糖尿病患病率和并发症发生率：在安大略省苏族湖地区的个别第一民族社区。

Diabetes prevalence and complication rates: In individual First Nations communities in the Sioux Lookout region of Ontario.

机构信息

Primary care physician and Assistant Professor of global health and quality management at the Institute for Health Policy, Management and Evaluation at the University of Toronto in Ontario.

Family physician with the University Health Network's Toronto Western Hospital Family Health Team and Associate Professor and Academic Lead for the Indigenous Health Partners Program at the University of Toronto.

出版信息

Can Fam Physician. 2021 Aug;67(8):601-607. doi: 10.46747/cfp.6708601.

DOI:10.46747/cfp.6708601

PMID:34385208

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9683426/

Abstract

OBJECTIVE

To test the feasibility of reporting diabetes indicators at a regional and community level in order to provide feedback to local leaders on health system performance.

DESIGN

Analysis of administrative data from hospital discharges and physician billings.

SETTING

Sioux Lookout region of Ontario.

PARTICIPANTS

Residents from 30 remote communities served by the Sioux Lookout First Nations Health Authority.

MAIN OUTCOME MEASURES

Incidence and prevalence of diabetes and incidence of diabetes complications, including heart attack, stroke, retinopathy, amputations, end-stage kidney disease, diabetes-related hospitalizations, and death.

RESULTS

Data were available for 18 542 residents from the 30 remote communities. Residents were almost entirely of First Nations descent. The prevalence of diabetes was 12.9%, the annual incidence was 1.0%, and the annual rate of complications was 5.4% in 2015-2016. Prevalence increased slightly over time. We had sufficient data to report prevalence in 25 of 30 communities (average population 738; range 234 to 2626). We reported statistically significant differences in prevalence by community; 8 were above average and 2 were below average. For diabetes complications, data were pooled over 5 years, and while community-level results could be reported, the variance was too high to allow detection of significant differences. Using 2-tailed tests for difference of proportions, we determined that grouping communities into subregions of approximately 2000 persons would permit the detection of differences of 30% from the average 5-year complication rate.

CONCLUSION

This study demonstrates the possibility of reporting diabetes prevalence by individual First Nations reserve communities. Complication rates can be reported by individual community, but estimates are more useful for comparison if the smallest communities are grouped together. Such studies could be replicated across Canada to promote local use of these data for resource planning and monitoring long-term progress of diabetes programs and services.

摘要

目的

测试在地区和社区层面报告糖尿病指标的可行性，以便为地方卫生系统绩效提供反馈。

设计

对医院出院和医生账单的行政数据进行分析。

地点

安大略省 Sioux Lookout 地区。

参与者

由 Sioux Lookout First Nations 卫生署服务的 30 个偏远社区的居民。

主要观察指标

糖尿病的发病率和患病率以及糖尿病并发症的发病率，包括心脏病发作、中风、视网膜病变、截肢、终末期肾病、糖尿病相关住院和死亡。

结果

30 个偏远社区的 18542 名居民的数据可用。居民几乎完全是第一民族血统。2015-2016 年，糖尿病患病率为 12.9%，年发病率为 1.0%，年并发症发生率为 5.4%。患病率随时间略有上升。我们有足够的数据报告 30 个社区中的 25 个（平均人口 738；范围 234 至 2626）的患病率。我们报告了社区间患病率的显著差异；8 个社区高于平均水平，2 个社区低于平均水平。对于糖尿病并发症，数据在 5 年内汇总，虽然可以报告社区层面的结果，但方差太高，无法检测到显著差异。使用双侧差异比例检验，我们确定将社区分组为大约 2000 人的子区域将允许检测到与平均 5 年并发症率相差 30%的差异。