Section of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada; St Boniface Hospital, Winnipeg, Manitoba, Canada.
Can J Cardiol. 2013 Dec;29(12):1629-36. doi: 10.1016/j.cjca.2013.06.003. Epub 2013 Aug 26.
Canada's Aboriginal people experience a disproportionate burden of comorbid illnesses predisposing them to higher rates of atherosclerotic disease. We set out to investigate secular rates of cardiovascular surgery (CVSx) and postsurgical outcomes in Aboriginals compared with non-Aboriginals.
All patients undergoing CVSx in Manitoba, Canada from 1995-2007 (N =12,170 [Aboriginal, 574, 4.7%; non-Aboriginal, 11,596, 95.3%]) were included in our study cohort. Race was self-identified. Age- and sex-adjusted incidence were determined using 2001 and 2006 census data. Multivariable logistic regression models were constructed to determine the association between race and the outcomes of death, infections, and a composite of adverse events.
CVSx rates were significantly lower in Aboriginals compared with non-Aboriginals (all CVSx, 63.6 vs 97.7 per 10,000 population; coronary artery bypass grafting only, 46.2 vs 71.9 per 10,000 population, respectively). The lower CVSx rates were most pronounced among Aboriginals residing in urban areas (21.0 vs 78.0 per 10,000). Postoperatively, Aboriginals experienced significantly higher odds of infections (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.13-2.34; P = 0.008), in particular pneumonia (OR, 2.24; 95% CI, 1.58-3.19; P < 0.0001). There was no increase in risk of death after surgery (OR, 1.15; 95% CI, 0.63-2.08; P = 0.6) or the composite outcome (OR, 1.0; 95% CI, 0.66-1.52; P = 1.0) compared with non-Aboriginals.
Aboriginal peoples, particularly in the urban setting, are considerably less likely to undergo CVSx. When they do, they have postoperative mortality similar to that of non-Aboriginals. Our findings suggest an urban racial disparity in access to CVSx.
加拿大原住民面临着多种疾病的沉重负担，使他们更容易患上动脉粥样硬化疾病。我们旨在研究与非原住民相比，原住民接受心血管手术（CVSx）和术后结果的变化趋势。
我们纳入了 1995 年至 2007 年期间在加拿大马尼托巴省接受 CVSx 的所有患者（原住民 574 例，占 4.7%；非原住民 11596 例，占 95.3%）。种族由患者自我认定。利用 2001 年和 2006 年的人口普查数据确定年龄和性别调整后的发病率。使用多变量逻辑回归模型确定种族与死亡、感染和不良事件综合指标之间的关联。
与非原住民相比，原住民的 CVSx 发生率明显较低（所有 CVSx 为 63.6 例/10000 人，仅冠状动脉旁路移植术为 46.2 例/10000 人）。在城市地区居住的原住民中，CVSx 发生率较低的情况更为明显（21.0 例/10000 人）。术后，原住民感染的风险显著增加（优势比 [OR]，1.63；95%置信区间 [CI]，1.13-2.34；P=0.008），尤其是肺炎（OR，2.24；95%CI，1.58-3.19；P<0.0001）。手术后死亡风险（OR，1.15；95%CI，0.63-2.08；P=0.6）或复合结果（OR，1.0；95%CI，0.66-1.52；P=1.0）均无增加。
原住民，尤其是在城市环境中，接受 CVSx 的可能性要低得多。当他们接受手术时，他们的术后死亡率与非原住民相似。我们的研究结果表明，CVSx 的获得存在城乡种族差异。
