Sociodemographic associations with abnormal estimated glomerular filtration rate (eGFR) in a large Canadian city: a cross-sectional observation study

BACKGROUND

Chronic kidney disease (CKD) is often asymptomatic in its early stages but is indicated and is diagnosed with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. Certain sociodemographic groups are known to be at risk for CKD, but it is unclear if there are strong associations between these at risk groups with abnormal eGFR test results in Canada. Using only secondary laboratory and Census data, geospatial variation and sociodemographic associations with abnormal eGFR result rate were investigated in Calgary, Alberta.

METHODS

Secondary laboratory data from all adult community patients who received an eGFR test result were collected from Calgary Laboratory Service's Laboratory Information System, which is the sole supplier of laboratory services for the large metropolitan city. Group-level sociodemographic variables were inferred by combining laboratory data with the 2011 Canadian Census data. Poisson regression and relative risk (RR) were used to calculate associations between sociodemographic variables with abnormal eGFR. Geographical distribution of abnormal eGFR result rates were analyzed by geospatial analysis using ArcGIS.

RESULTS

Of the 346,663 adult community patients who received an eGFR test result, 28,091 were abnormal (8.1%; eGFR < 60 ml/min/1.73m2). Geospatial analysis revealed distinct geographical variation in abnormal eGFR result rates in Calgary. Women (RR = 1.11, P < 0.0001), and the elderly (age ≥ 70 years; P < 0.0001) were significantly associated with an increased risk for CKD, while visible minority Chinese (RR = 0.73, P = 0.0011), South Asians (RR = 0.67, P < 0.0001) and those with a high median household income (RR = 0.88, P < 0.0001) had a significantly reduced risk for CKD.

CONCLUSIONS

Presented here are significant sociodemographic risk associations, and geospatial clustering of abnormal eGFR result rates in a large metropolitan Canadian city. Using solely publically available secondary laboratory and Census data, the results from this study aligns with known sociodemographic risk factors for CKD, as certain sociodemographic variables were at a higher risk for having an abnormal eGFR test result, while others were protective in this analysis.

Cultural Differences in Young Adults' Perceptions of the Probability of Future Family Life Events

Most young adults are exposed to family caregiving; however, little is known about their perceptions of their future caregiving activities such as the probability of becoming a caregiver for their parents or providing assistance in relocating to a nursing home. This study examined the perceived probability of these events among 182 young adults and the following predictors of their probability ratings: gender, ethnicity, work or volunteer experience, experiences with caregiving and nursing homes, expectations about these transitions, and filial piety. Results indicated that Asian or South Asian participants rated the probability of being a caregiver as significantly higher than Caucasian participants, and the probability of placing a parent in a nursing home as significantly lower. Filial piety was the strongest predictor of the probability of these life events, and it mediated the relationship between ethnicity and probability ratings. These findings indicate the significant role of filial piety in shaping perceptions of future life events.

"Mean mugging": an exploration of young Aboriginal women's experiences of bullying in team sports

Bullying among youth is rampant and research suggests that young Aboriginal women may be particularly susceptible to bullying. Sport participation has been identified as a possible mechanism to prevent bullying behaviors, yet few researchers have explored bullying within the context of sport. The purpose of this qualitative description study was to explore young Aboriginal women's experiences of bullying in team sports. Eight young Aboriginal women participated in one-on-one semistructured interviews and follow-up phone interviews. Data were analyzed using a content analysis, and findings were represented by five themes: (1) mean mugging, (2) sport specific, (3) happens all the time, (4) team bonding to address bullying, and (5) prevention through active coaches. The detailed descriptions shared by participants provide insight into a broad range of bullying experiences and serve as a foundation for addressing the bullying that occurs in sport.

Incidence and prevalence of chronic obstructive pulmonary disease among aboriginal peoples in Alberta, Canada

Background

Chronic obstructive pulmonary disease (COPD) is a major respiratory disorder, largely caused by smoking that has been linked with large health inequalities worldwide. There are important gaps in our knowledge about how COPD affects Aboriginal peoples. This retrospective cohort study assessed the epidemiology of COPD in a cohort of Aboriginal peoples relative to a non-Aboriginal cohort.

Methods

We used linkage of administrative health databases in Alberta (Canada) from April 1, 2002 to March 31, 2010 to compare the annual prevalence, and the incidence rates of COPD between Aboriginal and non-Aboriginal cohorts aged 35 years and older. Poisson regression models adjusted the analysis for important sociodemographic factors.

