Shah B R, Hux J E, Zinman B
Department of Medicine, University of Toronto, Ontario, Canada.
Arch Intern Med. 2000 Jun 26;160(12):1862-6. doi: 10.1001/archinte.160.12.1862.
The prevalence of ischemic heart disease (IHD) has been declining in North America since the 1960s. Over this time, Native populations, which have traditionally had low rates of IHD, have undergone striking lifestyle changes that may have had health consequences. In this context, IHD trends in the Native communities of Ontario, Canada, were evaluated.
To assess trends in admission rates for IHD in the Native population of Ontario compared with the general population of Ontario.
A comprehensive administrative database of all hospital admissions in Ontario 1981 to 1997, was used. Age- and sex-adjusted rates of hospital admissions with IHD-related diagnostic or procedure codes were determined in all residents of Ontario communities that had regular census participation and at least 95% of their population claiming Native origins (N=16,874 in 1991). Comparison was made with all residents of the surrounding northern Ontario region (N=822,450) and of the whole province (N = 10,084,885).
In 1981, the rate of IHD admissions was similar in all groups, at 99 to 124 per 10,000 persons. By 1997, it decreased to 82 per 10,000 in the province (slope, -1.09; 95% confidence interval, -1.26 to -0.91), with a similar trend in northern Ontario. However, in the Native communities, it increased to 155 per 10,000 (slope, 5.6; 95% confidence interval, 3.8-7.5). A similar trend was seen for acute myocardial infarction admissions, a more precisely coded subset of IHD. Spurious causes of increasing rates were ruled out.
Hospitalizations for IHD have doubled in the Native population despite declining rates in the general population. These findings document an alarming trend in Native health and support the need for further research and targeted intervention.
自20世纪60年代以来，北美缺血性心脏病（IHD）的患病率一直在下降。在此期间，传统上IHD发病率较低的原住民群体经历了显著的生活方式变化，这可能对健康产生了影响。在此背景下，对加拿大安大略省原住民社区的IHD趋势进行了评估。
评估安大略省原住民人口与安大略省普通人群相比，IHD住院率的趋势。
使用了1981年至1997年安大略省所有医院住院患者的综合行政数据库。在安大略省有定期人口普查参与且至少95%人口声称有原住民血统的社区的所有居民中（1991年为16,874人），确定了与IHD相关诊断或程序代码的年龄和性别调整后的住院率。与安大略省北部周边地区的所有居民（822,450人）和全省所有居民（10,084,885人）进行了比较。
1981年，所有组的IHD住院率相似，每10,000人中有99至124人。到1997年，该省降至每10,000人中有82人（斜率为-1.09；95%置信区间为-1.26至-0.91），安大略省北部也有类似趋势。然而，在原住民社区，该率增至每10,000人中有155人（斜率为5.6；95%置信区间为3.8 - 7.5）。急性心肌梗死住院情况也呈现类似趋势，急性心肌梗死是IHD编码更精确的一个子集。排除了导致发病率上升的虚假原因。
尽管普通人群中IHD住院率下降，但原住民人口中IHD住院率却翻了一番。这些发现记录了原住民健康方面令人担忧的趋势，并支持进一步研究和针对性干预的必要性。
