Acute health care among Indigenous patients in Canada: a scoping review

Figures & data

Figure 1. Research strategy for medline

Figure 2. Flow diagram

Figure 3. Distribution of articles by province

Figure 4. Studies’ design

Figure 5. Distribution of articles by year of publication

Table 1. Main features of articles

Indigenous Peoples by group: First Nations Métis Inuit Non specified Indigenous peoples	54 14 21 45
Age of population cohorts	All ages: 57 Paediatric*: 29 Adults*: 28
Type of acute health care Hospitalisation Emergency department visits Intensive care unit admissions Surgical intervention Other/Non defined	84 29 8 6 5
Journals which published >1 retrieved articles	Am J Public Health: 4 Am J Resp Crit Care: 2 BMC Public Health: 2 C J Public Health: 4 Can J of Cardiol: 3 Can J of Psychiat: 2 Chest: 2 CJEM: 3 CMAJ: 6 CMAJ Open: 2 Chron Dis Inj Can: 2 Ethnic Health: 2 Health Rep: 4 Int J Infect Dis: 2 Int J Circumpol Heal: 7 J Pediatr: 2 J Rheumatol: 2 Pediatr Infect Dis J: 3 Pediatr Pulm: 2 PLoS One: 3

* Given that the age of majority differs between provinces, the distinction between paediatric and adult patients was adjusted according to the province of origin of the studies. The age of majority is 18 years old in Alberta, Prince-Edward-Island, Manitoba, Ontario, Quebec and Saskatchewan and is 19 years old in British Columbia, New-Brunswick, Nova-Scotia, Nunavut, Newfoundland and Labrador, Northwest territory and Yukon.

Table 2. Distribution of articles by studied outcomes

Outcomes	Number of articles (%)
Health care satisfaction	9 (7.9%)
Access to care	14 (12.3%)
Hospitalisation rate	67 (58.8%)
Emergency department visit rate	26 (22.8%)
Mortality	29 (25.4%)
Quality of care	28 (24.6%)
Length of stay	32 (28.0%)
Cost	7 (6.1%)

Table 3. Studied health conditions

Illness	Number of articles
Pulmonary diseases Injuries and poisonings Cardiovascular diseases Psychiatric diseases Rheumatologic diseases Neurological diseases Endocrine-related conditions Paediatric-related diseases Gastrointestinal diseases Infectiology-related diseases Obstetrical and gynaecological conditions Nephrological-related conditions	27 16 9 8 5 5 5 5 4 4 4 1

Table

PULMONARY DISEASES (n = 27)
Main author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Alaghehbandan (2005, Am J of Epidemiology) (49)	Newfoundland and Labrador Retrospective	Pneumonia Hospitalisation	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Hospitalisation rates (/1000) (p < 0.0001) In-hospital mortality Length of stay	Gr 1: 11.6 (Innu: 16.9; Inuit 8.4); Gr 2: 3.0 Lower for Indigenous Shorter for Indigenous	7/11
Alaghehbandan (2007, Int J Infect Dis) (50)	Newfoundland and Labrador Retrospective	Pneumonia Hospitalisation	Innu and Inuit from Labrador (Gr 1) Non-Indigenous people from Newfoundland (Gr 2) All ages F/M	Standardised hospitalisations rates (/1000) (95% CI) Mortality (p < 0.00001) Median length of stay (days)	Gr 1: 4.82 (4.21-5.37); Gr 2: 1.03 (0.96-1. Gr 1: 2.1%; Gr 2: 10.1% Gr 1: 3.0; Gr 2: 5.0	18/22
Alharbi (2012, BMC Infect Dis) (105)	Manitoba Retrospective	LRTI ED visits	Indigenous people <5 y.o. F/M	ED visits rates Mortality	112/193 (58%) 0%	15/22
Banerji (2001, CMAJ) (35)	Nunavut Prospective	LRTI Hospitalisation	Inuit <6 months old F/M	Annualised incidence rate of admission (/1000)	484	12/22
Banerji (2001, Int J Circumpol Heal) (34)	Nunavut Prospective	Bronchiolitis Hospitalisation	Inuit <1 y.o. F/M	Rate of hospital admission (/1000)	306	10/22
Banerji, Greenberg et al (2009, Pediatr Infect Dis J) (51)	Nunavut Retrospective	LRTI Hospitalisation	Inuit Baffin Island (Gr 1) Iqaluit (Gr 2) Rural communities (Gr 3) High-risk communities (Gr 4) <1 y.o. F/M	Odds ratio for hospitalisation (95% CI) Average cost per admission (< 1 year old/ < 6 months old) Annual admission rate/1000 live births without use of Palivizumab (<1 year old/ <6 months old)	Inuit: 3.8 (1.1-12.8) Gr 1: 19,014$/21,145$; Gr 2: 3915$/ 3621$; Gr 3: 21,345$/23,030$; Gr 4: 20,770$/ 22,673$ Gr 1: 166/245; Gr 2: 63/72; Gr 3: 216/328; Gr 4: 349/512	14/22
Banerji (2013, Int J Circumpol Heal) (36)	Nunavut, Quebec, Northwest territory Prospective	LRTI Hospitalisation	Inuit Northwest Territory (Gr 1) Nunavut (Gr 2) Nunavik (Gr 3) <1 y.o. F/M	Hospitalisation rates/1000 live births Median length of stay (days) Cost per admission	Gr 1: 38; Gr 2: 236; Gr 3: 445 Gr 1: 5; Gr 2: 6; Gr 3: 5 Gr 1: 36,542$; Gr 2: 55,265$; Gr 3: 23,203$	14/22
Charland (2011, Epidemiol Infect) (98)	Quebec Retrospective	Influenza, Bronchitis, Pneumonia ED visits	Mohawks of Kahnawá:ke reserve Non-Indigenous people All ages F/M	Standardised Risk Ratios to visit ED for Mohawks all ages (95% CI)	Influenza: 1.58 (1.49-1.67) Influenza + Pneumonia: 1.51 (1.44-1.58) Influenza + Bronchitis: 1.48 (1.44-1.53) Respiratory infection: 1.21 (1.19-1.23)	15/22
Creery (2005, Int J Circumpol Heal) (37)	Nunavut Retrospective	Bronchiolitis Hospitalisation	Inuit < 1 y.o. F/M	Annual admission rate of children <1 year old Average length of stay (days) Overall average cost per admission Cost per admission to Baffin Regional Hospital Cost per admission to CHEO	197/1000 5.7 14,273$ 12,029$ 45,688$	17/22
Gershon (2014, PLoS One) (40)	Ontario Retrospective	Asthma, COPD Hospitalisation, ED visits	Metis of Ontario (Gr 1) Other Ontarians (Gr 2) ≥ 20 y.o. F/M	Standardised rates/1000 for people with Asthma (95% CI) Standardised rates /1000 for people with COPD (95% CI) Standardised all-cause mortality/1000 Metis/Ontarians	All-cause ED visits: Gr 1: 761.7 (729.0-795.8); Gr 2: 563.9 (562.9-565.0) Asthma ED visits: Gr 1: 26.3 (21.2-32.2); Gr 2: 21.5 (21.3-21.7) All-cause hospitalisations: Gr 1: 118.9 (104.5-134.7); Gr 2: 93.1 (92.6-93.5) Asthma hospitalisations: Gr 1: 5.8 (3.2-9.8); Gr 2: 4.7 (4.6-4.8) All-cause ED visits: Gr 1: 910.7 (861.3-962.2); Gr 2: 674.3 (672.5-676.2) COPD ED visits: Gr 1: 26.7 (20.4-34.3); Gr 2: 32.2 (31.9-32.5) All-cause hospitalisations: Gr 1: 176.3 (155.9-198.5); Gr 2: 132.7 (132.0-133.4) COPD hospitalisations: Gr 1: 32.9 (25.1-42.3); Gr 2: 25.0 (24.7-25.3) Asthma: 68.0/65.0 (p = 0.67) COPD: 39.0/29.0 (p = 0.01)	21/22
Houston (1979, CMAJ) (114)	Saskatchewan Prospective	Pneumonia Hospitalisation	Indigenous people (Gr 1) Whites (Gr 2) <14 y.o. F/M	Mortality Average length of stay (days)	Gr 1: 4/102; Gr 2: 0/64 Whites Gr 1: 26.9; Gr 2: 8.7	11/22
Hui (2016, Pediatr Infect Dis J) (54)	All provinces Prospective	LRTI Hospitalisation, ICU admissions	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) <1 y.o. F/M	Hazard ratio of hospitalisation (95% CI; p) % of ICU admission (p = 0.334) Mean Length of stay (days) (p = 0.598)	Gr 1: 1.2 (0.7-2.2; p = 0.383) Gr 1: 17.4%; Gr 2: 21.5% Gr 1: 9.0; Gr 2: 8.3	16/22
Jung (2011, Am J Resp Crit Care) (115)	All provinces Prospective	H1N1 Influenza A Hospitalisation ICU admissions	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Hospitalised critically ill patients (384 patients) Mortality (p = 0.25) Frequency of reception of antivirals (p = 0.50) Mean ICU length of stay (days) (p = 0.72) Mean hospital length of stay (days) (p = 0.20)	Gr 1: 16.7% Gr 1: 15.6%; Gr 2: 23.8% Gr 1: 92.2%; Gr 2: 94.4% Gr 1: 17.0; Gr 2: 14.6 Gr 1: 23.2; Gr 2: 24.4	9/11
Marrie (2004, Can Respir J) (22)	Alberta Retrospective	Pneumonia Hospitalisation	First Nations people (Gr 1) Non-First Nations people (Gr 2) ≥ 18 y.o. F/M	Hospital discharge rate for community acquired pneumonia/1000 (95% CI) Hospital discharge rate for aspiration pneumonia/1000 (95% CI) Mean distance to closest hospital (km) Mortality odds ratio (95% CI) Median length of stay (days) Odds ratio for daily hospital cost higher than the median cost of 722.71$ (95% CI)	Gr 1: 22.1 (20.7-23.6); Gr 2: 4.4 (4.4-4.5) Gr 1: 1.29 (0.96-1.6); Gr 2: 0.27 (0.26-0.29) Gr 1: 21; Gr 2: 6 Gr 1: 0.49 (0.37-0.66) Gr 1: 6.1; Gr 2: 7.8 Gr 1: 1.25 (1.14-1.36)	14/22
McCuskee (2014, Pediatr Infect Dis J) (52)	Ontario Retrospective	Bronchiolitis, Pneumonia Hospitalisation	First Nations people of Sioux Lookout Zone (Gr 1) Non-First Nations people (Gr 2) <1 y.o. F/M	Admission rate for < 1 year old (p = 0.011) Admission rate for <6 months old Mean length of stay	Gr 1: 4.4%; Gr 2: 2.5% Gr 1: 5.6% 3.2 days	17/22
Morrison (2014, Health Place) (23)	Manitoba Retrospective	H1N1 Influenza A Hospitalisation	First Nations people on-reserve All ages F/M	Access to care (p<0.001) Odds ratio for hospitalisation	On-reserve First Nations have a longer delay between infection and hospitalisation. OR = 2.34 (1.16-4.73)	18/22
Mostaco-Guidolin (2013, Am J Public Health) (53)	Manitoba Retrospective	H1N1 Influenza A Hospitalisation	First Nations people Non-First Nations people All ages F/M	Hospitalisation risk ratio (p < 0.001)	In all First Nations age groups during the first wave, they were significantly higher than those in non-First Nations age groups.	15/22
Ospina (2015, Am J Resp Crit Care) (92)	Alberta Retrospective	COPD Hospitalisation	Indigenous (Gr 1) First Nations (Gr 2) Metis (Gr 3) Inuit (Gr 4) Non-Indigenous (Gr 5) All ages F/M	Risk ratios for hospitalisation for all causes (95% CI) Risk ratios for hospitalisation for AECOPD (95% CI) Median hospital length of stay (days)	Gr 1: 1.31 (1.24-1.37); Gr 2:1.60 (1.52-1.69); Gr 3: 0.80 (0.72-0.88); Gr 4: 0.71 (0.64-0.79) Gr 2: 1.44 (1.26-1.65); Gr 3: 1.10 (0.89-1.36); Gr 4: 0.67 (0.52-0.86) Gr 2: 5; Gr 3: 5; Gr 4: 4 All shorter than for Non-Aboriginals.	10/11
Ospina (2016, CJEM) (93)	Alberta Retrospective	COPD ED visits	Indigenous (Gr 1) First Nations (Gr 2) Métis (Gr 3) Inuit (Gr 4) Non-Indigenous (Gr 5) ≥ 35 y.o. F/M	Adjusted Risk Ratio for ED visits rates (95% CI) Median ED length of stay (hours)	Gr 1: 1.72 (1.67-1.77); Gr 2: 2.02 (1.97-2.08); Gr 3: 1.28 (1.22-1.35); Gr 4: 0.94 (0.90-0.98) Gr 1: 2.8; Gr 2: 2.9; Gr 3: 2.4; Gr 4: 2.2; Gr 5: 3.7	16/22