Results

Compared to a non-Aboriginal cohort, prevalence estimates of COPD from 2002 to 2010 were 2.3 to 2.4 times greater among Registered First Nations peoples, followed by the Inuit (1.86 to 2.10 times higher) and the Métis (1.59 to 1.67 times higher). All Aboriginal peoples had significantly higher COPD incidence rates than the non-Aboriginal group (incidence rate ratio [IRR]: 2.1; 95% confidence interval [CI]: 1.97, 2.27). COPD incidence rates were higher in First Nation peoples (IRR: 2.37; 95% CI: 2.19, 2.56) followed by Inuit (IRR: 1.92; 95% CI: 1.64, 2.25) and Métis (IRR: 1.49; 95% CI: 1.32, 1.69) groups.

Conclusions

We found a high burden of COPD among Aboriginal peoples living in Alberta; a province with the third largest Aboriginal population in Canada. Altogether, the three Aboriginal peoples groups have higher prevalence and incidence of COPD compared to a non-Aboriginal cohort. The condition affects the three Aboriginal groups differently; Registered First Nations and Inuit have the highest burden of COPD. Reasons for these differences should be further explored within a framework of social determinants of health to help designing interventions that effectively influence modifiable COPD risk factors in each of the Aboriginal groups.

Rats in Alberta: looking at pest-control posters from the 1950s

How did the rat-control program, launched by the Government of Alberta in 1950, become associated with the identity and heritage of the province? The authors answer this question by undertaking close visual analyses of the anti-rat posters and pamphlets that were distributed by the government throughout the 1950s. Using a visual methodology inspired by semiotics, they argue that the early rat-control program ambitiously promoted Alberta as a unified, clean province that was both distinct from its prairie neighbours and for the most part populated with vigilant, hardworking citizens eager to remove unwanted intruders.

Alberta's and Ontario's liquor boards: why such divergent outcomes?

The provinces of Alberta and Ontario have chosen very different methods to distribute alcoholic beverages: Alberta privatized the Alberta Liquor Control Board (ALCB) in 1993 and established a private market to sell beverage alcohol, while Ontario, in stark contrast, opted to retain and expand the Liquor Control Board of Ontario (LCBO). This article examines the reasons for the divergent policy choices made by Ralph Klein and Mike Harris' Conservative governments in each province. The article draws on John Kingdon's “multiple streams decision-making model,” to examine the mindsets of the key decision-makers, as well as “historical institutionalism,” to organize the pertinent structural, historical and institutional variables that shaped the milieu in which decision-makers acted. Unique, province-specific political cultures, histories, institutional configurations (including the relative influence of a number of powerful actors), as well as the fact that the two liquor control boards were on opposing trajectories towards their ultimate fates, help to explain the different decisions made by each government. Endogenous preference construction in this sector, furthermore, implies that each system is able to satisfy all relevant stakeholders, including consumers.

Hospitalization for Community Acquired Pneumonia in Alberta First Nations Aboriginals Compared with Non-First Nations Albertans

BACKGROUND:The rates and outcomes of hospital admission for community-acquired pneumonia between First Nations Aboriginal and non-First Nations groups were compared.

METHODS:Alberta administrative hospital abstracts from April 1, 1997, to March 31, 1999, were analyzed, and each case of a First Nations Aboriginal person with pneumonia was matched by age and sex with three non-First Nations persons with pneumonia.

RESULTS:The First Nations Aboriginal age and sex-adjusted hospital discharge rate was 22 per 1000 (95% CI 20.7 to 23.6) compared with 4.4 per 1000 (95% CI 4.4 to 4.5) for the general population of Alberta. After accounting for comorbidity and severity of pneumonia, in-hospital mortality and hospital length of stay were lower for First Nations Aboriginals compared with the matched non-First Nations group (odds ratio 0.49; 95% CI 0.37 to 0.66, and odds ratio 0.87; 95% CI 0.79 to 0.97, respectively). The odds for 30-day hospital readmission were higher in First Nations Aboriginals compared with the non-First Nations group (odds ratio 1.42; 95% CI 1.21 to 1.68). The cost per hospital admission for First Nations Aboriginals was 94% of the average cost for the matched non-First Nations group (CDN$4,206). However, their median daily cost was 1.25 times higher (95% CI 1.14 to 1.36) than the matched non-First Nations group.

CONCLUSIONS:First Nations Aboriginals had higher rates of hospitalization, rehospitalization and hospital costs for community-acquired pneumonia than non-First Nations Albertans. It was unlikely that the high rate of hospitalizations in First Nations Aboriginals was due to more severe pneumonia or greater comorbidity. Other unexplained factors increase the burden of this disease in First Nation Aboriginals.