Epidemiology and Use of Health Services for Chronic Obstructive Pulmonary Disease among Aboriginal Peoples in Alberta: Insights into Aboriginal Peoples’ Respiratory Health

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a major respiratory disorder and a leading cause of morbidity and mortality. There is limited information about the burden of disease for COPD among Aboriginal peoples in Canada. Objectives: To compare the epidemiology and patterns of health services use for COPD between Aboriginal (First Nations peoples, Métis and Inuit) and non-Aboriginal peoples in Alberta, Canada while adjusting for important clinical and sociodemographic factors. Methods: A systematic review synthesized epidemiological evidence on the prevalence, mortality and health services use for COPD in Aboriginal and non-Aboriginal populations from a variety of settings. Three retrospective cohort studies based on linkage of administrative health databases in Alberta, Canada from April 1, 2002 to March 31, 2010 compared prevalence and incidence rates of COPD between Aboriginal and non-Aboriginal cohorts in the province, and evaluated all-cause mortality, and rates of hospitalizations and emergency department (ED) visits following a diagnosis of COPD. Poisson regression and Cox’s proportional hazard models were used in the multivariate analysis. Results: Limited scientific evidence informed differences in COPD prevalence, mortality and health services use between Aboriginal and non- Aboriginal populations. The retrospective cohort studies found that Aboriginal peoples in Alberta have higher prevalence and incidence rates of COPD than the non-Aboriginal cohort, with Registered First Nations peoples and Inuit having the highest rates of COPD. Overall, all-cause mortality in Aboriginal peoples did not differ from that of non-Aboriginals up to five years after being diagnosed with COPD. Métis and Inuit with COPD had a lower mortality hazard, whereas no differences in mortality were found between Registered First Nations peoples and non-Aboriginals. Given a diagnosis of COPD, Aboriginal peoples had higher hospitalizations and ED visits rates than non-Aboriginals, with Registered First Nations peoples having the highest utilization rates among the three Aboriginal groups. Conclusions: While Aboriginal peoples in Alberta have a higher burden of COPD than the non-Aboriginal population, the condition affects the three Aboriginal groups differently. Reasons for these differences should be further explored within a framework of social determinants of health to effectively influence modifiable risk factors in each of the Aboriginal groups.