Table

Poling (2014, Can J of rural medicine) (108)	Ontario Retrospective	Pneumonia Hospitalisation	First Nations people (87%) Non-Indigenous people All ages F/M	% of death resulting from pneumonia Mean length of stay (days)	3% 5.32	15/22
Rosychuk (2010, Pediatr Pulm) (99)	Alberta Prospective	Croup ED visits	Indigenous people (Gr 1) Alberta’s population (Gr 2) ≤ 2 y.o. F/M	ED visit rates/1000 infants for croup (95% CI)	1999-2000: Gr 1: 28.1 (23.7-32.4); Gr 2: 43.4 (41.8-44.9) 2004-2005: Gr 1: 29.7 (24.9-34.5); Gr 2: 34.1 (32.8-35.4)	17/22
Rosychuk (2010, Pediatr Pulm) (94)	Alberta Prospective	Asthma ED visits	Indigenous people (Gr 1) Alberta’s population (Gr 2) <18 y.o. F/M	Directly standardised rates per 1000 for ED visits for asthma (95% CI)	1999-2000: Gr 1: 28.1 (26.0-30.2); Gr 2: 21.1 (20.5-21.6) 2004-2005: Gr 1: 29.7 (27.5-31.9); Gr 2: 19.8 (19.3-20.2)	17/22
Rowe (2009, Chest) (95)	Alberta Retrospective	Asthma ED visits	Indigenous people (Gr 1) Alberta’s population (Gr 2) ≥ 18 y.o. F/M	ED visits rates (95% CI)	Gr 1: 14.9 (13.2-16.5); Gr 2: 6.8 (6.6-6.9)	16/22
Senthilselvan (1995, J Clin Epidemiol) (56)	Saskatchewan Retrospective	Asthma Hospitalisation	Indigenous people (Gr 1) Saskatchewan population (Gr 2) <65 y.o. F/M	Hospitalisation risk ratios for Gr 1 for 1985-1989 (95% CI) Hospitalisation rates/1000 for Gr 1 in 1989 Average length of stay	0-4 y.o.: 2.97 (2.75-3.20); 5-14 y.o.: 0.78 (0.67-0.92) 15-34 y.o.: 0.99 (0.81-1.21); 35-64 y.o.: 2.83 (2.42-3.33) 0-4 y.o.: Asthma: 21.73; Bronchitis: 53.47; LRTI: 4.11 35-64 y.o.: Asthma:3.43; Bronchitis: 5.24; LRTI: 3.24 Greater for Indigenous children under 14 years of age	15/22
Sin (2002, Chest) (96)	Alberta Retrospective	Asthma, COPD ED visits	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Risk ratio for ED visits for Gr 1 (95% CI) Quality of care	2.10 (2.01-2.19) Indigenous 55% less likely to see a specialist and 66% less likely to undergo spirometry	13/22
Sin (2004, Arch Pediat Adol Med) (97)	Alberta Retrospective	Asthma ED visits	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) 0-10 y.o. F/M	Risk ratio for ED visits for Gr 1 (95% CI)	1.20 (1.11-1.29)	17/22
Wang (1995, J Pediatr) (55)	Nova Scotia, Quebec, Ontario, Manitoba, British Columbia Prospective	LRTI ICU admission	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) <2 y.o. F/M	Odds ratio for ICU admission (95% CI) 95% CI odds ratio for ventilation Prolonged hospitalisation in days	Gr 1: 3.1 (1.0-9.2) Gr 1: 0.3-2.3 Gr 1 1.2 (1.1-1.4)	17/22

