End Stage Renal Disease Among People with Diabetes: A Comparison of First Nations People and Other Saskatchewan Residents from 1981 to 2005



      Since First Nations people (FN) with diabetes experience higher rates of end-stage renal disease (ESRD) than others, we aimed to better understand these disparities by comparing the epidemiology of ESRD between FN and other Saskatchewan residents (OSK) with diabetes over a prolonged period.


      We used healthcare system administrative databases to determine ESRD rates, distribution and mortality by ethnicity, age and sex among total diabetes populations in Saskatchewan from 1981 to 2005.


      Although similar initially, ESRD incidence among FN with diabetes peaked at levels 3 to 4 times higher than OSK with diabetes by 1991 to 1996. Differences in ESRD prevalence between diabetes populations were less pronounced. OSK men with diabetes experienced higher ESRD rates than OSK women with diabetes, while sex differences among FN were variable. FN with diabetes and ESRD were younger than OSK at diabetes diagnosis and experienced a longer time from diabetes to ESRD diagnosis. However, survival of FN adults with diabetes after ESRD diagnosis was reduced compared to others.


      Ethnicity-based disparities in ESRD incidence among people with diabetes remain pronounced, particularly among women. Differential mortality pre-ESRD may contribute to these differences, because FN are younger at diabetes diagnosis. This favours longer survival and increased exposure to the metabolic consequences of diabetes.


      OBJECTIF :

      Comme l'incidence de l'insuffisance renale au stade ultime (IRSU) est plus elevee chez les membres des Premieres Nations (MPN) qui sont diabetiques, nous avons cherche a expliquer la disparite en comparant, pendant une longue periode, l'epidemiologie de l'IRSU chez les MPN et chez les autres habitants de la Saskatchewan (AHS) atteints de diabete.

      METHODES :

      Nous avons utilise les bases de donnees administratives du systeme de sante pour determiner l'incidence et la distribution de l'IRSU et les taux de mortalite par IRSU en fonction de l'ethnicite, de l'age et du sexe chez l'ensemble des patients diabetiques de la Saskatchewan de 1981 a 2005.


      L'incidence de l'IRSU etait semblable au depart, mais entre 1991 et 1996, elle etait de trois a quatre fois plus elevee chez les MPN diabetiques que chez les AHS diabetiques. Les differences entre les populations de diabetiques ont ete moins marquees pour ce qui est de la prevalence de l'IRSU. L'incidence de l'IRSU etait plus elevee chez les AHS diabetiques de sexe masculin que de sexe feminin, mais chez les MPN, les differences entre les sexes etaient variables. Les MPN atteints de diabete et d'IRSU etaient plus jeunes que les AHS au moment du diagnostic de diabete et souffraient de diabete depuis plus longtemps au moment du diagnostic d'IRSU. Toutefois, les MPN diabetiques d'age adulte vivaient moins longtemps que les autres apres le diagnostic d'IRSU.


      Les disparites ethniques quant a l'incidence de l'IRSU chez les personnes diabetiques demeurent marquees, surtout chez les femmes. La mortalite differentielle avant l'IRSU pourrait contribuer a expliquer ces differences. En effet, comme les MPN sont plus jeunes au moment du diagnostic de diabete, leur survie est plus longue et ils sont davantage exposes aux repercussions metaboliques du diabete.



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