargas V, Aparicio-Ortiz AD, Serrano-Roman J, Cabello-Ganem A, Bautista-Perez-Gavilan A, Carvajal-Juarez I, Solorzano-Pinot E, Espinola-Zavaleta N. Comorbidities and cardiac symptoms can modify myocardial function regardless of ischemia: a cross-sectional study with PET/CT. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2023; 93:336-344. [PMID: 36194873 PMCID: PMC10406484 DOI: 10.24875/acm.22000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023] Open
Abstract
Objective Associating comorbidities and cardiac symptoms that alter myocardial mechanical function could help clinicians to correctly identify at-risk population. Methods We conducted a functional open population cross-sectional study of patients referred to a positron emission computed tomography/computed tomography unit in Mexico City for evaluation of myocardial function, perfusion, and coronary circulation. Ischemia was defined as a sum difference score (SDS) > 2. Association between comorbidities and cardiac symptoms was tested using logistic regression models and trend analysis. We performed an interaction analysis to evaluate the addition of any accompanying symptoms to comorbid conditions on impairment of myocardial function. Results One thousand two hundred and seventy-three patients were enrolled, 66.1% male, with a mean age of 62.4 (± 12.7) years, 360 (28.7%) with ischemia, 925 (72.7%) with at least one comorbidity, and 676 (53.1%) had at least one associated cardiac symptom. Patients without ischemia, type 2 diabetes, arterial hypertension, and adverse cardiac symptoms were associated with adverse function, perfusion, and coronary flow parameters. We observed a trend of a cumulative number of comorbidities and cardiac symptoms with increased ischemia and decreased coronary flow. Only in decreased LVEF, we demonstrated an interaction effect between increased comorbidities and adverse symptoms. Conclusions The high burden of comorbidities and symptoms in our population alter myocardial function regardless of the level of ischemia.
Collapse
Affiliation(s)
- Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez
- PET/CT Ciclotron, Faculty of Medicine, National Autonomous University of Mexico
- Department of Physiology, National Autonomous University of Mexico
| | | | | | - Hector Gurrola-Luna
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez
| | | | | | | | | | - Javier Serrano-Roman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez
| | | | | | | | | |
Collapse
|
5
|
Avery L, Maddox R, Abtan R, Wong O, Rotondi NK, McConkey S, Bourgeois C, McKnight C, Wolfe S, Flicker S, Macpherson A, Smylie J, Rotondi M. Modelling prevalent cardiovascular disease in an urban Indigenous population. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022:10.17269/s41997-022-00669-x. [PMID: 35945472 DOI: 10.17269/s41997-022-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Studies have highlighted the inequities between the Indigenous and non-Indigenous populations with respect to the burden of cardiovascular disease and prevalence of predisposing risks resulting from historical and ongoing impacts of colonization. The objective of this study was to investigate factors associated with cardiovascular disease (CVD) within and specific to the Indigenous peoples living in Toronto, Ontario, and to evaluate the reliability and validity of the resulting model in a similar population. METHODS The Our Health Counts Toronto study measured the baseline health of Indigenous community members living in Toronto, Canada, using respondent-driven sampling. An iterative approach, valuing information from the literature, clinical insight and Indigenous lived experiences, as well as statistical measures was used to evaluate candidate predictors of CVD (self-reported experience of discrimination, ethnic identity, health conditions, income, education, age, gender and body size) prior to multivariable modelling. The resulting model was then validated using a distinct, geographically similar sample of Indigenous people living in Hamilton, Ontario, Canada. RESULTS The multivariable model of risk factors associated with prevalent CVD included age, diabetes, hypertension, body mass index and exposure to discrimination. The combined presence of diabetes and hypertension was associated with a greater risk of CVD relative to those with either condition and was the strongest predictor of CVD. Those who reported previous experiences of discrimination were also more likely to have CVD. Further study is needed to determine the effect of body size on risk of CVD in the urban Indigenous population. The final model had good discriminative ability and adequate calibration when applied to the Hamilton sample. CONCLUSION Our modelling identified hypertension, diabetes and exposure to discrimination as factors associated with cardiovascular disease. Discrimination is a modifiable exposure that must be addressed to improve cardiovascular health among Indigenous populations.
