Cardiovascular disease rates, outcomes, and quality of care in Ontario Métis: a population-based cohort study.

BACKGROUND: The burden of cardiovascular disease in the Métis, Canada's fastest growing Aboriginal group, is not well studied. We determined rates of five cardiovascular diseases and associated outcomes in Ontario Métis, compared to the general Ontario population. METHODS: Métis persons were identified using the Métis Nation of Ontario Citizenship Registry. Métis citizens aged 20-105 were linked to Ontario health databases for the period of April 2006 to March 2011. Age- and sex-standardized prevalence and incidence of acute coronary syndromes (ACS), congestive heart failure (CHF), cerebrovascular disease (stroke), atrial fibrillation, and hypertension were compared between the Métis and the general population. Secondary outcome measures included one-year hospitalizations and mortality following the incident cardiovascular diagnosis, as well as quality-of-care measures. RESULTS: There were 12,550 eligible Métis persons and 10,144,002 in the general population. The adjusted prevalence of each disease was higher (p<0.05) among the Métis compared to the general population: ACS 5.3% vs. 3.0%; CHF 5.1% vs. 3.9%; stroke 1.4% vs. 1.1%; atrial fibrillation 2.1% vs. 1.4%; hypertension 34.9% vs. 29.8%. Incident ACS, stroke, and atrial fibrillation were also higher (p<0.05) among the Métis: ACS 2.4% vs. 1.5%; stroke 0.8% vs. 0.6%; atrial fibrillation 0.6% vs. 0.3%. One-year all-cause and cardiovascular-related mortality were not significantly different. Hospitalizations were higher for Métis persons with CHF (OR 1.93; 95% CI 1.34-2.78) and hypertension (OR 2.27; 95% CI 1.88-2.74). Métis with CHF made more emergency department (ED) visits in the year after diagnosis compared to non-Métis with CHF, while Métis aged ≥65 with ACS were more likely to be on beta-blockers following diagnosis. CONCLUSIONS: The burden of cardiovascular disease was markedly higher in the Métis compared to the general population: prevalence rates for five cardiovascular conditions were 25% to 77% higher. Métis persons with CHF had more frequent hospitalizations and ED visits following their diagnosis.

Premature mortality in health regions with high aboriginal populations.

OBJECTIVES: Potential years of life lost (PYLL) before age 75 in health regions with a relatively high proportion of Aboriginal residents is compared, by cause of death, with all other health regions. DATA SOURCES: The findings are based on mortality data for 1995 through 1997 from the Canadian Vital Statistics Database, and on population estimates for 1995, 1996 and 1997 at the health region level. ANALYTICAL TECHNIQUES: PYLL was calculated by age and sex for two groups of health regions: the 18 with a high proportion (19% or more) of Aboriginal residents and the remaining 120, which had smaller proportions of Aboriginal residents. PYLL rate differences and rate ratios were used to compare the two groups. MAIN RESULTS: The PYLL rate per 1,000 person-years at risk for all causes of death was about 50% greater in the high-Aboriginal health regions than in the other group. Almost 40% of total PYLL in high-Aboriginal health regions was attributable to injuries, notably, suicide and motor vehicles accidents.