Schultz Annette S H, Dahl Lindsey, McGibbon Elizabeth, Brownlie R Jarvis, Cook Catherine, Elbarouni Basem, Katz Alan, Nguyen Thang, Sawatzky Jo Ann, Sinclaire Moneca, Throndson Karen, Fransoo Randy
College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada.
Rankin School of Nursing Faculty of Health Sciences, St Francis Xavier University, Antigonish, Nova Scotia, Canada.
BMJ Open. 2018 Mar 25;8(3):e020856. doi: 10.1136/bmjopen-2017-020856.
To investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada.
Population-based, secondary analysis of provincial administrative health data.
All adults 18 years or older who received an index angiogram between 2000/2001 and 2008/2009. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Descriptive statistics for age, sex, income quintile by rural and urban residency and Charlson Comorbidity Index for FN and non-FN recipients. (2) Annual index angiogram rates for FN and non-FN populations and among those rates of 'urgent' angiograms based on acute myocardial infarction (AMI)-related hospitalisations during the previous 7 days. (3) Proportions of people who did not receive an angiogram in the 20 years preceding an ischaemic heart disease (IHD) diagnosis or a cardiovascular death; stratified by age (<65 or ≥65 years old).
FN recipients were younger (56.3vs63.8 years; p<0.0001) and had higher Charlson Comorbidity scores (1.32vs0.78; p<0.001). During all years examined, index angiography rates were lower among FN people (2.67vs3.33 per 1000 population per year; p<0.001) with no notable temporal trends. Among the index angiogram recipients, a higher proportion was associated with an AMI-related hospitalisation in the FN group (28.8%vs25.0%; p<0.01) and in both groups rates significantly increased over time. FN people who died from cardiovascular disease or were older (65+years old) diagnosed with IHD were more likely to have received an angiogram in the preceding 20-30 years (17.8%vs12.5%; p<0.01 and 50.9%vs49.5%; p<0.03, respectively). FN people diagnosed with IHD who were under the age of 65 were less likely to have received an angiogram (47.8%vs53.1%; p<0.01) CONCLUSIONS: Index angiogram use differences are suggested between FN and non-FN populations, which may contribute to reported IHD disparities. Investigating factors driving these rates will determine any association between ethnicity and angiography services.
调查加拿大曼尼托巴省原住民（FN）和非原住民人群的受者特征及首次血管造影率。
基于人群的省级行政卫生数据二次分析。
2000/2001年至2008/2009年间接受首次血管造影的所有18岁及以上成年人。主要和次要观察指标：（1）按城乡居住地、年龄、性别、收入五分位数以及FN和非FN受者的查尔森合并症指数进行描述性统计。（2）FN和非FN人群的年度首次血管造影率，以及基于前7天与急性心肌梗死（AMI）相关住院情况的“紧急”血管造影率。（3）在缺血性心脏病（IHD）诊断或心血管死亡前20年未接受血管造影的人群比例；按年龄（<65岁或≥65岁）分层。
FN受者更年轻（56.3岁对63.8岁；p<0.0001），查尔森合并症评分更高（1.32对0.78；p<0.001）。在所有检查年份中，FN人群的首次血管造影率较低（每年每1000人中有2.67例对3.33例；p<0.001），且无明显时间趋势。在首次血管造影受者中，FN组与AMI相关住院的比例更高（28.8%对25.0%；p<0.01），且两组的该比例均随时间显著增加。死于心血管疾病或年龄较大（65岁及以上）被诊断为IHD的FN人群在前20至30年接受血管造影的可能性更高（分别为17.8%对12.5%；p<0.01和50.9%对49.5%；p<0.03）。65岁以下被诊断为IHD的FN人群接受血管造影的可能性较小（47.8%对53.1%；p<0.01）。结论：FN和非FN人群在首次血管造影使用上存在差异，这可能导致所报告的IHD差异。调查驱动这些比率的因素将确定种族与血管造影服务之间的任何关联。
