Incidence, secular trends, and outcomes of cardiac surgery in Aboriginal peoples
Manish M Sood1, Navdeep Tangri, Paul Komenda
1Section of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada; St Boniface Hospital, Winnipeg, Manitoba, Canada.
Insights
Canadian Aboriginals have lower cardiovascular surgery rates and higher infection risks post-surgery, indicating potential urban access disparities in cardiovascular care.
Area of Science:
- Cardiovascular Surgery
- Health Disparities
- Indigenous Health
Background:
- Aboriginal populations in Canada face a higher burden of comorbid illnesses, increasing atherosclerotic disease risk.
- Investigated secular trends in cardiovascular surgery (CVSx) and post-surgical outcomes for Aboriginal versus non-Aboriginal individuals.
Purpose of the Study:
- To compare cardiovascular surgery (CVSx) rates between Aboriginal and non-Aboriginal populations in Manitoba.
- To analyze post-surgical outcomes, including infection and mortality, for Aboriginal patients undergoing CVSx compared to non-Aboriginal patients.
Main Methods:
- A cohort study included 12,170 patients (4.7% Aboriginal) undergoing CVSx in Manitoba from 1995-2007.
- Race was self-identified, and age- and sex-adjusted incidence rates were calculated using census data.
- Multivariable logistic regression analyzed the association between race and outcomes (death, infection, composite adverse events).
Main Results:
- CVSx rates were significantly lower in Aboriginals (63.6/10,000) compared to non-Aboriginals (97.7/10,000), especially in urban areas.
- Aboriginal patients had higher odds of postoperative infections (OR 1.63), particularly pneumonia (OR 2.24).
- No significant difference in post-surgical mortality (OR 1.15) or composite adverse events (OR 1.0) was observed between groups.
Conclusions:
- Aboriginal peoples, especially in urban settings, are less likely to undergo cardiovascular surgery (CVSx).
- Postoperative mortality rates for Aboriginals undergoing CVSx are similar to non-Aboriginals.
- Findings suggest a potential urban racial disparity in access to CVSx for Aboriginal populations.
Background:
Canada's Aboriginal people experience a disproportionate burden of comorbid illnesses predisposing them to higher rates of atherosclerotic disease. We set out to investigate secular rates of cardiovascular surgery (CVSx) and postsurgical outcomes in Aboriginals compared with non-Aboriginals.
Methods:
All patients undergoing CVSx in Manitoba, Canada from 1995-2007 (N =12,170 [Aboriginal, 574, 4.7%; non-Aboriginal, 11,596, 95.3%]) were included in our study cohort. Race was self-identified. Age- and sex-adjusted incidence were determined using 2001 and 2006 census data. Multivariable logistic regression models were constructed to determine the association between race and the outcomes of death, infections, and a composite of adverse events.
Results:
CVSx rates were significantly lower in Aboriginals compared with non-Aboriginals (all CVSx, 63.6 vs 97.7 per 10,000 population; coronary artery bypass grafting only, 46.2 vs 71.9 per 10,000 population, respectively). The lower CVSx rates were most pronounced among Aboriginals residing in urban areas (21.0 vs 78.0 per 10,000). Postoperatively, Aboriginals experienced significantly higher odds of infections (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.13-2.34; P = 0.008), in particular pneumonia (OR, 2.24; 95% CI, 1.58-3.19; P < 0.0001). There was no increase in risk of death after surgery (OR, 1.15; 95% CI, 0.63-2.08; P = 0.6) or the composite outcome (OR, 1.0; 95% CI, 0.66-1.52; P = 1.0) compared with non-Aboriginals.
Conclusions:
Aboriginal peoples, particularly in the urban setting, are considerably less likely to undergo CVSx. When they do, they have postoperative mortality similar to that of non-Aboriginals. Our findings suggest an urban racial disparity in access to CVSx.
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