Abstract
BackgroundThe prevalence of diabetes in North American is recognized to be higher in Aboriginal populations. The relative magnitude of health care utilization and expenditures between Aboriginal and non-Aboriginal populations is uncertain, however. Our objective was to compare health care utilization and per capita expenditures according to Registered Indian and diabetes status in the province of Saskatchewan.MethodsAdministrative databases from Saskatchewan Health were used to identify registered Indians and the general population diabetes cases and two controls for each diabetes case. Health care resource utilization (physician visits, hospitalizations, day surgeries and dialysis) and costs for these individuals in the 2001 calendar year were determined. The odds of having used each resource category, adjusted for age and location of residence, was assessed according to Registered Indian and diabetes status. The average number of encounters for each resource category and per capita healthcare expenditures were also determined.ResultsRegistered Indian diabetes cases were younger than general population cases (45.7 ± 14.5 versus 58.4 ± 16.4 years, p < 0.001) and fewer were male (42.3% versus 53.2%, p < 0.001). Registered Indians were more likely to visit a physician, be hospitalized or receive dialysis than the general population, regardless of diabetes status. Diabetes increased the probability of having used all resource categories for both Registered Indians and the general population. Per capita health care expenditures for the diabetes subgroups were more than twice that of their respective controls and were 40% to 60% higher for registered Indians than the general population, regardless of diabetes status.ConclusionRelative to individuals without the disease, both registered Indians and the general population with diabetes had substantially higher health care utilization and costs. Excess hospitalization and dialysis suggested that registered Indians with and without diabetes experienced greater morbidity than the general population.
Highlights
The prevalence of diabetes in North American is recognized to be higher in Aboriginal populations
11.3% of the diabetes cases were Registered Indians (n = 5,284) (Table 1). Both registered Indian and general population cases were significantly older than their respective controls (Table 1)
Registered Indian diabetes cases were younger than general population cases (45.7 ± 14.5 versus 58.4 ± 16.4 years, p < 0.001)
Summary
The prevalence of diabetes in North American is recognized to be higher in Aboriginal populations. There are significant disparities between the health status of Aboriginal and non-Aboriginal populations in Canada, the United States, New Zealand and Australia [1,2,3,4,5,6]. Aboriginals rate their health status lower and have higher mortality, hypertension, arthritis, heart disease and diabetes rates than the general Canadian population [1,4,5,6,7,8,9,10,11,12]. With the high prevalence of diabetes in Aboriginals, health care costs for this group is relevant from the perspective of Canada's publicly funded health care system
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