Abstract
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Background
Data and methods
Results
Interpretation
Keywords
Findings
Authors
What is already known on this subject?
What does this study add?
Background
Deaths from acute myocardial infarction (AMI) are higher among First Nations people than among non-Aboriginal Canadians. Hospital interventions often involve revascularization: percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Because patients’ ethnicity is not reported consistently in hospital records, no national information is available about AMI hospitalizations or the use of such procedures among First Nations people.
Data and methods
This study uses an area-based approach to identify AMI hospital patients who live in Dissemination Areas with relatively high percentages of First Nations residents. Within the AMI patient cohort, procedures received during the hospital admission were identified.
Results
The age-standardized hospitalized AMI event rates were 276.8 per 100,000 population for residents of high-percentage First Nations identity areas and 157.1 per 100,000 population for residents of low-percentage Aboriginal identity areas. AMI patients from high-percentage First Nations identity areas were less likely than patients from low-percentage Aboriginal identity areas to undergo revascularization, a difference largely driven by a lower PCI procedure rate. The lower PCI procedure rate persisted when controlling for age, sex, rural/urban residence, and the patient’s condition at admission.
Interpretation
Residents of high-percentage First Nations identity areas were more likely to be hospitalized for AMI, but were less likely to undergo revascularization.
Keywords
Aboriginal health, coronary artery bypass, heart diseases, hospital records, myocardial ischemia, percutaneous coronary intervention, revascularization, small area variations
Findings
Deaths from acute myocardial infarction (AMI), commonly known as a heart attack, are 25% higher among First Nations men and 55% higher among First Nations women than among non-Aboriginal Canadians. Appropriate and timely health care after an AMI can reduce mortality and improve a survivor's quality of life. Hospital treatment interventions for AMI focus on restoring blood flow to the heart by removing or bypassing blockages. This can be achieved through pharmaceutical interventions to dissolve blood clots, and through revascularization: percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). [Full Text]
Authors
Helen Ke Wei-Randall (1-613-694-6559; hwei@cihi.ca), Mélanie Josée Davidson, Jing Jin and Sushma Mathur are with the Canadian Institute for Health Information, Ottawa, Ontario, K2A 4H6. Lisa Oliver is with Statistics Canada.
What is already known on this subject?
- Deaths from acute myocardial infarction (AMI) are higher among First Nations people than among non-Aboriginal Canadians.
- Appropriate and timely health care after an AMI can reduce mortality and improve a survivor’s quality of life.
- Hospital treatment focuses on restoring blood flow to the heart, often through revascularization: percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
- Previous studies have reported that the use of such procedures to treat AMI is often lower among disadvantaged populations.
- The lack of ethnic identifiers on hospitalization records limits the information available on AMI hospitalizations and the use of cardiac procedures among hospitalized First Nations patients.
What does this study add?
- This analysis uses an area-based approach to identify AMI patients from high-percentage First Nations identity areas and from low-percentage Aboriginal identity areas.
- Residents of high-percentage First Nations identity areas were more likely to be hospitalized for AMI, and to do so earlier in life, but were less likely to undergo revascularization procedures, compared with residents of low-percentage Aboriginal identity areas.
- This difference in revascularization was largely driven by the relatively small share of patients from high-percentage First Nations areas who underwent PCIs.
- The pattern persisted when controlling for age, sex, rural/urban residence, and the patient’s condition at admission.
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