Table

INJURIES AND POISONINGS (n = 16)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Alaghehbandan (2010, Int J Circumpol Heal) (57)	Newfoundland and Labrador Retrospective	Unintentional injuries Hospitalisation	Indigenous people (Gr 1) Innu (Gr 2) Inuit (Gr 3) Metis (Gr 4) Non-Indigenous people (Gr 5) ≤ 19 y.o. F/M	Hospitalisation rates/100,000 (95% CI) Risk ratio for hospitalisation for Aboriginals (95% CI) Mortality/100,000 (p <0.001)	Gr 2: 1329.2 (1008.3-1650.2); Gr 3: 972.1 (731.3-1212.9); Gr 4: 1142.3 (857.3-1427.4); Gr 5: 614.2 (597.1-631.3) 0-4 y.o.: 1.78 (1.30-2.45); 5-9 y.o.: 1.62 (1.18-2.22); 10-14 y.o.: 1.83 (1.38-2.42); 15-19 y.o.: 2.28 (1.76-2.95) Gr 1: 84.3; Gr 5: 10.2	18/22
Alaghehbandan (2012, Burns) (58)	Newfoundland and Labrador Retrospective	Burns Hospitalisation	Low % of Indigenous people areas (Gr 1) High % of Indigenous people areas (Gr 2) ≤ 16 y.o. F/M	Hospitalisation rates/100,000 Median length of stay (days)	Total: (p <0.001)) Gr 1: 20.3/ Gr 2: 51.4 Gr 1: 5.0; Gr 2: 3.0	16/22
Anne George (2013, Int J Circumpol Heal) (59)	British Columbia Retrospective	Injuries Hospitalisation Primary care visits	First Nations people (Gr 1) Non-First Nations people (Gr 2) All ages F/M	Standardised risk ratio to be hospitalised Standardised risk ratio to visit primary care	Gr 1: 1.3-3.7; Gr 2: 0.6-1.9 * RR varies with health service delivery areas Gr 1: 1.2-2.1; Gr 2: 0.8-1.3	13/22
Bell (2011, Inj Prev) (60)	British Columbia Retrospective	Injuries Hospitalisation	First Nations people on reserve (Gr 1) People off reserve (Gr 2) <17 y.o. F/M	Hospitalisation rates/100,000 for Mortality rates/100,000 * p ≤ 0.05	Unintentional injuries: Gr 1: 622.2*; Gr 2 322.1 Intentional self harm: Gr 1: 7.5; Gr 2: 8.3 Injuries involving third party: Gr 1: 67.5*; Gr 2: 32.4 Unintentional injuries: Gr 1: 368.1*; Gr 2: 240.4 Intentional self harm: Gr 1: 168.7*; Gr 2: 97.7 Injuries involving third party: Gr 1: 23.0; Gr 2: 14.7	18/22
Boeckx (1977, Paediatrics) (109)	Manitoba Case report	Gasoline sniffing and tetraethyl lead poisoning Hospitalisation	Indigenous people 14 and 16 y.o. F/M	Mortality Type of treatment	1 death/ 2 cases CASE 1: 24h of EDTA and Dimercaprol. Then treatment with penicillamine. Discharge after 4 weeks with continued penicillamine. Returned 3 times to the hospital. The third time: treatment with Phenobarbital and Dilantin failed. He was diagnosed with aspiration pneumonia treated with Cloxacillin and Gentamicin. He died 72h after admission. CASE 2: Multivitamins, IV fluids and glucose. Then 5 days of EDTA twice. Then penicillamine for 4 weeks. He was readmitted and treated again because of gasoline sniffing 6 months later.	7/13
Bougie (2014, Health Rep) (65)	All provinces except Quebec Retrospective	Unintentional injuries Hospitalisation	Areas with a high % of First Nations people (Gr 1) Areas with a low % of Indigenous people (Gr 2) All ages F/M	Rate ratios for unintentional injury hospitalisations	Gr 1: Females: 1.25; Males: 1.20 Gr 2: Females: 1.20; Males: 1.23	17/22
Brussoni (2014, Prev Sci) (66)	British Columbia Retrospective	Injuries Hospitalisation	Indigenous people (Gr 1) North American Indians (Gr 2) Non-Indigenous people (Gr 5) All ages F/M	Standard relative risk of injury hospitalisation (95% CI)	Gr 1: 1.049 (0.994-1.107) Gr 2: 1.040 (0.984-1.098)	14/22
Brussoni (2016, BMC Public Health) (62)	British Columbia Retrospective	Injuries Hospitalisation	Indigenous people (Gr 1) On-reserve metropolitan (Gr 2) On-reserve non-metropolitan (Gr 3) Off-reserve metropolitan (Gr 4) Off-reserve non-metropolitan (Gr 5) British Columbia (Gr 6) All ages F/M	Standard relative risk of hospitalisation (95% CI)	Gr 1: 2.61 (2.58-2.64) Gr 2: 2.44 (2.34-2.54) Gr 3: 3.04 (2.98-3.10) Gr 4 1.99 (1.93-2.04) Gr 5: 2.51 (2.46-2.56) Gr 6: 1.0	18/22
Brussoni (2018, PLoS One) (63)	British Columbia Retrospective	Unintentional transport injuries Hospitalisation	Indigenous people (Gr 1) British Columbia population (Gr 2) All ages F/M	Standardised rate ratios (95% CI)	Gr 1, Females: 2.13 (2.03-2.24) Gr 1. Males: 1.69 (1.63-1.75)	15/22
Callegari (1989, Burns Incl Therm Inj) (116)	Alberta Retrospective	Burns Hospitalisation	Indigenous people (Treaty Indians and Metis) (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Deaths % Treatment: Gr 1/ Gr 2 (p <0.05) Number of days in hospital (p <0.05)	Gr 1: 4.8%; Gr 2: 4.3% Non operative: 34.4%/ 46.9% Surgical with healing: 60.85%/48.85% Surgical with death: 3.2%/1.8% Palliation: 1.6%/2.4% Gr 1: 42.3 days; Gr 2: 25.4 days	16/22
Finès (2013, Chron Dis Inj Can) (61)	All provinces except Quebec Retrospective	Unintentional injuries Hospitalisation	High % First Nations people areas (Gr 1) High % Inuit areas (Gr 2) High % Metis areas (Gr 3) Low % Indigenous people areas (Gr 4) All ages F/M	Age-standardised hospitalisation rate for injuries/10,000 person-years (95% CI) Males/Females	Gr 1: 145.94 (144.13-147.77)/ 103.47 (101.95-105.02) Gr 2: 100.47 (95.14-106.09)/ 86.87 (81.77-92.28) Gr 3: 111.76 (107.71-115.97)/ 73.63 (70.51-76.87) Gr 4: 54.53 (54.36-54.70)/ 37.13 (37.04-37.29)	16/22
Myers (2007, BMC Public Health (68)	Alberta Retrospective	Acetaminophen overdose Hospitalisation	Indigenous people (Gr 1) Alberta’s general population (Gr 2) All ages F/M	Risk ratio for hospitalisation for acetaminophen overdose for Gr 1	RR = 4.04 (p < 0.0005)	16/22
Myers (2007, CJEM) (69)	Alberta Retrospective	Acetaminophen overdose Hospitalisation	Indigenous people (Gr 1) Alberta’s general population (Gr 2) All ages F/M	Risk ratio for hospitalisation for Gr 1 (95% CI)	RR = 4.78 (4.24-5.39)	17/22
Newton, 2015 (CJEM) (106)	Alberta Retrospective	Self harm ED visits	First Nations people (Gr 1) Alberta’s general population (Gr 2) <18 y.o. F/M	Standardised visit rates/100,000 (95% CI) % of follow up visits for children at 30 days	2002-2003: Gr 1: 243.5 (194.8-292.1); Gr 2: 101.2 (93.2-109.1) 2010-2011: Gr 1: 201.5 (156.5-246.4); Gr 2: 70.8 (64.4-77.2) Gr 1: 11.6% Families receiving no subsidy: 65.3% Families receiving human services program subsidy: 6.2% Families receiving government-sponsored program subsidy: 16.9%	17/22
Oliver (2012, Health rep) (64)	All provinces except Quebec Retrospective	Unintentional injuries Hospitalisation	High % First Nation people areas (Gr 1) High % Metis areas (Gr 2) High % Inuit areas (Gr 3) Low % Indigenous areas (Gr 4) 0-19 y.o. F/M	Hospitalisation risk ratio (95% CI)	Gr 1: 2.3 (2.3-2.4); Gr 2: 2.4 (2.2-2.6); Gr 3: 2.2 (2.1-2.4) * RR are higher for Indigenous people for all types of injuries: fall, transportation, struck, poisoning, cut/pierce, fire, environmental, drowning, suffocation.	16/22
Oliver (2014, Chron Dis Inj Can) (67)	All provinces except Quebec Retrospective	Intentional injuries Hospitalisation	High % First Nation people areas (Gr 1) High % Metis areas (Gr 2) High % Inuit areas (Gr 3) Low % Indigenous people areas (Gr 4) All ages F/M	Age-standardised hospitalisation rates per 10,000 person-years for females (95% CI) Age-standardised hospitalisation rates per 10,000 person-years for males (95% CI)	Total self-inflicted: Gr 1: 28.44 (27.53-29.39); Gr 2: 19.14 (17.37-21.09); Gr 3: 44.04 (40.46-47.95); Gr 4: 6.25 (6.19-6.31) Total self-inflicted: Gr 1: 14.39 (13.75-15.06); Gr 2: 9.56 (8.33-10.96); Gr 3: 21.50 (19.07-24.23); Gr 4: 3.77 (3.73-3.82)	17/22

