Epidemiology and healthcare utilization of First Nations peoples living with spinal cord injury in Alberta: an observational study to explore health inequities.

IF 0.7 Q4 CLINICAL NEUROLOGY
Brett F Wegenast, Tara A Whitten, Jeffrey A Bakal, Lea Bill, Adalberto Loyola-Sanchez
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Abstract

Study design: Retrospective observational cohort study.

Objectives: Estimate spinal cord injury (SCI) prevalence in First Nations and non-First Nations populations and compare healthcare utilization as an indirect marker of health inequities.

Setting: Alberta, Canada.

Methods: We created a prevalent adult SCI cohort by identifying cases between April 1, 2002 and December 31, 2017 who were followed for common SCI complications and location of healthcare access from January 1, 2018 to December 31, 2019 using administrative data sources housed within Alberta Health Services (AHS). First Nations and non-First Nations SCI cohorts were divided into SCI etiology: traumatic SCI (TSCI) and non-traumatic SCI (NTSCI). Statistical analyses compared prevalence, demographics, healthcare utilization, and SCI complication rates. A secondary analysis was performed using case matching for demographics, injury type, injury level, and comorbidities.

Results: TSCI prevalence: 248 and 117 per 100,000 in First Nations and non-First Nations cohorts, respectively. NTSCI prevalence: 74 and 50 per 100,000 in First Nations and non-First Nations cohorts, respectively. Visit rates were higher in the TSCI First Nations cohort for visits to General Practitioner (GP), Emergency Department (ED), inpatient visits, and inpatient days with higher complication rates due to pulmonary, genitourinary, skin, and 'other' causes after case matching. Visits rates were higher in the NTSCI First Nations cohort for GP and specialists without differences in complication types after case matching.

Conclusions: Significant differences exist between First Nations and non-First Nations cohorts living with SCI in Alberta, suggesting healthcare inequities against First Nations Peoples in this province.

Abstract Image

阿尔伯塔省第一民族脊髓损伤患者的流行病学和医疗保健利用:一项探索卫生不平等的观察性研究。
研究设计:回顾性观察队列研究。目的:估计第一民族和非第一民族人群中脊髓损伤(SCI)的患病率,并比较医疗保健利用作为卫生不平等的间接标志。背景:加拿大阿尔伯塔省。方法:利用艾伯塔省卫生服务中心(AHS)的管理数据源,通过确定2002年4月1日至2017年12月31日期间的病例,创建了一个流行的成人SCI队列,这些病例于2018年1月1日至2019年12月31日期间进行了常见的SCI并发症和医疗保健就诊地点的随访。第一民族和非第一民族脊髓损伤队列分为脊髓损伤病因:创伤性脊髓损伤(TSCI)和非创伤性脊髓损伤(NTSCI)。统计分析比较了患病率、人口统计学、医疗保健利用和脊髓损伤并发症发生率。采用人口统计学、损伤类型、损伤程度和合并症的病例匹配进行二次分析。结果:TSCI患病率:第一民族和非第一民族人群中分别为每10万人248例和117例。NTSCI患病率:在第一民族和非第一民族人群中,分别为每10万人74人和50人。在TSCI第一民族队列中,就诊于全科医生(GP)、急诊科(ED)、住院就诊和住院天数的就诊率较高,在病例匹配后,由于肺部、泌尿生殖系统、皮肤和“其他”原因导致的并发症发生率较高。就诊率较高的NTSCI第一民族队列的全科医生和专家在病例匹配后没有并发症类型的差异。结论:阿尔伯塔省第一民族和非第一民族的脊髓损伤患者之间存在显著差异,表明该省存在针对第一民族的医疗保健不公平。
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来源期刊
Spinal Cord Series and Cases
Spinal Cord Series and Cases Medicine-Neurology (clinical)
CiteScore
2.20
自引率
8.30%
发文量
92
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