Kidney Disease Among Registered Métis Citizens of Ontario: A Population-Based Cohort Study.

BACKGROUND: Indigenous peoples in Canada have higher rates of kidney disease than non-Indigenous Canadians. However, little is known about the risk of kidney disease specifically in the Métis population in Canada. OBJECTIVE: To compare the prevalence of chronic kidney disease and incidence of acute kidney injury and end-stage kidney disease among registered Métis citizens in Ontario and a matched sample from the general Ontario population. DESIGN: Population-based, retrospective cohort study using data from the Métis Nation of Ontario's Citizenship Registry and administrative databases. SETTING: Ontario, Canada; 2003-2013. PATIENTS: Ontario residents ≥18 years. MEASUREMENTS: Prevalence of chronic kidney disease and incidence of acute kidney injury and end-stage kidney disease. Secondary outcomes among patients hospitalized with acute kidney injury included non-recovery of kidney function and mortality within 1 year of discharge. METHODS: Database codes and laboratory values were used to determine study outcomes. Métis citizens were matched (1:4) to Ontario residents on age, sex, and area of residence. The analysis included 12 229 registered Métis citizens and 48 916 adults from the general population. RESULTS: We found the prevalence of chronic kidney disease was slightly higher among Métis citizens compared with the general population (3.1% vs 2.6%, P = 0.002). The incidence of acute kidney injury was 1.2 per 1000 person-years in both Métis citizens and the general population (P = 0.54). Of those hospitalized with acute kidney injury, outcomes were similar among Métis citizens and the general population except 1-year mortality, which was higher for Métis citizens (24.5% vs 15.3%, P = 0.03). The incidence of end-stage kidney disease did not differ between groups (<3.0 per 10 000 person-years, P = 0.73). LIMITATIONS: The Métis Nation of Ontario Citizenship Registry only captures about 20% of Métis people in Ontario. Administrative health care codes used to identify kidney disease are highly specific but have low sensitivity. CONCLUSIONS: Rates of kidney disease were similar or slightly higher for Métis citizens in Ontario compared with the matched general population.

CONTEXTE: Les autochtones du Canada présentent des taux plus élevés d'insuffisance rénale que les Canadiens non autochtones. Cependant, on en sait encore très peu au sujet des risques de maladies rénales spécifiques aux populations de Métis au Canada. OBJECTIF: L'étude visait à comparer la prévalence de l'insuffisance rénale chronique et l'incidence de l'insuffisance rénale aigüe ou terminale parmi les citoyens métis inscrits en Ontario avec un échantillon apparié de la population non autochtone de l'Ontario. MODÈLE D'ÉTUDE: Il s'agit d'une étude de cohorte rétrospective basée sur la population qui a utilisé les données du registre de citoyenneté de la nation métisse de l'Ontario et les bases de données administratives. CADRE DE L'ÉTUDE: L'étude a été menée en Ontario, au Canada, entre 2003 et 2013. PATIENTS: La cohorte était constituée d'adultes résidants de l'Ontario. MESURES: La prévalence de l'insuffisance rénale chronique et l'incidence de l'insuffisance rénale aigüe ou terminale ont été mesurées. Les critères d'évaluation secondaires observés chez les patients hospitalisés pour insuffisance rénale aigüe incluaient le non-recouvrement de la fonction rénale et la mortalité du patient dans l'année suivant la sortie de l'hôpital. MÉTHODOLOGIE: Les codes des bases de données et les valeurs de laboratoire ont été utilisés pour déterminer les résultats de l'étude. Les citoyens métis ont été appariés (1:4) à des résidents non autochtones de l'Ontario en tenant compte de l'âge, du sexe et de la région de résidence. L'analyse a porté sur un total de 12 229 citoyens métis inscrits et 48 916 adultes de la population générale. RÉSULTATS: Nous avons constaté que la prévalence de l'insuffisance rénale chronique était légèrement plus élevée chez les citoyens métis par rapport à la population générale (3.1% contre 2.6%, P = 0.002). L'incidence de l'insuffisance rénale aigüe a été de 1.2 pour 1000 années-personnes tant pour les citoyens métis que pour l'ensemble de la population (P = 0.54). Parmi les personnes hospitalisées pour insuffisance rénale aigüe, les résultats étaient similaires pour les citoyens métis et la population générale sauf en ce qui a trait à la mortalité du patient dans l'année suivant l'hospitalisation, qui s'est avérée plus élevée chez les citoyens métis (24.5% contre 15.3%, P = 0.03). Quant à l'incidence de l'insuffisance rénale terminale, aucune différence n'a été observée entre les deux groupes (<3.0 pour 10 000 années-personnes, P = 0.73). LIMITES DE L'ÉTUDE: Le registre des citoyens de la nation métisse de l'Ontario ne répertorie que 20% environ des Métis résidant en Ontario. Les codes administratifs du système de santé qui servent à repérer les cas d'insuffisance rénale sont très spécifiques, mais présentent une faible sensibilité. CONCLUSION: Les taux d'insuffisance rénale se sont avérés similaires ou légèrement plus élevés pour les citoyens métis par rapport à la population générale en Ontario.

Osteoporosis management and fractures in the Métis of Ontario, Canada.