Table

MULTIPLE ACUTE HEALTH PROBLEMS (n = 15)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Carrière (2016, Health Rep) (41)	All provinces except Quebec Retrospective	Acute care Hospitalisation	First Nations people on-reserve (Gr 1) First Nations people off-reserve (Gr 2) Metis (Gr 3) Inuit (Gr 4) Non-Indigenous people (Gr 5) All ages F/M	Age-standardised acute care hospitalisation rates/100,000 (95% CI)	Gr 1: 17,042 (16,901-17,183); Gr 2: 11,190 (11,005-11,379); Gr 3: 9535 (9360-9713); Gr 4: 13,227 (12,865-13,598); Gr 5: 6459 (6440-6479)	17/22
Firestone (2014, BMJ) (31)	Ontario Retrospective	ED visits, Hospitalisation	First Nations people (Gr 1) Non-First Nations people (Gr 2) ≥ 18 y.o. F/M	Number (%) of ED visits for acute reason (95% CI) Gr 1/Gr 2 Number (%) of ED visits for non-acute reasons (95% CI) Gr 1/Gr 2 Perception of availability of healthcare among First Nations adults (95% CI) Hospitalisation rates	None: 50.2% (43.9-57.5)/80.1% 1: 24.7% (18.7-30.1)/13.1% 2-5: 20.7% (15.3-26.1)/6.3% ≥ 6: 4% (1.6-6.9)/0.6% None: 54.3% (47.6-61.2)/81.2% 1: 22.4% (17.3-28.5)/12.2% 2-5: 20.4% (14.5-25.4)/6% ≥ 6: 2.9% (1-5.6)/0.6% Excellent: 16.7% (11.4-22.1); Good: 43.3% (36.1-49.6) Fair: 28.9% (23.3-35.2); Poor: 11.1% (7.9-15.6) Slightly higher among the First Nations population	18/22
Kashuba (1994, C J Public Health) (42)	Alberta Retrospective	Acute diseases Hospitalisation	Blood Indian Band people (Gr 1) Alberta’s population (Gr 2) All ages F/M	Hospital separation rate ratio for Gr 1 Patient days rate ratio for Gr 1 Age-adjusted separation rate ratio for Gr 1	Males: 2.59; Females: 2.65 Males: 2.18; Females: 2.26 Infectious and parasitic diseases: 4.09 Neoplasms: 0.32 Endocrine, nutritional and metabolic diseases: 7.48 Diseases of blood: 2.09 Mental disorders: 6.81 Diseases of the nervous system: 3.23 Diseases of the circulatory system: 1.58 Diseases of the respiratory system: 2.92 Diseases of the digestive system: 2.43 Diseases of the genitourinary system: 1.66 Diseases of the skin: 5.16 Diseases of the musculoskeletal system: 1.88 Conditions originating in the perinatal period: 1.14 Injury and poisoning: 2.79	13/22
Kendall (2016, Harm Reduct J) (43)	Ontario Retrospective	ED visits, Hospitalisation for people who use drugs	Indigenous people (Gr 1) Ottawa’s population (Gr 2) ≥ 16 y.o. F/M	Risk ratio for Gr 1 to have ≥ 2 ED visits (95% CI) Risk ratio for Gr 1 to have ≥ 1 hospitalisation (95% CI)	1.58 (0.98-2.55) 2.39 (95% CI 1.38-4.13)	19/22
Khan (2008, Crit Care Med) (119)	British Columbia Retrospective	Critical diseases Hospitalisation, ICU admissions	First Nations people (Gr 1) European descent people (Gr 2) ≥ 18 y.o. F/M	Median hospital length of stay (days) ICU median length of stay (days) ICU mortality, % (95% CI) Adjusted OR for hospital mortality (95% CI)	Gr 1: 16; Gr 2: 16 Gr 1: 5.7; Gr 2: 8.3 Gr 1: 22.2 (17.4-27.0); Gr 2: 19.0 (18.0-20.1) Gr 1: 1.24 (1.21-1.29)	19/22
Kliewer (2002, CCM and Manitoba Health) (44)	Manitoba Retrospective	Hospitalisation	Metis people (Gr 1) Manitoba’s general population (Gr 2) >15 y.o. F/M	Age-standardised hospitalisation rates/1000	Gr 1, males: 293.4; Gr 1, females: 454.2 Gr 2, males: 228.6; Gr 2, females: 301.9	15/22
Lafond (2016, J Eval Clin Pract) (104)	Saskatchewan Retrospective	ED visits, Hospitalisation	First Nations people (Gr 1) (n = 203) Non-First Nations people (Gr 2) (n = 200) All ages F/M	Emergency department admissions Adjusted mean length of stay (days) (p=0.064) Delay in discharge for Gr 1	Gr 1: 82.8%; Gr 2: 92.5% Gr 1: 12.01; Gr 2: 9.05 17.7% (Delays were related to transportation, bed availability, lack of medical equipment in the community and lack of family support)	20/22
Laupland (2006, J Crit Care) (45)	Alberta Prospective	Critical illnesses ICU admission	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) ≥ 18 y.o. F/M	Annual incidence of critical illness/100,000 Annual incidence of critical illness rate ratio (95% CI; p) Odds ratio for in-hospital death for Status-Aboriginals (95% CI; p) Median ICU length of stay (p = 0.9) Overall median length of hospital stay (p <0.1)	Gr 1: 620.6; Gr 2: 302.6 2.1 (1.78-2.35; p < 0.001) 1.40 (0.88-2.23; p = 0.15) Gr 1: 1.8 days; Gr 2: 1.9 days Gr 1: 9 days; Gr 2: 11 days	16/22
Martens (2005, C J Public Health) (46)	Manitoba Retrospective	Hospitalisation	First Nations people (Gr 1) Manitoba’s general population (Gr 2) All ages F/M	Overall hospitalisation rate per person (p <0.05) Premature mortality rate/1000 (p<0.05) Overall hospital days of care per person (p<0.05)	Gr 1: 0.35; Gr 2: 0.16 Gr 1: 6.61; Gr 2: 3.30 Gr 1: 1.75; Gr 2: 1.05	15/22
Martens (2010, MCHP) (47)	Manitoba Retrospective	Hospitalisation	Metis people (Gr 1) Manitoba’s general population (Gr 2) All ages F/M	Total mortality rates/1000 Premature mortality rates/1000 Hospital separation rates/1000	Gr 1: 9.7; Gr 2: 8.4 (RR for Gr 1 = 1.15) Gr 1: 4.0; Gr 2: 3.3 (RR for Gr 1 = 1.21) Gr 1: 194; Gr 2: 154	16/22
Rivers (2013, J Adolescent Health) (19)	British Columbia Prospective	Health care access	Marginalised young men (22% were Indigenous people) 19-25 y.o. Male	Perception of health care Access to health care	Most youth had positive experiences with nurses and doctors. They preferred immediate access services (emergency room, clinics). Most youth avoided care until their problem couldn’t be ignored. Marginalised young men were more likely to have accessed emergency room.	13/22
Shah (2003, Am J Public Health) (48)	Ontario Retrospective	Hospital admissions for ambulatory care-sensitive conditions (ACSC)	Indigenous people (Gr 1) Ontario’s general population (Gr 2) All ages F/M	Risk ratio for admission for ACSC Risk ratio for utilisation of specialist procedures Risk ratio for utilisation of acute care for insensitive conditions	Gr 1: 2.54 (p <0.001) Gr 1: 0.64 (p <0.001) Gr 1: 1.39 (p <0.001)	14/22
Stergiopoulos (2016, Psychiatr Serv) (26)	British Columbia, Manitoba, Ontario, Quebec, New Brunswick Retrospective	ED visits	Indigenous people (Gr 1) White people (Gr 2) Black people (Gr 3) Adults F/M	Unmet need for health care Adjusted RR for ED visits for Gr 1 (95% CI; p) Adjusted RR for hospital days for Gr 1 (95% CI; p)	Gr 1: 52%; Gr 2: 50%; Gr 3: 32% 0.85 (0.71-1.01; p = 0.07) 0.91 (0.64-1.29; 0.60)	14/22
Waldram (1991, Artic Med Res) (27)	Saskatchewan Prospective	ED visits	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Time from onset of symptoms to contact with a physician (not statistically significant) % of patients who visited an ED in the past year (not statistically significant)	Gr 1: 3.8 days Gr 2 5.0 days Gr 1: 51% Gr 2: 47.6%	11/22
Wen (1996, Ethnic Health) (100)	Ontario Retrospective	ED visits	Indigenous people (Gr 1) Ontario’s general population (Gr 2) 16-64 y.o. F/M	% of people who had an ED visits in the past year Odds ratio for Gr 1 to visit the ED (95% CI)	Gr 1: 32.2%; Gr 2: 22.6% 1.39 (1.00-1.94)	17/22

