Distribution and determinants of critical illness among status Aboriginal Canadians. A population-based assessment

Laupland, Kevin B.; Karmali, Shahzeer; Kirkpatrick, Andrew W.; Crowshoe, Lindsay; Hameed, S. Morad

doi:10.1016/j.jcrc.2006.03.012

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Volume 21, Issue 3 , Pages 243-247, September 2006

Distribution and determinants of critical illness among status Aboriginal Canadians. A population-based assessment

Kevin B. Laupland
- Department of Critical Care Medicine, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada T2L 2K8
- Department of Medicine, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada T2L 2K8
- Department of Community Health Sciences, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada T2L 2K8
- Corresponding author. University of Calgary, Calgary, Alberta, Canada T2L 2K8. Tel.: +1 403 770 3208; fax: +1 403 770 3347.
Shahzeer Karmali
- Department of Surgery, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada T2L 2K8
Andrew W. Kirkpatrick
- Department of Critical Care Medicine, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada T2L 2K8
- Department of Surgery, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada T2L 2K8
Lindsay Crowshoe
- Department of Family Medicine, Calgary Health Region, University of Calgary, Calgary, Alberta, Canada T2L 2K8
S. Morad Hameed
- Department of Surgery, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, British Columbia, Canada V5Z 1M9

Abstract

Purpose

The aim of the study is to determine the incidence, demographic risk factors, and outcomes of critical illness among all adult status Aboriginal Canadians (SACs) admitted to intensive care units (ICUs).

Patients and Methods

A population-based cohort was conducted among adult residents of the Calgary Health Region admitted to ICUs between May 1999 and April 2002. Patients were classified as SAC based on an alternate premium arrangement field within their Alberta personal health number.

Results

The annual incidence of critical illness among SACs of 620.6 per 100000 was significantly higher than the non-SAC population of 302.6 per 100000 (RR, 2.1; 95% CI, 1.78-2.35); this was due to a 3-fold higher admission rate to the multisystem ICUs among SAC (579.6 per 100000/y) as compared with non-SAC patients (210.7 per 100000/y; RR, 2.75; 95% confidence interval [CI], 2.37-3.17). The highest risk for ICU admission among SAC patients was observed in those aged 20 to 49 years, and the incidence was higher in males than females (772.3 vs 479.8 per 100000/y; RR, 1.6; 95% CI, 1.21-2.14). Although the in-hospital case-fatality rate was only slightly higher among SAC (18%, 38/212) as compared with non-SAC patients (922/7159; 13%; RR, 1.39; 95% CI, 1.04-1.87), the annual mortality rate was much higher (146.4 per 100000 for SAC vs 60.9 per 100000 for non-SAC; RR, 2.40; 95% CI, 1.78-3.19).

Conclusion

This study demonstrates that SACs have an increased burden of critical illness as compared with the general non-SAC population and supports further research aimed at exploring means to reduce its adverse impact in this population.

Keywords: Aboriginal Canadians, Critical illness, Calgary Health Region