Collapse
Affiliation(s)
- Lisa Avery
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Raglan Maddox
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
- Aboriginal and Torres Strait Islander Health Group, National Centre for Epidemiology and Public Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Robert Abtan
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Octavia Wong
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Nooshin Khobzi Rotondi
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
- Ontario Tech University, Oshawa, ON, Canada
| | - Stephanie McConkey
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
| | - Cheryllee Bourgeois
- Seventh Generation Midwives Toronto, Toronto, ON, Canada
- Metropolitan University, Toronto, ON, Canada
| | | | - Sara Wolfe
- Seventh Generation Midwives Toronto, Toronto, ON, Canada
| | - Sarah Flicker
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Alison Macpherson
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Janet Smylie
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
| | - Michael Rotondi
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| |
Collapse
|
6
|
Vervoort D, Kimmaliardjuk DM, Ross HJ, Fremes SE, Ouzounian M, Mashford-Pringle A. Access to Cardiovascular Care for Indigenous Peoples in Canada: A Rapid Review. CJC Open 2022; 4:782-791. [PMID: 36148252 PMCID: PMC9486860 DOI: 10.1016/j.cjco.2022.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/31/2022] [Indexed: 11/15/2022] Open
Abstract
Indigenous peoples in Canada are at an increased risk of cardiovascular disease compared to non-Indigenous people. Contributing factors include historical oppression, racism, healthcare biases, and disparities in terms of the social determinants of health. Access to and inequity in cardiovascular care for Indigenous peoples in Canada remain poorly studied and understood. A rapid review of the literature was performed using the PubMed/MEDLINE, Web of Science, and Indigenous Studies Portal (iPortal) databases to identify articles describing access to cardiovascular care for Indigenous peoples in Canada between 2002 and 2021. Included articles were presented narratively in the context of delays in seeking, reaching, or receiving care, or as disparities in cardiovascular outcomes, and were assessed for their successful engagement in indigenous health research using a preexisting framework. Current research suggests that gaps most prominently present as delays in receiving care and as poorer long-term outcomes. The literature is concentrated in Alberta, Manitoba, and Ontario, as well as among First Nations people, and is largely rooted in a biomedical worldview. Additional community-driven research is required to better elucidate the gaps in access to holistic cardiovascular care for Indigenous peoples in Canada. Healthcare professionals, researchers, and policymakers should reflect further upon their actions and privilege, educate themselves about historical facts and the Truth and Reconciliation Commission, tackle prevailing disparities and systemic barriers in the healthcare systems, and develop culturally safe and ethically appropriate healthcare interventions to improve the health of all Indigenous peoples in Canada.
Collapse
Affiliation(s)
- Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Dominique Vervoort, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, Ontario M5T 3M6, Canada. Tel.: +1-416-989-7874.
| | - Donna May Kimmaliardjuk
- Division of Cardiovascular Surgery, Eastern Health, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Heather J. Ross
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E. Fremes
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Angela Mashford-Pringle
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Abstract
Racism and racial bias influence the lives and cardiovascular health of minority individuals. The fact that minority groups tend to have a higher burden of cardiovascular disease risk factors is often a result of racist policies that restrict opportunities to live in healthy neighbourhoods and have access to high-quality education and healthcare. The fact that minorities tend to have the worst outcomes when cardiovascular disease develops is often a result of institutional or individual racial bias encountered when they interact with the healthcare system. In this review, we discuss bias, discrimination, and structural racism from the viewpoints of cardiologists in Canada, the United Kingdom, and the US, and how racial bias impacts cardiovascular care. Finally, we discuss proposals to mitigate the impact of racism in our specialty.