Table

CARDIOVASCULAR DISEASES (n = 9)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Atzema (2015, PLoS One) (74)	Ontario Retrospective	ACS, CHF, AF, Stroke, HTN Hospitalisation, ED visits	Metis people (Gr 1) Ontario general population (Gr 2) ≥ 20 y.o. F/M	Age and sex-adjusted rate ratios of one-year disease-specific hospitalisations for Gr 1 (95% CI; p) Age and sex-adjusted all-cause mortality/100 in the year after diagnosis Gr 1/Gr 2 (95% CI) Age and sex-adjusted cardiovascular mortality in the year after diagnosis/100 Gr 1/Gr 2 (95% CI) Frequency of beta-blocker use within 3 months after ACS diagnosis (95% CI) Frequency of outpatient echocardiogram within 6 months after AF diagnosis (95% CI) Rate ratio for ED visits for Gr 1 in the year after diagnosis (95% CI)	ACS: 1.23 (0.95-1.61; p = 0.12) CHF: 1.93 (1.34-2.78; p <0.001) Stroke: 1.03 (0.54-1.98; p= 0.93) AF: 1.23 (0.73-2.08; p = 0.44) HTN: 2.27 (1.88-2.74; p <0.001) ACS: 11.5 (5.7-17.2)/ 16.2 (16.1-16.4) CHF: 25.2 (13.1-37.3)/ 22.80 (22.5-23.1) Stroke: 20.7 (13.0-28.5)/ 14.8 (14.6-15.0) AF: 16.6 (7.3-25.4)/ 7.8 (7.4-8.1) HTN: 1.8 (0.89-2.6)/ 1.3 (1.2-1.3) ACS: 9.8 (4.7-14.8)/ 11.4 (11.3-11.6) CHF: 13.0 (6.5-19.5)/ 9.3 (9.1-9.5) Stroke: 25.4 (13.4-37.3)/ 21.8 (21.4-22.1) AF: 10.0 (2.4-17.7)/ 4.8 (4.6-5.0) HTN: 0.82 (0.24-1.4)/ 0.54 (0.52-0.56) Gr 1: 77.8% (67.8-85.9); Gr 2: 66.9% (66.6-67.3) Gr 1: 52.9% (38.5-67.1); Gr 2: 42.1% (41.5-42.6) CHF: 2.03 (1.47-2.80) HTN: 1.51 (0.95-2.40)	19/22
Bresee (2014, CMAJ) (118)	Alberta Retrospective	AMI Coronary angiography, PCI, CABG	First Nations people (Gr 1) Non-First Nations (Gr 2) >18 y.o. F/M	Adjusted odds ratio of coronary angiography within 1 day after AMI (95% CI) Adjusted hazard ratios for likelihood of PCI after coronary angiography (95% CI) Adjusted hazard ratios for likelihood of CABG after coronary angiography (95% CI) Adjusted hazard ratios for all-cause mortality for Gr 1 after coronary angiography (95% CI)	Gr 1: 0.73 (0.62-0.87) Gr 1: 0.92 (0.83-1.02) Gr 1: 1.03 (0.85-1.25) Medical management: 1.38 (1.07-1.77) PCI: 1.38 (1.06-1.80); CABG: 0.91 (0.56-1.47)	19/22
King (2009, Am J Cardiol) (25)	Alberta Retrospective	AMI ED visits, PCI, CABG	First Nations people (Gr 1) Caucasian’s people (Gr 2) All ages F/M	Time to ED presentation (hours): Gr 1/ Gr 2 (p=0.015) % of patients who saw provider ≤ 72h to ED presentation (p=0.002) Accompanying person fluent in English Time from ED presentation to cardiac catheterisation: Gr 1/Gr 2 (p = 0.001) % of patients who had PCI (p <0.001) % of patients who had CABG (p=0.022)	<1h: 23%/20%; 1-2 h: 26%/25%; 3-6 h: 11%/27%; 7-12h: 5.7%/1.8%; 13-24h: 34%/27% Gr 1: 21%; Gr 2: 12% Gr 1: 100%; Gr 2: 93% (p=0.940) <3h: 18%/42%; 3-6h: 7.7%/5.1%; 6-24h: 0.0%/9.4%; >24h: 46%/27%; Not done: 28%/16% Gr 1: 62%; Gr 2: 63% Gr 1: 2.6%; Gr 2: 6.0%	15/22
Lyons (2013, Can J of Cardiol) (70)	Alberta Retrospective	Heart failure Hospitalisation, ED visits	Status Indigenous people (Gr 1) Other Albertans (Gr 2) ≥ 20 y.o. F/M	Odds ratio of death for Gr 1 (95% CI) Hospitalisations per patient in the year after hospitalisation for HF Gr 1/Gr 2 ED visits per patient in the year after hospitalisation for HF Gr 1/Gr 2	1 year: 1.18 (1.02-1.38); 3 years: 1.43 (1.22-1.66); 5 years: 1.39 (1.16-1.67) All causes: 1.68/1.03 (p <0.0001) HF related: 0.21/0.14 (p = 0.004) All causes: 4.95/2.30 (p <0.0001) HF related: 0.32/0.19 (p = 0.0003)	10/22
Rosychuk (2016, BMC Emerg Med) (30)	Alberta Retrospective	AF and flutter ED visits	First Nations people (Gr 1) Non-First Nations people (Gr 2) > 35 y.o. F/M	ED visits Time for specialist follow-up visits	“First Nations seniors also had approximately three times as many ED presentations as would have been expected by the population proportion”. Gr 1 <65 y.o.: 103 days; Gr 1 >65 y.o.: 182 days	16/22
Shavadia (2020, Can J of Cardiol) (117)	Saskatchewan Prospective	ACS Hospitalisation	First Nations people (Gr 1) Saskatchewan’s population (Gr 2) All ages F/M	In-hospital mortality (95% CI)	OR = 1.88 (0.63-4.8)	8/11
Shultz (2018, Can J of Cardiol) (71)	Manitoba Retrospective	AMI, CHF, IHD, Stroke Hospitalisation, PCI, CABG	First Nations people (Gr 1) Non-First Nations people (Gr 2) All ages F/M	AMI group Hazard ratio for mortality for Gr 1 (95% CI) Hazard ratio for hospitalisations for Gr 1 (95% CI) Hazard ratio of revascularization following coronary angiogram for Gr 1 (95% CI) Non-AMI group Hazard ratio for mortality for Gr 1 (95% CI) Hazard ratio for hospitalisations for First Nations (95% CI) Hazard ratio of revascularization following coronary angiogram for Gr 1 (95% CI)	All-cause: 1.30 (0.96-1.75); Cardiovascular: 1.57 (1.05-2.35) All-causes: 1.35 (1.17-1.55); AMI: 1.30 (0.92-1.85); CHF: 1.54 (1.06-2.24); IHD: 1.46 (1.20-1.78); Stroke: 0.71 (0.33-1.52) PCI: 0.88 (0.75-1.02) CABG: 1.19 (0.94-1.49) All-cause: 1.52 (1.28-1.79); Cardiovascular: 1.50 (1.17-1.94) All-cause: 1.40 (1.29-1.51); AMI: 2.26 (1.79-2.85); CHF: 1.71 (1.38-2.12); IHD: 1.33 (1.17-1.50); Stroke: 1.47 (1.05-2.06) PCI: 0.85 (0.73-0.99) CABG: 1.26 (1.10-1.45)	19/22
Wei-Randall (2013, Health Rep) (72)	All Canada Retrospective	AMI Hospitalisation, PCI, CABG, Coronary angiogram	High-% First Nations people identity areas (Gr 1) Low-% Indigenous people identity areas (Gr 2) ≥ 20 y.o. F/M	Age-standardised hospitalised AMI events rates Age-standardised % of patients who had a coronary angiogram (95% CI) Age-standardised % of patients who had revascularization (95% CI) Age-standardised % of patients who had PCI (95% CI) Age-standardised % of patients who had CABG (95% CI)	Gr 1: 276.8/100,000; Gr 2: 157.1/100,000 (p <0.05) Gr 1: 51.1% (49.9-52.3); Gr 2: 58.1% (57.9-58.3) Gr 1: 39.6% (38.5-40.7); Gr 2: 46.8% (46.6-47.0) Gr 1: 30.7% (29.6-31.8); Gr 2: 38.1% (37.9-38.3) Gr 1: 9.3% (8.6-10.0); Gr 2: 9.2% (9.1-9.3%)	15/22
Young (1993, Am J Public Health) (73)	Northwest Territory Retrospective	Cardiovascular diseases Hospitalisation	First Nations people (Gr 1) Inuit (Gr 2) General population of Canada (Gr 3) All ages F/M	Age-standardised mortality rates/100,000 for diseases of the circulatory system (men/women) Hospitalisation rates/100,000 for diseases of the circulatory system Male/Female	Gr 1: 195/187; Gr 2: 205/149; Gr 3: 349/198 Keewatin Region (90% Inuit): 438/404; Northwest Territory: 891/640; All Canada: 1914/1472	15/22