UNLABELLED: Half of Métis citizens, compared to less than 10 % of the general population of Ontario, reside in northern regions, with little access to bone mineral density (BMD) testing. Métis citizens had lower sex-specific and age-standardized rates of BMD testing, yet similar rates of fracture (both sexes) and pharmacotherapy (women only). PURPOSE: To examine osteoporosis management and common osteoporosis-related fractures among Métis citizens compared to the general population of older adults residing in Ontario. METHODS: We linked healthcare (medical and pharmacy) utilization and administrative (demographic) databases with the Métis Nation of Ontario citizenship registry to estimate osteoporosis management (bone mineral density [BMD] testing, pharmacotherapy) and fractures (hip, humerus, radius/ulna) among adults aged ≥50 years, from April 1, 2006 to March 31, 2011. Pharmacotherapy data were limited to residents aged ≥65 years. Sex-specific and age-standardized rates were compared between the Métis and the general population. Multivariable logistic regression was used to compare rates of BMD testing after controlling for differences in age and region of residence between the Métis and the general population. RESULTS: We studied 4219 Métis citizens (55 % men), and 140 (3 %) experienced a fracture. Half of Métis citizens, compared to less than 10 % of the general population of Ontario, resided in northern regions. We identified significantly lower sex-specific and age-standardized rates of BMD testing among Métis compared to the general population, yet found little difference in fracture rates (both sexes) or pharmacotherapy (women only). Differences in BMD testing disappeared after adjusting for region of residence among women yet remained significant among men. CONCLUSIONS: Despite finding significantly lower rates of osteoporosis management among men, Métis men and women were found to have similar age-standardized fracture rates to the general population.

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.

Asthma and chronic obstructive pulmonary disease (COPD) prevalence and health services use in Ontario Métis: a population-based cohort study.

INTRODUCTION: Chronic respiratory diseases cause a significant health and economic burden around the world. In Canada, Aboriginal populations are at increased risk of asthma and chronic obstructive pulmonary disease (COPD). There is little known, however, about these diseases in the Canadian Métis population, who have mixed Aboriginal and European ancestry. A population-based study was conducted to quantify asthma and COPD prevalence and health services use in the Métis population of Ontario, Canada's largest province. METHODS: The Métis Nation of Ontario Citizenship Registry was linked to provincial health administrative databases to measure and compare burden of asthma and COPD between the Métis and non-Métis populations of Ontario between 2009 and 2012. Asthma and COPD prevalence, health services use (general physician and specialist visits, emergency department visits, hospitalizations), and mortality were measured. RESULTS: Prevalences of asthma and COPD were 30% and 70% higher, respectively, in the Métis compared to the general Ontario population (p<0.001). General physician and specialist visits were significantly lower in Métis with asthma, while general physician visits for COPD were significantly higher. Emergency department visits and hospitalizations were generally higher for Métis compared to non-Métis with either disease. All-cause mortality in Métis with COPD was 1.3 times higher compared to non-Métis with COPD (p = 0.01). CONCLUSION: There is a high burden of asthma and COPD in Ontario Métis, with significant prevalence and acute health services use related to these diseases. Lower rates of physician visits suggest barriers in access to primary care services.

Twenty-year trends in physical activity among Canadian adults.

OBJECTIVE: Physical inactivity is associated with increased risk of mortality and chronic diseases, yet trend information is lacking in most countries. This investigation examines physical activity levels of Canadian adults aged 18 years and older. METHODS: Data were collected in six national surveys between 1981 and 2000. Sample sizes ranged from 2,500 to 18,000. Prevalences were tested using Chi-square and Student's t-tests. Socio-demographic correlates were examined using odds ratios adjusted for age, sex, education and income. RESULTS: Physical activity increased in the 1980s and 1990s among men and women and for all age, education and income groups (p<0.01). Although education differentials narrowed over the period, age differentials widened and income differentials emerged. DISCUSSION: The positive trend in Canada is consistent with Finland, but contrary to recent trends for Australia, England and the United States. Despite increases, sedentary living remains a public health issue particularly among women, older adults and lower income groups.

Reliability and validity of Canada's Physical Activity Monitor for assessing trends.

PURPOSE: This investigation assessed the reliability and criterion validity of the Physical Activity Monitor, a telephone-interview adaptation of the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ), which is currently used to assess trends in the Canadian population. METHODS: A sample of 512 people aged 18 yr and older was selected by random-digit dialing for telephone interviewing in the reliability study. The Monitor questions were administered twice, 3 wk apart. For the criterion validity study, a sample of 148 people aged 18-69 yr was selected at random from households. Participants completed the Monitor questions by telephone and an in-home step test to estimate maximum oxygen uptake. Another random sample of individuals aged 18-69 yr participated in a comparison study of the Monitor against the 1988 Campbell's Survey of Well-Being (CSWB) instrument. All studies were conducted in the vicinity of Toronto, Ontario. Spearman correlations controlling for age and sex were calculated as a measure of association for the reliability, validity, and comparison studies. Validity estimates were further adjusted for body mass index and physical activity demands of work and chores. RESULTS: The Monitor instrument produced reliable estimates of total energy expenditure (P=0.90, P<0.0001) with criterion validity of 0.36 (P<0.0001). The association between estimates of total energy expenditure derived from the Monitor and CSWB instruments was 0.77 (P<0.0001). CONCLUSION: The Physical Activity Monitor has acceptable test-retest reliability and criterion validity. The research also demonstrated that for the purpose of population monitoring a change in data collection mode-telephone interview versus self-administration in households-can yield reasonably comparable estimates from two adaptations of the MLTPAQ.