Collapse
|
8
|
Schultz A, Nguyen T, Sinclaire M, Fransoo R, McGibbon E. Historical and Continued Colonial Impacts on Heart Health of Indigenous Peoples in Canada: What's Reconciliation Got to Do With It? CJC Open 2021; 3:S149-S164. [PMID: 34993444 PMCID: PMC8712585 DOI: 10.1016/j.cjco.2021.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/12/2021] [Indexed: 12/04/2022] Open
Abstract
Colonization and enforced genocidal strategies have collectively fractured and changed Indigenous people by attempting to erase and dismiss their voices and knowledge. Nearly a decade ago, we were reminded by Dr Ku Young of the cardiovascular health disparities, in evidence among Indigenous people in Canada. compared with White people. He went on to say that beyond a biomedical understanding of this health status is the ongoing impact of long-standing marginalization and oppression faced by Indigenous people. Limited attention has been afforded to advance our understanding of these colonial impacts on Indigenous people and their heart health. This article contributes to our collective understanding of Indigenous people and their cardiac health by covering the following topics: layers of foundational truths of relevance to healthcare contexts and Indigenous people; a critical reflection of Western (biomedical) perspectives concerning cardiac health among Indigenous people; and materials from 2 studies, funded by the Canadian Institutes of Health Research, in which Indigenous voices and experiences were privileged concerning the heart and caring for the heart. In the final section, 3 topics are offered as starting points for self-reflection and acts of reconciliation within healthcare practice, decision-making, and research: reflections on self and one's worldview; anti-racist healthcare practice; and 2-eyed seeing approaches to work within healthcare contexts. A common thread is the imperative for "un-silencing" Indigenous people's voices, experiences, and knowledge, which is a requirement if addressing the identified cardiovascular health disparities is truly a health priority.
Collapse
Affiliation(s)
- Annette Schultz
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba (UM), Winnipeg, Manitoba, Canada
- St Boniface Research Centre, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Thang Nguyen
- Cardiac Sciences Manitoba, Asper Clinical Research Institute, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Moneca Sinclaire
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba (UM), Winnipeg, Manitoba, Canada
| | - Randy Fransoo
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth McGibbon
- Rankin School of Nursing Faculty of Health Sciences, Faculty of Health Sciences, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| |
Collapse
|
9
|
Intersectionality and heart failure: what clinicians and researchers should know and do. Curr Opin Support Palliat Care 2021; 15:141-146. [PMID: 33905386 DOI: 10.1097/spc.0000000000000547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW To review the application of intersectionality to heart failure. Intersectionality refers to the complex ways in which disenfranchisement and privilege intersect to reproduce and influence health and social outcomes. RECENT FINDINGS Intersectionality challenges approaches that focus on a single or small number of socio-demographic characteristics, such as sex or age. Instead, approaches should take account of the nature and effects of a full range of socio-demographic factors linked to privilege, including: race and ethnicity, social class, income, age, gender identity, disability, geography, and immigration status. Although credible and well established across many fields - there is limited recognition of the effects of intersectionality in research into heart disease, including heart failure. This deficiency is important because heart failure remains a common and burdensome syndrome that requires complex pharmacological and nonpharmacological care and collaboration between health professionals, patients and caregivers during and at the end-of-life. SUMMARY Approaches to heart failure clinical care should recognize more fully the nature and impact of patients' intersectionality- and how multiple factors interact and compound to influence patients and their caregivers' behaviours and health outcomes. Future research should explicate the ways in which multiple factors interact to influence health outcomes.
Collapse
|
10
|
Scheirer O, Leach A, Netherton S, Mondal P, Hillier T, Lafond G, LaFontaine T, Davis PJ. Outcomes of out of hospital cardiac arrest in First Nations and non-First Nations patients in Saskatoon. CAN J EMERG MED 2020; 23:75-79. [PMID: 33683612 DOI: 10.1007/s43678-020-00015-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION One in nine (11.7%) people in Saskatchewan identify as First Nations. It is known that First Nations people have a higher burden of cardiovascular disease, but not whether outcomes of out of hospital cardiac arrest are different. METHODS/METHODOLOGY We reviewed pre-hospital and inpatient records of patients with out of hospital cardiac arrest between January 1st, 2015 and December 31st, 2017. The population consisted of patients aged 18 years or older with out of hospital cardiac arrest of presumed cardiac origin occurring in the catchment area of Saskatoon's emergency medical services (EMS). Variables of interest included age, gender, First Nations status, EMS response times, bystander cardiopulmonary resuscitation (CPR), and shockable rhythm. Outcomes of interest included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge. RESULTS In all, 372 patients sustained out of hospital cardiac arrest, of which 27 were status First Nations. There were no differences between First Nations and non-First Nations patients in terms of shockable rhythms (24% vs 26%; p = 0.80), ROSC (42% vs 41%; p = 0.87), survival to hospital admission (27% vs 33%; p = 0.53), and survival to hospital discharge (15% vs 12%; p = 0.54). First Nations patients with out of hospital cardiac arrest were significantly younger (mean age 46 vs. 65 years; p < 0.0001) and had shorter EMS response times (median times 5.3 vs. 6.2 min; p = 0.01) when compared to non-First Nations patients. CONCLUSIONS In Saskatoon, First Nations patients with out of hospital cardiac arrest appear to have similar survival rates when compared with non-First Nations patients. However, First Nations patients sustaining out of hospital cardiac arrest were significantly younger than their non-First Nations counterparts. This highlights a significant public health issue.
