Abstract
Objective/Background: Aboriginals constitute a substantial portion of the population of Northern Alberta. Determinants such as poverty and education can compound health-care accessibility barriers experienced by Aboriginals compared to non-Aboriginals. A diabetes care enhancement study involved the collection of baseline and follow-up data on Aboriginal and non-Aboriginal patients with known type 2 diabetes in two rural communities in Northern Alberta. Analyses were conducted to determine any demographic or clinical differences existing between Aboriginals and non-Aboriginals.
Methods: 394 diabetes patients were recruited from the Peace and Keeweetinok Lakes health regions. 354 self-reported whether or not they were Aboriginal; a total of 94 selfreported being Aboriginal. Baseline and follow-up data were collected through interviews, standardized physical assessments, laboratory testing and self-reporting questionnaires (RAND-12 and HUI3).
Results: Aboriginals were younger, with longer duration of diabetes, more likely to be female, and less likely to have completed high school. At baseline, self-reported health status was uniformly worse, but the differences disappeared with adjustments for sociodemographic confounders, except for perceived mental health status. Aboriginals considered their mental health status to be worse than non-Aboriginals at baseline. Some aspects of health utilization were also different.
Discussion: While demographics were different and some utilization differences existed, overall this analysis demonstrates that “Aboriginality” does not contribute to diabetes outcomes when adjusted for appropriate variables.
MeSH terms: Aboriginal, North America; type 2 diabetes mellitus; practice guidelines; health status indicators; rural communities
Résumé
Objectif et contexte: Les Autochtones représentent une part substantielle de la population du Nord de l’Alberta. Les déterminants comme la pauvreté et l’instruction peuvent aggraver les problèmes d’accès aux soins de santé que vivent les Autochtones par rapport au reste de la population. Dans le cadre d’une étude sur l’amélioration des soins du diabète, nous avons recueilli des données de référence et de suivi auprès de patients autochtones et non autochtones ayant reçu un diagnostic de diabète de type II dans deux communautés rurales du Nord de l’Alberta. Nous avons ensuite effectué des analyses pour déterminer l’existence de différences démographiques ou cliniques entre les Autochtones et les non-Autochtones.
Méthode: Nous avons recruté 394 patients diabétiques dans les régions sanitaires de Peace et de Keeweetinok Lakes. De ces patients, 354 ont indiqué s’ils étaient autochtones ou non; 94 ont dit l’être. Nous avons recueilli les données de référence et de suivi au moyen d’entretiens, d’examens médicaux standardisés, d’épreuves de laboratoire et de questionnaires d’auto-évaluation (le RAND- 12 et le HUI3).
Résultats: Les Autochtones étaient plus jeunes, ils étaient diabétiques depuis plus longtemps, ils comptaient proportionnellement plus de femmes dans leurs rangs, et ils étaient moins susceptibles d’avoir terminé leurs études secondaires. Dans les données de référence, leur état de santé autoperçu était uniformément pire que celui des non-Autochtones, mais ces écarts disparaissent après ajustement selon les facteurs confusionnels sociodémographiques, sauf pour l’état de santé mentale autoperçu. Les Autochtones considéraient leur état de santé mentale pire que celui des non-Autochtones dans les données de référence. Nous avons aussi observé des écarts dans certains aspects de leur utilisation des services de santé.
Discussion: Malgré un profil démographique différent et quelques écarts au chapitre de l’utilisation des services de santé, dans l’ensemble, notre analyse démontre que le fait d’être autochtone ne contribue pas aux résultats du diabète lorsqu’on apporte des ajustements selon les variables pertinentes.
Footnotes
for the DOVE Investigators
Sources of funding: Financial support was provided by the Institute of Health Economics and the Canadian Diabetes Association. La traduction du résumé se trouve à la fin de l’article.
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