Lavoie Josée G, McLeod Lorraine, Zacharias James, Cook Tannyce, Whitlock Reid
University of Manitoba, Winnipeg, Canada.
First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada.
BMC Health Serv Res. 2025 Aug 18;25(1):1095. doi: 10.1186/s12913-025-13179-6.
End-stage kidney disease continues to disproportionally impact the lives of First Nations peoples. Systemic racism is a key determinant, and manifests as differential access to determinants of health (housing, employment, access to care) and differential care. This paper discusses how different models of primary healthcare operating in rural and remote Manitoba communities results in different outcomes for patients identified as being at risk of kidney disease.
This study is a partnership between researchers from the First Nations Health and Social Secretariat of Manitoba and the University of Manitoba. We used health administrative data held at the Manitoba Centre for Health Policy for the period of 2006-2019, linked to the Manitoba First Nations Research File to identify First Nations. We compared rates of laboratory follow-up tests, nephrology consults, PHC visits, and hospitalizations between different models of care using a negative binomial regression model adjusted for age, sex, eGFR heat-map category, urine ACR heat-map category, and Elixhauser comorbidity index.
We identified 12,613 First Nations people with chronic kidney disease (CKD) during the study period. First Nations individuals with CKD who reside in communities served by Nursing Stations (most remote communities) when supplemented by additional Indigenous programs were consistently more likely to receive follow-up serum creatinine (OR 1.37, 95% CI: 1.30-1.45, p<0.001), urine ACR (OR 1.22, 95% CI: 1.16-1.28, p<0.001), serum potassium (OR 1.40, 95% CI: 1.32-1.49, p<0.001) than individuals who lived in communities served by Nursing Stations alone, Health Centres, Health Offices, or Off Reserve.
Our results show that addressing the rise in premature mortality experienced by First Nations from kidney diseases require greater investments in First Nations-centric primary healthcare, that is locally managed. Additionally, off-reserve primary healthcare services must be alerted to their need to better address the needs of First Nations at risk of CKD, with more consistent follow up, referrals, and in providing culturally safe care. Finally, First Nations-led research in kidney health and primary healthcare is leading to significant improvements in outcomes, and needs to be better supported and resourced, and imbedded in a context of greater investments to improve access to all determinants of health and counter systemic racism.
终末期肾病对原住民生活的影响仍不成比例。系统性种族主义是一个关键决定因素，表现为在获得健康决定因素（住房、就业、医疗服务）方面的差异以及医疗服务的差异。本文讨论了在曼尼托巴农村和偏远社区运行的不同初级医疗保健模式如何导致被确定有患肾病风险的患者产生不同的结果。
本研究是曼尼托巴第一民族健康与社会秘书处的研究人员与曼尼托巴大学之间的合作项目。我们使用了曼尼托巴健康政策中心2006 - 2019年期间保存的健康管理数据，并与曼尼托巴第一民族研究档案相链接以识别原住民。我们使用负二项回归模型，对年龄、性别、估算肾小球滤过率（eGFR）热图类别、尿白蛋白肌酐比值（ACR）热图类别和埃利克斯豪泽共病指数进行调整，比较了不同医疗模式之间的实验室随访检查率、肾病咨询率、初级医疗保健就诊率和住院率。
在研究期间，我们识别出12,613名患有慢性肾病（CKD）的原住民。与仅由护理站、健康中心、健康办公室服务的社区或非保留地社区的居民相比，居住在由护理站服务（最偏远社区）且有额外原住民项目补充的社区中的患有CKD的原住民，更有可能接受血清肌酐随访（比值比[OR] 1.37，95%置信区间[CI]：1.30 - 1.45，p < 0.001）、尿ACR随访（OR 1.22，95% CI：1.16 - 1.28，p < 0.001）、血清钾随访（OR 1.40，95% CI：1.32 - 1.49，p < 0.001）。
我们的结果表明，要解决原住民因肾病导致的过早死亡率上升问题需要对以原住民为中心的、由当地管理的初级医疗保健进行更多投资。此外，必须提醒非保留地的初级医疗保健服务机构，它们需要更好地满足有患CKD风险的原住民的需求，进行更一致的随访、转诊，并提供具有文化安全性的护理。最后，由原住民主导的关于肾脏健康和初级医疗保健的研究正在显著改善结果，需要得到更好的支持和资源投入，并融入到为改善获得所有健康决定因素的机会和对抗系统性种族主义而进行的更多投资的背景中。
