First Nations’ hospital readmission ending in death: a potential sentinel indicator of inequity?

Figures & data

Table 1. Categories of ACSC explored in this study

Categories of ACSC	Conditions
Chronic conditions	Diabetes; Diabetes with complications; Hypertension; Asthma; acute Bronchitis; Chronic Obstructive Pulmonary Disease (COPD), Pneumonia; Epilepsy; Angina, Heart Failure and Pulmonary Oedema; Iron Deficiency Anaemia
Acute conditions	Dental Conditions; Cellulitis; Severe Ear, Nose, and Throat infections (ENT)
Mental health	Schizophrenia and mood disorder
Vaccine preventable conditions	Hepatitis A and B; Influenza; Haemophilic Influenza; Measles; Mumps; Rubella; Meningitis; Tuberculosis; Tetanus; Rubella; Poliomyelitis; Pertussis
All ACSC	All conditions combined

Table 2. Most prevalent diagnoses for readmission ending in death, in percentage

ICD-9 codes and definition	FN	R&R	R&NR	RM	Urban
436 Acute, ill-defined cerebrovascular disease				2.51	2.11
486 Pneumonia, organism unspecified		2.68	6.83	2.15	1.87
496 Chronic airway obstruction	6.56	12.05	8.7	11.11	9.7
2504 Diabetes with renal manifestations	6.01				1.37
2507 Diabetes with peripheral circulatory disorders	3.83				2.24
4101 Acute myocardial infarctions of other anterior wall		2.68			0.75
4109 Acute myocardial infarction, unspecified site	6.56	3.13		3.23	1.87
4148 Other specified forms chronic ischaemic heart disease				2.15	1.87
4275 Cardiac arrest		2.68			1.12
4280 Congestive heart failure	13.66	24.55	18.63	22.94	20.52
4281 Left heart failure		3.57			1.24
4912 Obstructive chronic bronchitis			4.35	5.73	3.61
5188 Other diseases of the lung	3.83	3.13	4.35		1.62
7855 Shock without mention of trauma				2.15	1.12
All other diagnoses	59.56	45.54	57.14	48.03	48.99
Total	100.00	100.01	100.00	100.00	100.00

FN: FN; R&R: rural remote communities; R&NR: rural communities that are not remote; RM: rural areas that are not organised as municipalities.

Table 3. Frequencies and percentages of ACSC readmissions ending in death by Regional Health Authority (RHA) and type of community (population), 1986–2016

	IE Interlake-Eastern RHA		NO Northern Health Region		SO Southern Health-Santé Sud		WE Prairie Mountain Health		WP Winnipeg RHA
FN living on-reserve as % of RHA population	8.9%		41.0%		2.2%		3.3%		0
% of All Initial ACSC Hospitalisations within each discharging hospital RHA that were for patients from FN Communities	30.06%		48.13%		16.00%		18.46%		5.55%
Community Type (of patient)	Freq.	%	Freq.	%	Freq.	%	Freq.	%	Freq.	%
FN Communities	37	24.83	76	49.67	s	s	37	9.84	28	3.26
Rural Communities that are also remote	28	18.79	30	19.61	40	19.51	130	34.57	9	1.05
Rural Communities that are not considered remote	21	14.09	32	20.92	81	39.51	24	6.38	14	1.63
Rural municipalities/Local Government Districts (rural sparsely populated area with few services)	52	34.90	s	S	62	30.24	107	28.46	53	6.18
Urban Communities	11	7.38	s	S	s	s	78	20.74	754	87.88

S = number suppressed because N < 5.

Table 4. Frequencies and percentages of ACSC readmissions ending in death by Re–Admission Hospital Type and type of community (population), 1986–2016

Facility type	Tertiary		Urban Community		Major Rural		Intermediate Rural		Small Rural		Long term Care Facility
Community Type (of patient)	Freq.	%	Freq.	%	Freq.	%	Freq.	%	Freq.	%	Freq.	%
FN Communities	42	9.29	s	s	77	20.59	26	14.53	34	22.08	7	17.95
Rural Communities that are also remote	16	3.54	17	3.15	46	12.30	92	51.40	49	31.82	17	43.59
Rural Communities that are not considered remote	11	2.43	s	s	154	41.18	s	s	0	0.00	0	0.00
Rural municipalities/Local Government Districts (rural sparsely populated area with few services)	22	4.87	40	7.41	89	23.80	55	30.73	65	42.21	15	38.46
Urban Communities	361	79.87	468	86.67	8	2.14	s	s	6	3.90	0	0.00

S = number suppressed because N < 5.

Table 5. Readmissions ending in death by Tribal Council and municipalities, 1986–2016

Tribal Council*	PMR	Readmissions ending in death
		% change (different than 0)	Direction	P value
Dakota Ojibway	7.35	1.36	Increasing	0.25
Independent North	7.46	4.60	Increasing	0.03*
Independent South	5.76	1.50	Increasing	0.58
Swampy Cree	7.34	1.92	Decreasing	0.05*
West Region	5.98	3.89	Increasing	0.34
General population
Rural municipalities/Local Government Districts (rural sparsely populated area with few services)	3.00	0.53	Increasing	0.56
Rural Communities that are not considered remote	3.65	0.30	Increasing	0.70
Rural Communities that are also remote	3.76	0.23	Decreasing	0.79
Urban Communities (communities with populations over 8000 inhabitants)	3.07	0.67	Decreasing	0.08
All Manitoba (ACSC)	3.57	0.47	Increasing	<.0001*

Interlake Reserve, Island Lake, Keewatin, and Southeast Resource Rev Council were excluded because of low numbers.