Abstract

Background. The purpose of this study was to determine the prevalence of measured chronic kidney disease (CKD) among First Nations people in Alberta. We also examined whether the likelihood of a nephrologist visit differed for First Nations versus non-First Nations people with severe CKD, and assessed whether access to health care and management of CKD differs for these two groups with CKD based on hospitalization rates for CKD relevant ambulatory care sensitive conditions (ACSC).

Subjects and Methods. Computerized laboratory data was used to identify out-patients 20 years of age or older with at least one serum creatinine measurement during a six-month period (July 1, 2003 to Dec 31, 2003) in Alberta, Canada. We calculated the age and sex standardized period prevalence of measured CKD for First Nations and non-First Nations. Access to ambulatory care was measured by assessing likelihood of a nephrologist visit for patients with GFR < 30 mLmin/1.73 m^{2</super> using logistic regression model, and rate of hospitalizations for a CKD relevant ACSC using negative binomial regression models, for First Nations compared to non-First Nations.}

Results. A total of 70,601 subjects with CKD were identified. The age and sex adjusted prevalence of measured CKD was 4.45% among non-First Nations and was 4.16% among First Nations. First Nations with more severe CKD were less likely to visit a nephrologist (OR 0.63; 95% CI 0.40--0.99). After adjustment for sex, age, diabetes and GFR, First Nations were more than twice as likely as non-First Nations with CKD to be hospitalized for an ACSC (rate ratio 2.59; 95% CI 1.76--3.81).

Conclusions. First Nations with CKD had reasonable access to GPs, but a trend towards reduced access to a nephrologist. They were also twice as likely to be hospitalized for a CKD relevant ACSC. These results suggest that there may be potential inequities in either access to specialized health care for First Nations with CKD, management of this chronic condition by the health care system or the patients’ themselves, or an overall poorer health status of First Nations with CKD.