Abstract
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Background
National data about acute care hospitalization of Aboriginal people are scarce. This study addresses that information gap by describing patterns of hospitalization by Aboriginal identity for leading diagnoses for all provinces and territories except Quebec.
Data and Methods
The 2006 Census was linked to the 2006/2007-to-2008/2009 Discharge Abstract Database, which contains hospital records from all acute care facilities in Canada (excluding Quebec). With these linked data, hospital records could be examined by Aboriginal identity, as reported to the census. Hospitalizations were grouped by International Classification of Diseases (ICD-10) chapters based on “the most responsible diagnosis.” Age-standardized hospitalization rates were calculated per 100,000 population, and rate ratios (RR) were calculated for Aboriginal groups relative to non-Aboriginal people.
Results
Hospitalization rates were almost invariably higher for First Nations living on and off reserve, Métis, and Inuit living in Inuit Nunangat than for the non-Aboriginal population, regardless of ICD diagnostic chapter. The ranking of age-standardized hospitalization rates by frequency of diagnoses varied slightly by Aboriginal identity. RRs were highest among First Nations living on reserve, especially for endocrine, nutritional and metabolic diseases (RR = 4.9), mental and behavioural disorders (RR = 3.6), diseases of the respiratory system (RR = 3.3), and injuries (RR = 3.2). As well, the rate for endocrine, nutritional and metabolic diseases was high among First Nations living off reserve (RR = 2.7). RRs were also high among Inuit for mental and behavioural disorders (RR = 3.3) and for diseases of the respiratory system (RR = 2.7).
Interpretation
Hospitalization rates varied by Aboriginal identity, and were consistent with recognized health disparities between Aboriginal and non-Aboriginal people. Because many factors besides health affect hospital use, further research is required to understand differences in hospital use by Aboriginal identity. These national data are relevant to health policy formulation and service delivery planning.
Keywords
Administrative data, census, data linkage, First Nations, health care, hospital records, Inuit, medical record linkage, Métis, on reserve
Findings
Differences in health, health determinants and use of health care services between Aboriginal and non-Aboriginal people suggest that the frequency and nature of acute care hospitalization may vary. However, national information about hospital admissions of Aboriginal people is scarce. In some provinces—Manitoba, British Columbia, Alberta, and Saskatchewan—hospital records contain First Nations identifiers, or for Métis persons, identifiers were appended, which enable analyses of hospitalizations of these groups. In other jurisdictions, Aboriginal identity is not routinely included on hospital records. As a result, in Canada, national-level data about the hospitalization of Aboriginal people are not available. [Full Text]
Authors
Gisèle Carrière (gisele.carriere@canada.ca), Evelyne Bougie, Dafna Kohen, Michelle Rotermann, and Claudia Sanmartin are with the Health Analysis Division at Statistics Canada.
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What is already known on this subject?
- This is the first analysis of acute care hospitalization by Aboriginal group for all Canada except Quebec.
- Previous analyses have found elevated rates of acute care hospitalization in areas with higher percentages of Aboriginal people.
- Provincial studies from British Columbia, Alberta, Saskatchewan, and Manitoba that used individual-level hospital data with First Nations or Métis identifiers found hospitalization rates to generally be higher among these groups than among their non-Aboriginal counterparts or the total provincial population.
What does this study add?
- This is the first national-level analysis of acute care hospitalization by Aboriginal identity group.
- Age-standardized hospitalization rates were higher for each group relative to non-Aboriginal people for the nine leading diagnostic chapters analysed.
- Ranking of diagnostic chapters differed slightly depending on the Aboriginal identity group.
- This study helps to fill gaps in understanding hospitalization patterns among Aboriginal people.
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