Applied Research (Srugo, Jiang) and Lifespan Chronic Disease and Conditions Divisions (Ricci, Luo, Nelson), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Anthropology and Archaeology (Leason), University of Calgary, Calgary, Alta.
CMAJ. 2023 Aug 28;195(33):E1097-E1111. doi: 10.1503/cmaj.221407.
Access to primary care protects the reproductive and non-reproductive health of females. We aimed to quantify health care disparities among "off-reserve" First Nations, Métis and Inuit females, compared with non-Indigenous females of reproductive age.
We used population-based data from cross-sectional cycles of the Canadian Community Health Survey (2015-2020), including 4 months during the COVID-19 pandemic. We included all females aged 15-55 years. We measured health care access, use and unmet needs, and quantified disparities through weighted and age-standardized absolute prevalence differences compared with non-Indigenous females.
We included 2902 First Nations, 2345 Métis, 742 Inuit and 74 760 non-Indigenous females of reproductive age, weighted to represent 9.7 million people. Compared with non-Indigenous females, Indigenous females reported poorer health and higher morbidity, yet 4.2% (95% confidence interval [CI] 1.8% to 6.6%) fewer First Nations females and 40.7% (95% CI 34.3% to 47.1%) fewer Inuit females had access to a regular health care provider. Indigenous females waited longer for primary care, more used hospital services for nonurgent care, and fewer had consultations with dental professionals. Accordingly, 3.2% (95% CI 0.3% to 6.1%) more First Nations females and 4.0% (95% CI 0.7% to 7.3%) more Métis females reported unmet needs, especially for mental health (data for Inuit females not reported owing to high variability).
During reproductive age, Indigenous females in Canada face many disparities in health care access, use and unmet needs. Solutions aimed at increasing access to primary care are urgently needed to advance health care reconciliation.
初级保健的可及性可保护女性的生殖和非生殖健康。我们旨在量化“保留地以外”的第一民族、梅蒂斯和因纽特女性与育龄非土著女性之间的卫生保健差距。
我们使用了来自加拿大社区健康调查（2015-2020 年）的基于人群的横断面数据，包括 COVID-19 大流行期间的 4 个月。我们纳入了所有 15-55 岁的女性。我们测量了卫生保健的可及性、使用情况和未满足的需求，并通过与非土著女性相比，使用加权和年龄标准化的绝对流行率差异来量化差异。
我们纳入了 2902 名第一民族女性、2345 名梅蒂斯女性、742 名因纽特女性和 74760 名育龄非土著女性，这些数据经过加权处理，以代表 970 万人。与非土著女性相比，土著女性报告的健康状况较差，发病率更高，但只有 4.2%（95%置信区间 [CI] 1.8%至 6.6%）的第一民族女性和 40.7%（95% CI 34.3%至 47.1%）的因纽特女性能够获得常规医疗服务提供者。土著女性等待初级保健的时间更长，更多地因非紧急情况使用医院服务，而且较少咨询牙科专业人员。因此，有 3.2%（95% CI 0.3%至 6.1%）的第一民族女性和 4.0%（95% CI 0.7%至 7.3%）的梅蒂斯女性报告有未满足的需求，尤其是心理健康方面（因因纽特女性的数据因高度变异性而未报告）。
在育龄期，加拿大的土著女性在卫生保健的可及性、使用情况和未满足的需求方面面临着许多差距。迫切需要旨在增加初级保健机会的解决方案，以推进卫生保健和解。
