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The post-fracture care gap among Canadian First Nations peoples: a retrospective cohort study

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Abstract

Summary

Despite targeted attempts to reduce post-fracture care gaps, we hypothesized that a larger care gap would be experienced by First Nations compared to non-First Nations people. First Nations peoples were eight times less likely to receive post-fracture care compared to non-First Nations peoples, representing a clinically significant ethnic difference in post-fracture care.

Introduction

First Nations peoples are the largest group of aboriginal (indigenous or native) peoples in Canada. Canadian First Nations peoples have a greater risk of fracture compared to non-First Nations peoples. We hypothesized that ethnicity might be associated with a larger gap in post-fracture care.

Methods

Non-traumatic major osteoporotic fractures for First Nations and non-First Nations peoples aged ≥50 years were identified from a population-based data repository for Manitoba, Canada between April 1996 and March 2002. Logistic regression analysis was used to examine the probability of receiving a BMD test, a diagnosis of osteoporosis, or beginning an osteoporosis-related drug in the 6 months post-fracture.

Results

A total of 11,234 major osteoporotic fractures were identified; 502 occurred in First Nations peoples. After adjustment for confounding covariates, First Nations peoples were less likely to receive a BMD test [odds ratio (OR) 0.1, 95% confidence interval (CI), 0.0–0.5], osteoporosis-related drug treatment (OR, 0.5; 95% CI, 0.3–0.7), or a diagnosis of osteoporosis (OR, 0.5; 95% CI, 0.3–0.7) following a fracture compared to non-First Nations peoples. Females were more likely to have a BMD test (OR, 5.0; 95% CI, 2.6–9.3), to be diagnosed with osteoporosis (OR, 1.7; 95% CI, 1.5–2.0), and to begin drug treatment (OR, 4.1; 95% CI, 2.7–6.4) compared to males.

Conclusions

An ethnicity difference in post-fracture care was observed. Further work is needed to elucidate underlying mechanisms for this difference and to determine whether failure to initiate treatment originates with the medical practitioner, the patient, or a combination of both. It is imperative that all residents of Manitoba receive efficacious and equal care post-fracture, regardless of ethnicity.

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Acknowledgments

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC project # 2000/2001-08). The authors are indebted to the First Nations and Inuit Health Branch and Aboriginal Affairs and Northern Development Canada for permission to use the Status Verification System and to the Health Information Research Committee of the Assembly of Manitoba Chiefs for actively supporting this work. The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, the Assembly of Manitoba Chiefs, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

Funding

This research was funded through an operating grant (ACB-65731) from the Canadian Institutes of Health Research (CIHR). Sharon L. Brennan was funded by a National Health and Medical Research Council (NHMRC) of Australian Early Career Fellowship (#1012472). Lisa M. Lix was funded by a CIHR New Investigator Award.

Conflicts of interest

William D. Leslie received speaker fees and research grants from Merck Frosst Canada Ltd and research grants from Sanofi-Aventis, Procter & Gamble Pharmaceuticals, Novartis, Amgen Pharmaceuticals, and Genzyme. He is also a member of the advisory board for Genzyme, Novartis, and Amgen Pharmaceuticals. Lisa M. Lix and Colleen Metge both received a research grant from Amgen. Authors Sharon L. Brennan, Heather J. Prior, and Brenda Elias declared that they have no competing interests.

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Authors and Affiliations

  1. Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, Canada, R2H 2A6

    W. D. Leslie

  2. Department of Medicine, NorthWest Academic Centre, University of Melbourne, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia

    S. L. Brennan

  3. Barwon Epidemiology and Biostatistics Unit, School of Medicine, Department of Medicine, Barwon Health, Deakin University, Ryrie Street, Geelong, VIC, 3220, Australia

    S. L. Brennan

  4. Manitoba Centre for Health Policy, University of Manitoba, 408, 727 McDermot Avenue, Winnipeg, Canada, R3E 3P5

    H. J. Prior & C. Metge

  5. School of Public Health, University of Saskatchewan, 105 Administration Place, Saskatoon, Canada, S7N 5A2

    L. M. Lix

  6. Centre for Aboriginal Health Research, University of Manitoba, 409 Tache Avenue, Winnipeg, Canada, R2H 2A6

    B. Elias

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  1. W. D. Leslie
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Correspondence to W. D. Leslie.

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Leslie, W.D., Brennan, S.L., Prior, H.J. et al. The post-fracture care gap among Canadian First Nations peoples: a retrospective cohort study. Osteoporos Int 23, 929–936 (2012). https://doi.org/10.1007/s00198-011-1880-y

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