Table

PSYCHIATRIC DISEASES (n = 8)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Carriere (2018, Statistics Canada) (82)	All provinces excluding Ontario and Quebec Retrospective	Mental disorders Hospitalisation	First Nations people on-reserve (Gr 1) First Nations people off-reserve (Gr 2) Non-Indigenous people (Gr 3) All ages F/M	Rate ratios for age-standardised hospitalisation rates/100,000 (95% CI)	Total: Gr 1: 2.4 (2.3-2.5); Gr 2: 2.0 (1.9-2.1) Substance-related: Gr 1: 7.0 (6.6-7.4); Gr 2: 4.3 (3.8-4.8) Mood: Gr 1: 1.2 (1.1-1.3); Gr 2: 1.6 (1.4-1.8) Schizophrenic/Psychotic: Gr 1: 1.8 (1.6-2.0); Gr 2: 1.9 (1.6-2.2) Anxiety: Gr 1: 2.3 (2.0-2.7); Gr 2: 1.7 (1.3-2.3) Organic: Gr 1: 1.1 (0.9-1.3); Gr 2: 1.0 (0.7-1.3) Personality: Gr 1: 1.2 (0.9-1.5); Gr 2: 1.3 (0.9-2.1) Other: Gr 1: 1.7 (1.6-1.9); Gr 2: 1.5 (1.3-1.8)	15/22
D’Arcy (1979, Can J Psychiat) (83)	Saskatchewan Descriptive	Mental illnesses Hospitalisation	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Admissions per 10,000 population Gr 1/Gr 2	Total: 41/36; Psychoses: 16/19; Psychoneuroses: 12/7; Personality/Behaviour: 9/6; Mental Retardation: 1/0; Other/Unknown: 3/4	6/22
Dalrymple (1995, Can J Psychiat) (14)	Ontario Retrospective	Mental illnesses Hospitalisation	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Consumer satisfaction survey (% Gr 1/% Gr 2) Length of stay in 1991-1992 (days)	Schizophrenia and other psychoses: 31.5%/37.8%; Mood disorders: 15.7%/21.3%; Substance abuse disorders: 0%/3.8%; Anxiety, Adjustment, Conduct and personality disorders: 0%/2.9%; Other disorders: 42.1%/33.9% Gr 1: 69.5; Gr 2: 32.8	14/22
Lavoie (2018, Int J Equity Health) (84)	British Columbia Retrospective	Mental health related-ambulatory care sensitive conditions Hospitalisation	First Nations people (Gr 1) British Columbia people (Gr 2) All ages F/M	Access to care Hospitalisation rate for mental health conditions Length of stay	First Nation communities served by nursing station have the lowest rate of hospitalisation. Communities served by health centres have highest rate of hospitalisation (poorer access to care). First Nations living off-reserve had significantly higher hospitalisation rates People in Gr 2 stay 4-6 days longer than Gr 1 in the hospital.	17/22
Lavoie (2020, Can J of Pub Health) (32)	Manitoba Retrospective	Mental illnesses Hospitalisation	First Nations people (Gr 1) Manitoba’s population (Gr 2) All ages F/M	Hospitalisation rates/1000 (95% CI; p) Adjusted rate of length of stay	Gr 1: 26.00 (17.59-38.42; p < 0.0001) Gr 2: 12.55 (12.34-12.75; p = 0.8596) Gr 1: 9.79 (7.08-13.52; p = 0.0466) Gr 2: 23.68 (23.60-23.76; p=0.5596)	17/22
Newton (2012, CMAJ) (103)	Alberta Retrospective	Mental health crisis ED visits	First Nations people (Gr 1) Alberta’s population (Gr 2) <18 y.o. F/M	Median length of stay in hours (95% CI) Age and sex-adjusted standardised visit rate/100,000 for Gr 1 (p = 0.004) Age and sex-adjusted standardised visit rate/ 100,000 for Gr 1 of 15-17 y.o. Hazard ratio for time to physician follow-up visit for Gr 1 (95% CI)	Gr 1: 2h27 (1h05-5h40); Gr 2: 3h (1h30-5h21) 2002-2003: 1368.0 2007-2008: 1664.0 Females: 7047.6 Males: 5787.3 Psychiatrist: 0.47 (0.32-0.70)	16/22
Newton (2016, Pediatr emerg care) (107)	Alberta Retrospective	Anxiety and stress disorders ED visits	First Nations people (Gr 1) Alberta’s population (Gr 2) < 18 y.o. F/M	ED visit rates/100,000 (95% CI) Follow-up visits	2002-2003: Gr 1: 263.49 (218.43-308.55); Gr 2: 126.87 (119.16-134.57) 2010-2011: Gr 1: 345.59 (294.18-397.00); Gr 2: 168.95 (160.51-177.39) Gr 1 children had less follow-up visits after discharge. Median time to follow-up visits = 32 days.	17/22
Soleimani (2016, BMC Psychiatry) (85)	Alberta Retrospective	Psychotic symptoms Hospitalisation	First Nations people (Gr 1) Alberta’s general population (Gr 2) 13-17 y.o. F/M	Hazard ratio for inpatient hospitalisation within 90 days of first ED visit (95% CI)	Gr 1 females: 4.18 (1.24-14.06) Gr 1 males: 0.57 (0.13-2.49)	17/22

