Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Clin J Am Soc Nephrol. 2013 Jul;8(7):1188-94. doi: 10.2215/CJN.10461012. Epub 2013 Feb 28.
Compared with non-First Nations, First Nations People with diabetes experience higher rates of kidney failure and death, which may be related to disparities in care. This study examined First Nations and non-First Nations People with diabetes for differences in quality indicators and their association with kidney failure and death.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Adults with diabetes and an outpatient creatinine in Alberta from 2005 to 2008 were identified. Logistic regression was used to determine the likelihood of process of care indicators (measurement of urine albumin/creatinine ratio [ACR], LDL, and hemoglobin A1C [A1C]) and surrogate outcome indicators (achievement of LDL and A1C targets). Cox regression was used to determine the association between lack of achievement of indicator targets and each of kidney failure and death.
This study identified 140,709 non-First Nations and 6574 First Nations People with diabetes. There was a significant interaction between First Nations status and CKD for the outcomes (P<0.01); therefore, results are stratified by CKD. Among participants without CKD, First Nations People were less likely to receive process of care indicators and achieve target A1C compared with non-First Nations People. For those with CKD, First Nations People were as likely to receive these indicators (other than LDL) and achieve LDL and A1C targets. Lack of LDL and A1C assessment and achievement of targets were associated with increased risk of kidney failure and death similarly for both groups.
Compared with non-First Nations, First Nations People with diabetes but without CKD experience disparities in assessment of quality indicators and achievement of A1C target.
与非第一民族相比，患有糖尿病的第一民族人群的肾衰竭和死亡发生率更高，这可能与护理方面的差异有关。本研究比较了第一民族和非第一民族的糖尿病患者在质量指标方面的差异及其与肾衰竭和死亡的关系。
设计、地点、参与者和测量方法：从 2005 年至 2008 年，在艾伯塔省，确定了患有糖尿病且门诊肌酐水平正常的成年人。采用逻辑回归确定了护理过程指标（尿白蛋白/肌酐比[ACR]、低密度脂蛋白[LDL]和糖化血红蛋白[A1C]的测量）和替代结局指标（LDL 和 A1C 目标的实现）的可能性。采用 Cox 回归确定了未达到指标目标与肾衰竭和死亡之间的关系。
本研究确定了 140709 名非第一民族和 6574 名第一民族的糖尿病患者。结果存在第一民族地位和 CKD 之间的显著交互作用（P<0.01）；因此，结果按 CKD 进行分层。在没有 CKD 的参与者中，与非第一民族相比，第一民族人群接受护理过程指标和达到 A1C 目标的可能性较低。对于患有 CKD 的患者，第一民族人群同样有可能接受这些指标（除 LDL 外）并达到 LDL 和 A1C 目标。缺乏 LDL 和 A1C 评估以及未达到目标与两组的肾衰竭和死亡风险增加有关。
与非第一民族相比，患有糖尿病但没有 CKD 的第一民族人群在评估质量指标和实现 A1C 目标方面存在差异。