Collapse
Affiliation(s)
- Owen Scheirer
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Andrew Leach
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Stuart Netherton
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Prosanta Mondal
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Gabe Lafond
- First Nations and Métis Health Council, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Tania LaFontaine
- First Nations and Métis Health Council, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Philip J Davis
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
| |
Collapse
|
11
|
Pace R, Harris S, Parry M, Zaran H. Primary and Secondary Cardiovascular Prevention Among First Nations Peoples With Type 2 Diabetes in Canada: Findings From the FORGE AHEAD Program. CJC Open 2020; 2:547-554. [PMID: 33305215 PMCID: PMC7711009 DOI: 10.1016/j.cjco.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background First Nations (FN) peoples in Canada face spiraling rates of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Data on the extent of CVD risk-factor management in FN peoples with T2DM in Canada are scarce. Methods A T2DM registry with data from 7 FN communities in Canada was utilized to identify individuals eligible for primary and secondary CVD prevention. Proportions of individuals meeting clinical practice guideline-specified targets (hemoglobin A1c ≤7.0%; blood pressure ≤130/80 mm Hg; low-density lipoprotein ≤2 mmol/L) were calculated. Prescription of recommended cardioprotective medications (antithrombotic medication, lipid-lowering agents, renin-angiotensin-aldosterone system inhibitors, and beta-blockers) among those with CVD was assessed. χ2 tests were employed to evaluate differences between CVD prevention groups and sexes. Results Of the 2098 individuals in the registry, 18% had documented CVD (female: male = 1.12). Overall, <10% met all 3 clinical practice guideline targets. Attainment of hemoglobin A1c and blood pressure targets was comparable between primary and secondary CVD prevention groups, with<50% achieving targets. A greater proportion of the secondary prevention group met low-density lipoprotein targets compared to those without CVD (61.6% vs 40.9%, P < 0.01). In the secondary prevention group, beta-blockers were prescribed to only 20%, and <60% were prescribed antithrombotics, lipid-lowering medications, or agents targeting the renin-angiotensin-aldosterone system; <2% were prescribed medications from all 4 classes of cardioprotective medications. Conclusions Primary and secondary CVD prevention recommendations for individuals with T2DM are not being met for an alarmingly high proportion of FN peoples. These findings serve as an urgent call for proactive measures to reduce CVD events and related mortality in this high-risk population.
Collapse
Affiliation(s)
- Romina Pace
- Centre for Outcomes Research & Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stewart Harris
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Corresponding author: Dr Stewart B. Harris, Centre for Studies in Family Medicine, Western University, The Western Centre for Public Health and Family Medicine, 1151 Richmond St, London, Ontario N6A 3K7, Canada. Tel.: +1-519-858-5028; fax: +1-519-858-5029.
