Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
, 179 (10), 1007-12

Access to Health Care Among Status Aboriginal People With Chronic Kidney Disease

Comparative Study

Access to Health Care Among Status Aboriginal People With Chronic Kidney Disease

Song Gao et al. CMAJ.


Background: Ethnic disparities in access to health care and health outcomes are well documented. It is unclear whether similar differences exist between Aboriginal and non-Aboriginal people with chronic kidney disease in Canada. We determined whether access to care differed between status Aboriginal people (Aboriginal people registered under the federal Indian Act) and non-Aboriginal people with chronic kidney disease.

Methods: We identified 106 511 non-Aboriginal and 1182 Aboriginal patients with chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m(2)). We compared outcomes, including hospital admissions, that may have been preventable with appropriate outpatient care (ambulatory-care-sensitive conditions) as well as use of specialist services, including visits to nephrologists and general internists.

Results: Aboriginal people were almost twice as likely as non-Aboriginal people to be admitted to hospital for an ambulatory-care-sensitive condition (rate ratio 1.77, 95% confidence interval [CI] 1.46-2.13). Aboriginal people with severe chronic kidney disease (estimated glomerular filtration rate < 30 mL/min/1.73 m(2)) were 43% less likely than non-Aboriginal people with severe chronic kidney disease to visit a nephrologist (hazard ratio 0.57, 95% CI 0.39-0.83). There was no difference in the likelihood of visiting a general internist (hazard ratio 1.00, 95% CI 0.83-1.21).

Interpretation: Increased rates of hospital admissions for ambulatory-care-sensitive conditions and a reduced likelihood of nephrology visits suggest potential inequities in care among status Aboriginal people with chronic kidney disease. The extent to which this may contribute to the higher rate of kidney failure in this population requires further exploration.

Comment in

Similar articles

  • Prevalence of Chronic Kidney Disease and Survival Among Aboriginal People
    S Gao et al. J Am Soc Nephrol 18 (11), 2953-9. PMID 17942955.
    Globally, it is known that the incidence of end-stage renal disease is higher among Aboriginals, but it is unknown whether this is due to an increased prevalence of chron …
  • Use and Outcomes of Peritoneal Dialysis Among Aboriginal People in Canada
    M Tonelli et al. J Am Soc Nephrol 16 (2), 482-8. PMID 15590757.
    There has been a dramatic increase in the incidence of ESRD among Aboriginal people in North America. Although peritoneal dialysis (PD) seems to be the dialysis modality …
  • Wait-listing for Kidney Transplantation Among Aboriginal Hemodialysis Patients
    M Tonelli et al. Am J Kidney Dis 46 (6), 1117-23. PMID 16310578.
    The likelihood of referral for transplantation was similar between Aboriginal and non-Aboriginal people. However, Aboriginal people were approximately half as likely to b …
  • Aboriginal Health
    HL MacMillan et al. CMAJ 155 (11), 1569-78. PMID 8956834. - Review
    Canadian aboriginal people die earlier than their fellow Canadians, on average, and sustain a disproportionate share of the burden of physical disease and mental illness. …
  • Kidney Disease in the Elderly: Update on Recent Literature
    KH Campbell et al. Curr Opin Nephrol Hypertens 17 (3), 298-303. PMID 18408482. - Review
    We advise caution in applying current guidelines to the care of the large number of individuals aged 70 years and older with chronic kidney disease. Ideally, the care of …
See all similar articles

Cited by 35 PubMed Central articles

See all "Cited by" articles

Publication types

MeSH terms