Assistant Professor in the Department of Family Medicine at NOSM University in Thunder Bay, Ont, who locums in Sioux Lookout, Ont.
Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario.
Can Fam Physician. 2022 Jun;68(6):e190-e195. doi: 10.46747/cfp.6806e190.
To measure the incidence of poststreptococcal glomerulonephritis (PSGN) and resulting complications in northwestern Ontario, including among Indigenous and rural populations.
Cross-sectional study.
As the only tertiary care hospital in northwestern Ontario, Thunder Bay Regional Health Sciences Centre (TBRHSC) functions as the primary referral centre for most of the region. The catchment population has substantial Indigenous (21.5%) and rural (34.2%) populations.
All cases of PSGN managed at TBRHSC over an 8-year period from January 1, 2010, to December 31, 2017.
Cases were classified as confirmed, probable, or possible based on the type of evidence available. Patients' rurality and Indigenous status were recorded. Incidence rates and incidence rate ratios of all, pediatric (<18 years), and adult PSGN cases were calculated, as were incidence rates and incidence rate ratios of those requiring dialysis. Linear interpolation and extrapolation were used to estimate the population in non-census years.
Over the 8-year study period, 33 cases of PSGN were observed with annual incidence rates of 0.0 to 4.8 per 100,000 person-years and a mean annual incidence rate of 1.8 (95% CI 1.2 to 2.5) per 100,000 person-years. Of these 33 cases, 28 were confirmed with renal biopsy or clinical and laboratory data. Indigenous patients accounted for 61% (n=17) of confirmed cases and were 6.0 (95% CI 2.8 to 13, <.001) times as likely to have PSGN and 9.6 (95% CI 3.0 to 31, <.001) times as likely to require dialysis compared with non-Indigenous patients. Patients living in rural areas accounted for 71% (n=20) of confirmed cases and were 3.2 (95% CI 1.4 to 7.3, =.006) times as likely to have PSGN and 3.9 (95% CI 1.0 to 10, =.02) times as likely to require dialysis compared with patients in urban areas.
The main burden of PSGN in northwestern Ontario occurs among Indigenous and rural populations. Additional research is required to investigate the true overall burden of PSGN in the region. In collaboration with regional Indigenous groups, advocacy is needed for PSGN to be made reportable and public health action must be taken to address these pronounced disparities.
在安大略省西北部测量链球菌后肾小球肾炎（PSGN）的发病率和由此产生的并发症，包括在原住民和农村人群中的发病率和并发症。
横断面研究。
桑德贝地区健康科学中心（TBRHSC）作为安大略省西北部唯一的三级保健医院，是该地区大多数患者的主要转诊中心。该服务人群中有大量的原住民（21.5%）和农村人口（34.2%）。
2010 年 1 月 1 日至 2017 年 12 月 31 日期间，在 TBRHSC 接受管理的所有 PSGN 病例。
根据现有证据类型，将病例分类为确诊、可能或疑似。记录患者的农村和原住民身份。计算所有、儿科（<18 岁）和成人 PSGN 病例的发病率和发病率比，以及需要透析的病例的发病率和发病率比。使用线性插值和外推法估计非普查年份的人口。
在 8 年的研究期间，观察到 33 例 PSGN，年发病率为 0.0 至 4.8/100000 人年，平均年发病率为 1.8（95%CI 1.2 至 2.5）/100000 人年。在这 33 例中，28 例通过肾活检或临床和实验室数据得到确诊。原住民患者占确诊病例的 61%（n=17），患 PSGN 的可能性是非原住民患者的 6.0 倍（95%CI 2.8 至 13，<.001），需要透析的可能性是其 9.6 倍（95%CI 3.0 至 31，<.001）。居住在农村地区的患者占确诊病例的 71%（n=20），患 PSGN 的可能性是城市地区患者的 3.2 倍（95%CI 1.4 至 7.3，=.006），需要透析的可能性是其 3.9 倍（95%CI 1.0 至 10，=.02）。
安大略省西北部 PSGN 的主要负担发生在原住民和农村人群中。需要进一步研究以调查该地区 PSGN 的真实总负担。应与地区原住民团体合作，争取报告 PSGN，并采取公共卫生行动，以解决这些明显的差异。
