Wiens Dana, Smolik Irene A, MacKay Dylan, Fowler-Woods Amanda, Robinson David B, Barnabe Cheryl, El-Gabalawy Hani S, O'Neil Liam J
D. Wiens, BSc, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba.
I.A. Smolik, PhD, D.B. Robinson, MD, H.S. El-Gabalawy, MD, L.J. O'Neil, MD, MHSc, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba.
J Rheumatol. 2024 Jul 1;51(7):654-662. doi: 10.3899/jrheum.2023-1080.
There are complex and interrelated factors that lead to inequitable healthcare delivery in Canada. Many of the factors that underlie these inequities for Canada's geographically dispersed Indigenous peoples remain underexamined.
A cohort of 831 First Nations (FN) individuals from urban and remote communities were recruited into a longitudinal study of rheumatoid arthritis (RA) risk from 2005 to 2017. Data from each participant's initial enrollment visit were assessed using a survey that captured concerns with healthcare access.
We found that remote participants with RA reported poor access compared to remote first-degree relatives (FDRs; < 0.001); this difference was not observed for urban participants with RA. We observed substantial differences based on sex; female participants perceived access to care to be more difficult than male participants in both urban and remote cohorts ( < 0.001). We also observed that male participants with RA reported poor access to care compared to male FDRs. Importantly, access to care in remote communities appeared to improve over the duration of the study ( = 0.01). In a logistic regression analysis, female sex, remote location, and older age were independent predictors of poor access to care. Predictors of poor access in participants with RA also included female sex, remote location, and older age.
FN peoples living in remote communities, particularly those with an established RA diagnosis, report more problems accessing health care. Sex-based inequities exist, with FN female individuals reporting greater difficulties in accessing appropriate health care, regardless of RA diagnosis. Addressing these sex-based inequities should be a high priority for improving healthcare delivery.
在加拿大，导致医疗服务不公平的因素复杂且相互关联。加拿大地理上分散的原住民群体中，构成这些不公平现象的许多因素仍未得到充分研究。
从2005年至2017年，招募了831名来自城市和偏远社区的第一民族（FN）个体，纳入一项类风湿性关节炎（RA）风险的纵向研究。使用一项调查评估了每位参与者初次入组访视的数据，该调查收集了对医疗服务可及性的担忧。
我们发现，患有RA的偏远地区参与者报告称，其医疗服务可及性比偏远地区的一级亲属（FDRs）差（<0.001）；而患有RA的城市参与者未观察到这种差异。我们观察到基于性别的显著差异；在城市和偏远地区队列中，女性参与者都认为获得医疗服务比男性参与者更困难（<0.001）。我们还观察到，患有RA的男性参与者报告称其获得医疗服务的机会比男性FDRs差。重要的是，在研究期间，偏远社区的医疗服务可及性似乎有所改善（=0.01）。在逻辑回归分析中，女性、偏远地区居住和年龄较大是医疗服务可及性差的独立预测因素。患有RA的参与者中，医疗服务可及性差的预测因素还包括女性、偏远地区居住和年龄较大。
生活在偏远社区的FN群体，尤其是那些已确诊患有RA的群体，报告称在获得医疗保健方面存在更多问题。存在基于性别的不公平现象，无论是否患有RA，FN女性个体在获得适当医疗保健方面都报告有更大困难。解决这些基于性别的不公平现象应是改善医疗服务的高度优先事项。