Table

PERCEPTION OF HEALTH CARE (n = 6)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Baker (2000, Western J Nurs Res) (15)	New-Brunswick Qualitative	Satisfaction of cross-cultural hospital care	Mi’kmaq people All ages F/M	Patient satisfaction	Major source of misunderstanding is different ways of thinking. Indigenous want their whole family to stay with them at all times, but it is not compatible with hospital rules and it can bother other patients. Majority of caregivers give good care, but every participant has experienced a misunderstanding with caregivers. Mi’kMaq feel isolated in the hospital and have difficulties to understand hospital’s rules. Mi’kMaq have difficulties to understand their treatment, but they never ask questions. They sometimes think they didn’t give the chance to caregivers to understand their needs. Mi’kMaq appreciated when their family were allowed to visit them and when they felt they received the same treatment as anybody else. They also appreciated when caregivers were kind.	23/32
Cameron (2014, Adv Nurs Sci) (16)	All provinces Qualitative	Inequalities in access to health care Emergency care services	First Nations people (Gr 1) Other Canadians (Gr 2) All ages F/M	Satisfaction of health care Barriers in access to care Access to care % of people who did not receive needed health care in the past year	Participants reported stories of racism, stigmatisation, language difficulties, intimidation, harassment and fear. They felt that professionals did not always take time to explain things properly or to assess participant’s needs and concerns. Limited access to comprehensive and specialised care, long waiting time, barriers in the communication and understanding of medical jargon, barriers in the interaction with professionals. 35% of Gr 1 felt that their access to health care was worst than Gr 2. Gr 1: 18% Gr 2: 12%	24/32
Goodman (2017, Soc Sci Med) (17)	British Columbia Qualitative	ED visits, Hospital visits	Indigenous people living in Vancouver’s inner city 19-70 y.o. Female/ Male	Satisfaction of health care	They feel they are treated differently than other patients. Some are scared to go to the hospital. Several reported only seeking healthcare once their illness or symptoms had become severe. The security or staff of the hospital often threatens them. Hospital policies exacerbate cultural barriers. There is facility devoted space for Indigenous, but Indigenous don’t know it exist and when they looked for it, it was not accessible. Presence of stereotypes associating Indigenous to substance use. Because of that, requests for pain medication are often perceived as drug seeking. Health care professionals care more about proving the patient took drug than providing medical care. Lack of empathy, Incompetent addiction medicine training.	20/32
Hole (2015, Qual Health Res) (18)	British Columbia Qualitative	Health care at a community hospital	Urban Indigenous people 19-75 y.o. F/M	Things appreciated in health care Bad perceptions of health care	Being recognised as Indigenous, heard and respected. People with lower income wait longer in the waiting room. Professionals think that Indigenous are drunk and treat Indigenous differently than others. It’s hard for the staff to give good care when they are short-staffed and exhausted. It’s when the staff is stressed that all the bad commentaries tend to come out. Hospital rules exclude Indigenous realities. Indigenous staff is not allowed to speak up about the problems. Professionals are too concentrated in having access to the patient to do medical procedures rather than letting the patient have family support. The professionals sometimes hide information from the family. Professionals have access to a lot of pain reliever medication, but they don’t want to give them because they are afraid that the patient will get addicted.	18/32
Tang (2008, Ethnic Health) (20)	Western Canadian province Qualitative	ED visits, hospital visits	Indigenous people All ages F/M	Patients’ satisfaction Health care professionals’ perceptions	Health care professionals often think that the cause of the symptoms is alcohol even when the patient claims he did not drink. Some Indigenous get kicked out of the ED because the security thinks they are drunk or that they aren’t really sick. A lot of Indigenous won’t go to the hospitals unless they are almost dying. Some feel they have to wait longer for getting health care professional’s attention towards an important health problem. Believe they provide the same quality of care to any patients. There is no judgment towards patients of First Nation status. Some professionals think you can give them the best care in the world and they will not be able to access it because they can’t or they do not want to. One ED professional recognised that sometimes health care professionals tend to generalise that all Indigenous have a drinking problem and have a low social economic background. Another said he is more guarded with an Indigenous patient.	20/32
Tang (2015, Sociol Health Illn) (21)	Western Canadian province Qualitative	ED visits	Indigenous people All ages F/M	Health care providers opinions towards indigenous people: Indigenous people perception towards health care providers:	Indigenous have addictions and they present physical signs of their addiction. Many are on welfare and don’t have a job nor take care of themselves. They want to be seen as needy people. They misuse the money from tax payers. Some Indigenous just come to the hospital to have food and drugs. There are other population groups which misuse the health care system and have poverty issues but the stigma is not the same as with Indigenous. When all their requests are not met, they become frustrated and it’s hard to remain compassionate and non-judgemental when those behaviours are seen. Providers always think that you’re a drug addict or a drunk. Sometimes, Indigenous are getting escorted out of the hospital because the staff think they are here just to get drugs or to get free food.	21/32

a All the information from this table comes from the articles directly, it does not represent our opinion

Table

RHEUMATOLOGIC DISEASES (n = 5)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Barnabe (2016, J Rheumatol) (38)	Alberta Comparative	RA, AS, PsD Hospitalisation	First Nations people (Gr 1) Non-First Nations people (Gr 2) All ages F/M	Hospitalised infection rates/1000 for Gr 1	RA: 29.7; AS: 19.8; PsD: 22.4	5/11
Barnabe (2016, J Rheumatol) (126)	Alberta Prospective	RA Hospitalisation ED visits	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Cost estimates for Gr 1 patients (95% CI)	Hospital: −5406$ (−11,552 – 470) Emergency room: 660$ (−38 – 1357)	6/11
Barnabe (2017, Arthrit Care Res) (80)	Alberta Retrospective	RA, AS, PsD, CRA Hospitalisation	First Nations people (Gr 1) Non-First Nations people (Gr 2) All ages F/M	Crude all-cause hospitalisation rates/100 (95% CI) Arthritis-specific hospitalisation/100 (95% CI)	RA: Gr 1: 38.9 (38.2-39.7); Gr 2: 25.1 (24.9-25.3) AS: Gr 1: 37.5 (35.8-39.2); Gr 2: 20.2 (19.9-20.6) PsD: Gr 1: 36.8 (34.1-39.7); Gr 2: 17.9 (17.6-18.3) Crystal-related arthritis: Gr 1: 34.1 (32.5-35.7); Gr 2: 23.9 (23.7-24.1) RA: Gr 1: 2.3 (2.1-2.5); Gr 2: 3.4 (3.3-3.4) AS: Gr 1: 1.0 (0.7-1.3); Gr 2: 1.3 (1.2-1.4) PsD: Gr 1: 1.7 (1.2-2.4); Gr 2: 1.4 (1.3-1.5) CRA: Gr 1: 1.6 (1.2-1.9); Gr 2: 1.6 (1.6-1.7)	17/22
Levy (2013, Arthritis Rheum) (102)	Ontario Retrospective	Childhood-onset SLE Hospitalisation ED visits	Indigenous people (Gr 1) White people (Gr 2) Asian people (Gr 3) Black people (Gr 4) South Asian people (Gr 5) < 18 y.o. F/M	Distribution of patients ED visit in the first year of diagnosis % of patients hospitalised % of patients who required at least 3 hospitalisations	Gr 1: 1.3%; Gr 2: 42% Whites; Gr 3: 24%; Gr 4: 15%; Gr 5: 13% 43% 38% 12%	10/11
Oppenheimer (2007, South med J) (28)	Manitoba, Ontario Retrospective	Blastomycosis of bones and joints Hospitalisation, ICU admission	Indigenous people (First Nations/ Metis) (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Time from first symptoms to admission (days) Time from admission to diagnosis (days) Duration of hospital stay (days) % of death	Gr 1: 31 ± 30; Gr 2: 95 ± 150 Gr 1: 10 ± 30; Gr 2: 15 ± 30 Gr 1: 30 ± 20; Gr 2: 22 ± 30 Gr 1: 8%; Gr 2: 3%	15/22

