Clinical ResearchIncidence, Secular Trends, and Outcomes of Cardiac Surgery in Aboriginal Peoples
Section snippets
Study population
In this retrospective study, the analytic cohort included all patients (> 15 years of age) who underwent CVSx from 1995-2007 in the province of Manitoba (population, 1.2 million). All adult cases of cardiac surgery in Manitoba were captured. This study was approved by the Research Ethics Board of the University of Manitoba, the Hospital Ethics Board at St. Boniface Hospital in Winnipeg, Manitoba, and the Assembly of Manitoba Chiefs. For additional information regarding data collection methods,
Comparison of Aboriginal and non-Aboriginal patient characteristics
Over the study period, 12,793 patients underwent CVSx. From this cohort 623 (4.9%) were missing data and excluded from the analysis, leaving 12,170 patients (574 Aboriginal; 11,596 non-Aboriginal) in the study cohort used to determine the baseline characteristics and postoperative outcomes. A further 423 patients (3.5%) were missing postal code information and 623 (5.1%) resided outside of Manitoba and were excluded from the regional analysis. There was no significant difference in missing
Discussion
In this large retrospective population-based study, Aboriginals were less likely to undergo CVSx than were non-Aboriginals. In particular, Aboriginals residing in a large urban centre had the lowest rate of CVSx, lower than those residing in the North, suggesting that remoteness and geographic barriers to care did not explain the disparate findings. These results were consistent over time and after age- and sex-adjustment. These data are concerning and suggest a racial disparity in the access
Conclusions
We have demonstrated marked cumulative and paradoxical geographic differences in the CVSx rates for Aboriginal vs non-Aboriginal patients. Further research is needed to discern whether these differences are caused by inadequate access to care or whether they reflect unmeasured differences in clinical status or patient preference. Finally, despite a higher postoperative infection rate, mortality was similar across racial groups.
Disclosures
M.M.S. has received speaker fees and has served on advisory boards for Roche, Ortho Biotech, and Sanofi. The other authors have no conflicts of interest to disclose.
References (36)
- et al.
Risk factors, atherosclerosis, and cardiovascular disease among Aboriginal people in Canada: The Study of Health Assessment and Risk Evaluation in Aboriginal Peoples (SHARE-AP)
Lancet
(2001) - et al.
A review of the cardiometabolic risk experience among Canadian Métis populations
Can J Cardiol
(2013) - et al.
Racial disparities in revascularization rates among patients with similar insurance coverage
J Natl Med Assoc
(2009) Cardiac surgery in African Americans
Ann Thorac Surg
(2003)- et al.
Racial disparities in prescriptions for cardioprotective drugs and cardiac outcomes in veterans affairs hospitals
Am J Cardiol
(2010) - et al.
Trends in quality of care for patients with acute myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006
Am Heart J
(2008) - et al.
Racial and ethnic disparities in access to higher and lower quality cardiac surgeons for coronary artery bypass grafting
Am J Cardiol
(2009) - et al.
Cardiac procedure use following acute myocardial infarction among American Indians
Am Heart J
(2006) - et al.
The use of coronary revascularisation procedures in urban Australian Aboriginals and a matched general population: coronary procedures in Aboriginals
Heart Lung Circ
(2010) - et al.
Indigenous people in Australia, Canada, New Zealand and the United States are less likely to receive renal transplantation
Kidney Int
(2009)
The Canadian heart health strategy and action plan
Can J Cardiol
Recent temporal trends and geographic distribution of cardiac procedures in Alberta
Can J Cardiol
Surgical challenges in rheumatic heart disease in the Australian indigenous population
Heart Lung Circ
Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives
Royal Commission on Aboriginal People. Report of the Royal Commission on Aboriginal People, Vol. 3
Global burden of cardiovascular diseases: Part II: Variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies
Circulation
Strategies for multivessel revascularization in patients with diabetes
N Engl J Med
Racial and ethnic disparities in the Va Healthcare System: a systematic review
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