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Harsh Zaran
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | |
Collapse
|
12
|
Green ME, Shah BR, Slater M, Khan S, Jones CR, Walker JD. Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes. CMAJ 2020; 192:E937-E945. [PMID: 32816998 DOI: 10.1503/cmaj.191039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Indigenous people worldwide are disproportionately affected by diabetes and its complications. We aimed to assess the monitoring, treatment and control of blood glucose and lipids in First Nations people in Ontario. METHODS We conducted a longitudinal population-based study using administrative data for all people in Ontario with diabetes, stratified by First Nations status. We assessed age- and sex-specific rates of completion of recommended monitoring for low-density lipoprotein (LDL) and glycated hemoglobin (A1c) from 2001/02 to 2014/15. We used data from 2014/15 to conduct a cross-sectional analysis of rates of achievement of A1c and LDL targets and use of glucose-lowering medications. RESULTS The study included 22 240 First Nations people and 1 319 503 other people in Ontario with diabetes. Rates of monitoring according to guidelines were 20%-50% for A1c and 30%-70% for lipids and were lowest for younger First Nations men. The mean age- and sex-adjusted A1c level was higher among First Nations people than other people (7.59 [95% confidence interval (CI) 7.57 to 7.61] v. 7.03 [95% CI 7.02 to 7.03]). An A1c level of 8.5% or higher was observed in 24.7% (95% CI 23.6 to 25.0) of First Nations people, compared to 12.8% (95% CI 12.1 to 13.5) of other people in Ontario. An LDL level of 2.0 mmol/L or less was observed in 60.3% (95% CI 59.7 to 61.6) of First Nations people, compared to 52.0% (95% CI 51.1 to 52.9) of other people in Ontario. Among those aged 65 or older, a higher proportion of First Nations people than other Ontarians were using insulin (28.1% v. 15.1%), and fewer were taking no medications (28.3% v. 40.1%). INTERPRETATION As of 2014/15, monitoring and achievement of glycemic control in both First Nations people and other people in Ontario with diabetes remained suboptimal. Interventions to support First Nations patients to reach their treatment goals and reduce the risk of complications need further development and study.
Collapse
Affiliation(s)
- Michael E Green
- Department of Family Medicine (Green, Slater), Queen's University; ICES Queen's (Green, Khan), Kingston, Ont.; ICES Central (Shah, Walker); Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.
| | - Baiju R Shah
- Department of Family Medicine (Green, Slater), Queen's University; ICES Queen's (Green, Khan), Kingston, Ont.; ICES Central (Shah, Walker); Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Morgan Slater
- Department of Family Medicine (Green, Slater), Queen's University; ICES Queen's (Green, Khan), Kingston, Ont.; ICES Central (Shah, Walker); Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Shahriar Khan
- Department of Family Medicine (Green, Slater), Queen's University; ICES Queen's (Green, Khan), Kingston, Ont.; ICES Central (Shah, Walker); Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Carmen R Jones
- Department of Family Medicine (Green, Slater), Queen's University; ICES Queen's (Green, Khan), Kingston, Ont.; ICES Central (Shah, Walker); Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Jennifer D Walker
- Department of Family Medicine (Green, Slater), Queen's University; ICES Queen's (Green, Khan), Kingston, Ont.; ICES Central (Shah, Walker); Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| |
Collapse
|
13
|
Slater M, Green ME, Shah B, Khan S, Jones CR, Sutherland R, Jacklin K, Walker JD. First Nations people with diabetes in Ontario: methods for a longitudinal population-based cohort study. CMAJ Open 2019; 7:E680-E688. [PMID: 31767570 PMCID: PMC6944142 DOI: 10.9778/cmajo.20190096] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To improve diabetes care, First Nations leaders and others need access to population-level health data. We provide details of the collaborative methods we used to describe the prevalence and incidence of diabetes in First Nations people in Ontario and present demographic data for this population compared to the rest of the Ontario population. METHODS To identify the population of First Nations people and other people in Ontario, we created annual cohorts of the Ontario population for each year between Apr. 1, 1995, and Mar. 31, 2015. Through a partnership between First Nations and academic researchers, we linked provincial population-based health administrative data stored at ICES with the Indian Register, which identifies all Status First Nations people. Our collaborative process was guided by the First Nations principles of ownership, control, access and possession (OCAP). RESULTS Demographic characteristics for the 2014/15 cohort (n = 13 406 684) are presented here. The cohort includes 158 241 Status First Nations people and 13 248 443 other people living in Ontario. Using postal codes, we were able to identify virtually all (99.9%) First Nations people in Ontario as living in (n = 55 311) or outside (n =102 889) a First Nations community. First Nations people were younger and more likely to live in semiurban or rural areas than the rest of Ontario's population. INTERPRETATION The collaborative methodology used in this study is applicable to many jurisdictions working with Indigenous groups who have access to similar data. The Ontario cohort defined here is being used to conduct analyses of health outcomes and use of health care services among First Nations people with diabetes in Ontario.
Collapse
Affiliation(s)
- Morgan Slater
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Michael E Green
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Baiju Shah
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Shahriar Khan
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Carmen R Jones
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Roseanne Sutherland
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Kristen Jacklin
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Jennifer D Walker
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|