Abstract
BackgroundIt is widely recognised that significant discrepancies exist between the health of indigenous and non-indigenous populations. Whilst the reasons are incompletely defined, one potential cause is that indigenous communities do not access healthcare to the same extent. We investigated healthcare utilisation rates in the Canadian Aboriginal population to elucidate the contribution of this fundamental social determinant for health to such disparities.MethodsHealthcare utilisation data over a nine-year period were analysed for a cohort of nearly two million individuals to determine the rates at which Aboriginal and non-Aboriginal populations utilised two specialties (Cardiology and Ophthalmology) in Alberta, Canada. Unadjusted and adjusted healthcare utilisation rates obtained by mixed linear and Poisson regressions, respectively, were compared amongst three population groups - federally registered Aboriginals, individuals receiving welfare, and other Albertans.ResultsHealthcare utilisation rates for Aboriginals were substantially lower than those of non-Aboriginals and welfare recipients at each time point and subspecialty studied [e.g. During 2005/06, unadjusted Cardiology utilisation rates were 0.28% (Aboriginal, n = 97,080), 0.93% (non-Aboriginal, n = 1,720,041) and 1.37% (Welfare, n = 52,514), p = <0.001]. The age distribution of the Aboriginal population was markedly different [2.7%≥65 years of age, non-Aboriginal 10.7%], and comparable utilisation rates were obtained after adjustment for fiscal year and estimated life expectancy [Cardiology: Incidence Rate Ratio 0.66, Ophthalmology: IRR 0.85].DiscussionThe analysis revealed that Aboriginal people utilised subspecialty healthcare at a consistently lower rate than either comparatively economically disadvantaged groups or the general population. Notably, the differences were relatively invariant between the major provincial centres and over a nine year period. Addressing the causes of these discrepancies is essential for reducing marked health disparities, and so improving the health of Aboriginal people.
Highlights
The significant disparity between the health of Aboriginal and non-Aboriginal populations is a worldwide phenomenon [1,2,3,4,5,6,7,8]
The objective of this study was to determine whether Aboriginal status was associated with lower healthcare access rates. Since this key social determinant of health [21] represents the first step in receiving treatment, discrepancies at this stage would be expected to manifest in subsequent morbidity, potentially for a range of diseases
This study provides data supporting the hypothesis that Aboriginal peoples utilise healthcare at lower rates than the general population and reveals ways in which this issue can be addressed
Summary
The significant disparity between the health of Aboriginal and non-Aboriginal populations is a worldwide phenomenon [1,2,3,4,5,6,7,8]. The objective of this study was to determine whether Aboriginal status was associated with lower healthcare access rates. Since this key social determinant of health [21] represents the first step in receiving treatment, discrepancies at this stage would be expected to manifest in subsequent morbidity, potentially for a range of diseases. This study provides data supporting the hypothesis that Aboriginal peoples utilise healthcare at lower rates than the general population and reveals ways in which this issue can be addressed. We investigated healthcare utilisation rates in the Canadian Aboriginal population to elucidate the contribution of this fundamental social determinant for health to such disparities
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