Abstract
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Background
Hospitalizations for ambulatory care sensitive conditions (ACSCs) are potentially preventable, but may be required if these conditions are not managed well. National-level information about ACSC hospitalizations is available for Canada, but not for Aboriginal groups. This study describes ACSC hospitalizations among urban Métis adults relative to their non-Aboriginal counterparts.
Data and methods
The 2006/2007-to-2008/2009 Discharge Abstract Database, which contains hospitalization records from all acute care facilities (excluding Quebec), was linked to the 2006 Census to obtain Aboriginal identity information. Age-standardized ACSC hospitalization rates (ASHRs) per 100,000 population and rate ratios were calculated for Métis aged 18 to 74 relative to non-Aboriginal people of the same ages. Odds of ACSC hospitalizations were estimated using logistic regression models, adjusting for demographic, geographic, and socioeconomic characteristics.
Results
The ASHR for ACSCs among urban Métis adults was twice that among non-Aboriginal adults (393 versus 184 per 100,000 population). Even when demographic, geographic, and socioeconomic characteristics were taken into account, Métis had higher odds of ACSC hospitalizations overall (OR 1.5). Most commonly, these hospitalizations were for diabetes (OR 1.8) or chronic obstructive pulmonary disease (OR 1.5). Modelled factors partly reduced differences between Métis and non-Aboriginal adults, but variations between the groups remained after all adjustments.
Interpretation
Rates of ACSC hospitalizations were higher among Métis than among non-Aboriginal adults who lived in urban areas. Further research using other data sources is warranted to assess the roles of factors not available for this analysis, such as primary care, co-morbidity, and health behaviours.
Keywords
Aboriginal, avoidable hospitalizations, census, chronic obstructive pulmonary disease, data linkage, diabetes, health care
Findings
Ambulatory care sensitive conditions (ACSCs) are potentially preventable, but if untreated, can result in high use of health care services. In fact, hospitalization rates for ACSCs are used as an indirect measure of the adequacy and accessibility of primary health care. The people most at risk for ACSC hospitalizations tend to be older; have poorer health, lower socioeconomic status, and comorbidities; be regular smokers; and live in rural areas. [Full Text]
Authors
Gisèle M. Carrière (gisele.carriere@canada.ca) and Claudia Sanmartin are with the Health Analysis Division, and Mohan B. Kumar is with the Social and Aboriginal Statistics Division, at Statistics Canada, Ottawa, Ontario.
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What is already known on this subject?
- Less than half of one percent of Canadians younger than 75 are hospitalized for ambulatory care sensitive conditions (ACSCs), but they account for more than one in ten hospital days.
- National-level ACSC hospitalizations have not been estimated for the Aboriginal population.
What does this study add?
- Based on linked data from the 2006 Census and the 2006/2007-to-2008/2009 Discharge Abstract Database, rates of ACSC hospitalization were significantly higher among urban Métis adults (Quebec excluded) than among non-Aboriginal people, even when demographic, socioeconomic, and geographical factors are taken into account.
- The age-standardized ACSC hospitalization rate among Métis was twice as high as that for non-Aboriginal adults.
- Most ACSC hospitalizations were attributable to diabetes, COPD and asthma, with rates two to three times higher among Métis.
- The age-standardized prevalence of at least two comorbidities was higher among Métis than among non-Aboriginal ACSC patients.
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