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BMJ Open. 2018 Mar 25;8(3):e020856. doi: 10.1136/bmjopen-2017-020856.

Index coronary angiography use in Manitoba, Canada: a population-level descriptive analysis of First Nations and non-First Nations recipients.

Author information

1
College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada.
2
Rankin School of Nursing Faculty of Health Sciences, St Francis Xavier University, Antigonish, Nova Scotia, Canada.
3
Department of History, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada.
4
Indigenous Health, Rady Faculty of Health Sciences (RFHS), First Nations, Métis and Inuit Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
5
Max Rady College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada.
6
College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada.
7
Clinical Nurse Specialist Cardiac Sciences Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada.
8
Manitoba Centre for Health Policy, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada.

Abstract

OBJECTIVES:

To investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada.

SETTING:

Population-based, secondary analysis of provincial administrative health data.

PARTICIPANTS:

All adults 18 years or older who received an index angiogram between 2000/2001 and 2008/2009. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Descriptive statistics for age, sex, income quintile by rural and urban residency and Charlson Comorbidity Index for FN and non-FN recipients. (2) Annual index angiogram rates for FN and non-FN populations and among those rates of 'urgent' angiograms based on acute myocardial infarction (AMI)-related hospitalisations during the previous 7 days. (3) Proportions of people who did not receive an angiogram in the 20 years preceding an ischaemic heart disease (IHD) diagnosis or a cardiovascular death; stratified by age (<65 or ≥65 years old).

RESULTS:

FN recipients were younger (56.3vs63.8 years; p<0.0001) and had higher Charlson Comorbidity scores (1.32vs0.78; p<0.001). During all years examined, index angiography rates were lower among FN people (2.67vs3.33 per 1000 population per year; p<0.001) with no notable temporal trends. Among the index angiogram recipients, a higher proportion was associated with an AMI-related hospitalisation in the FN group (28.8%vs25.0%; p<0.01) and in both groups rates significantly increased over time. FN people who died from cardiovascular disease or were older (65+years old) diagnosed with IHD were more likely to have received an angiogram in the preceding 20-30 years (17.8%vs12.5%; p<0.01 and 50.9%vs49.5%; p<0.03, respectively). FN people diagnosed with IHD who were under the age of 65 were less likely to have received an angiogram (47.8%vs53.1%; p<0.01) CONCLUSIONS: Index angiogram use differences are suggested between FN and non-FN populations, which may contribute to reported IHD disparities. Investigating factors driving these rates will determine any association between ethnicity and angiography services.

KEYWORDS:

adult cardiology; cardiovascular imaging; coronary intervention; epidemiology

PMID:
29581209
PMCID:
PMC5875607
DOI:
10.1136/bmjopen-2017-020856
[Indexed for MEDLINE]
Free PMC Article

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