Table

NEUROLOGICAL DISEASES (n = 5)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Ahmed (2020, Can J of Surg) (121)	Saskatchewan Retrospective	Traumatic spinal cord injury Hospitalisation	Indigenous people (Gr 1) Saskatchewan’s population (Gr 2) All ages F/M	Time from admission to surgery, h, median (p=0.20) Proportion of surgical management (%)	Gr 1: 20.0 Gr 2: 15.0 Gr 1: 71% Gr 2: 85%	16/22
Blackmer (1999, Brain injury) (122)	Saskatchewan Retrospective	Traumatic brain injury Hospitalisation	Indigenous people (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Acute care length of stay (days) Time to follow-up (days) (p <0.0001)	Gr 1: 33.33; Gr 2: 35.23 (p = 0.734) Gr 1: 56.50; Gr 2: 28.10	15/22
Jetté (2008, Epilepsia) (78)	Alberta Retrospective	Epilepsy Hospitalisation, ED visits	First Nations people (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	Odds ratio for hospitalisation (95% CI) Odds ratio for ED visits (95% CI) Mean hospital length of stay	Gr 1: 2.8 (1.49-5.13) Gr 1: 2.3 (1.09-4.98) 2 ± 12 days	16/22
Kapral (2020, CMAJ Open) (75)	Ontario Retrospective	Stroke or transient ischaemic attack Hospitalisation	First Nations people (Gr 1) Ontario’s population (Gr 2) 20 y.o. and over F/M	Rate of hospital admission per 100,000 (95% CI) % of mortality at 7 days (95% CI) % of mortality at 1 year (95% CI) % of patients with neuroimaging (95% CI) % of thrombolysis (95% CI) % of carotid revascularization (95% CI)	Gr 1: 641.2 (539.8-756.2); Gr 2: 540.2 (527.6-552.9) Gr 1: 12.0 (8.9-15.9); Gr 2: 8.5 (8.0-9.0) Gr 1: 33.8 (28.2-40.2); Gr 2: 28.1 (27.1-29.1) Gr 1: 94.6 (85.9-100.0); Gr 2: 96.0 (94.2-97.9) Gr 1: 6.3 (3.9-9.7); Gr 2: 11.0 (10.3-11.7) Gr 1: 1.4 (0.5-3.0); Gr 2: 2.7 (2.4-3.0)	20/22
Lasry (2016, Can J Neurol Sci) (79)	Quebec Retrospective	Traumatic brain injury Hospitalisation	Cree population (Gr 1) Entire province of Quebec population (Gr 2) All ages F/M	Rate ratios for hospitalisation (95% CI)	Gr 1: 1.86 (1.56-2.17)	4/11

Table

ENDOCRINE-RELATED CONDITIONS (n = 5)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Booth (2005, Diabetes Care) (88)	Ontario Retrospective	Complications of diabetes ED visits, Hospitalisation	Indigenous people Ontario’s general population ≥ 18 y.o. F/M	Risk ratio for ED visits or hospital admission for diabetes for Indigenous	1.8	17/22
Campbell (2014, Diabetol Metab Syndr) (89)	Alberta Retrospective	Complications of diabetes, Hospitalisation	First Nations people (Gr 1) Non-First Nations people (Gr 2) ≥ 18 y.o. F/M	Adjusted odds ratio for hospitalisation for Gr 1 (95% CI)	30 y.o.: 3.94 (3.11-4.99) 55 y.o.: 4.75 (3.24-6.97) 80 y.o.: 5.74 (3.36-9.80)	15/22
Pohar (2007, BMC health serv res) (91)	Saskatchewan Retrospective	Diabetic patients Hospitalisation	Indigenous people (First Nations, Inuit, Metis) (Gr 1) General population (Gr 2) All ages F/M	Odds ratio for hospitalisation for diabetic patients (p <0.05) Age-standardised per capita health care cost for Gr 1 (95% CI) Age-standardised per capita health care cost for Gr 2 (95% CI)	Gr 1: 2.2; Gr 2: 2.1 Without diabetes: 1 395$ (1 394-1 397) With diabetes: 3 204$ (3 201-3 206) Without diabetes: 875$ (875-875) With diabetes: 2 257$ (2 256- 2 258)	16/22
Rose (2008, Foot Ankle Surg) (90)	Manitoba Retrospective	Diabetic ulcers, Hospitalisation	Indigenous people (First Nations, Metis) (Gr 1) Non-Indigenous people (Gr 2) All ages F/M	% of patients with amputation Gr 1/Gr 2	Toe only: 39%/ 53% Forefoot: 13%/ 7% Below knee: 45%/ 33% Above knee: 3%/ 7%	17/22
Shah (2020, CMAJ Open) (101)	Ontario Retrospective	Diabetes complications Hospitalisation, ED visits	First Nations people on-reserve (Gr 1) First Nations people off-reserve (Gr 2) Ontario’s population (Gr 3) All ages F/M	% admitted to hospital for ambulatory-care-sensitive-conditions Emergency department visits for hypo- or hyperglycaemia (%)	Gr 1: 2.5 (2.1-2.9) Gr 2: 2.4 (2.1-2.7) Gr 3: 1.2 (1.2-1.2) Gr 1: 1.1 (0.9-1.3) Gr 2: 1.8 (1.5-2.0) Gr 3: 0.8 (0.8-0.9)	18/22

Table

PAEDIATRIC-RELATED DISEASES (n = 5)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
He (2017, CMAJ) (87)	Quebec Retrospective	Hospitalisation	First Nations people (Gr 1) Inuit people (Gr 2) Non-Indigenous people (Gr 3) <1 y.o. F/M	Adjusted rate ratios for infant hospitalisation (95% CI)	Any cause: Gr 1: 1.43 (1.37-1.50); Gr 2: 1.37 (1.24-1.52) Infections: Gr 1: 1.66 (1.54-1.78); Gr 2: 1.31 (1.10-1.57) Injuries/accidents: Gr 1: 1.16 (0.97-1.39); Gr 2: 1.36 (0.86-2.15) Congenital anomalies: Gr 1: 1.35 (1.15-1.59); Gr 2: 1.40 (1.01-1.95) Perinatal-originated conditions: Gr 1: 0.95 (0.75-1.19); Gr 2: 0.92 (0.58-1.45) Respiratory system: First Nations: 1.91 (1.80-2.03) Inuit: 1.82 (1.59-2.08) Digestive system: Gr 1: 1.49 (1.31-1.69); Gr 2: 1.01 (0.73-1.39) Nervous system: Gr 1: 1.64 (1.43-1.89); Gr 2: 1.64 (1.20-2.25) Genitourinary system: Gr 1: 1.75 (1.45-2.11); Gr 2: 0.61 (0.32-1.16) Musculoskeletal system: Gr 1: 1.34 (0.60-2.98) Circulatory system: Gr 1: 1.50 (0.86-2.61) Endocrine system: Gr 1: 1.49 (1.29-1.73); Gr 2: 2.61 (1.50-4.53) Skin and subcutaneous tissue: Gr 1: 3.00 (2.58-3.49); Gr 2: 2.86 (1.57-5.23) Blood: Gr 1: 0.96 (0.57-1.60) Mental/neurodevelopmental disorders: Gr 1: 1.20 (0.50-2.95) Neoplasms: Gr 1: 0.91 (0.50-1.71)	18/22
Reime (2007, Paediatr Perinat Epidemiol) (24)	All of Canada Retrospective	ICU admissions	Indigenous people (Gr 1) White people (Gr 2) Neonates F/M	No access to prenatal care Mortality (p <0.001) Adjusted odds ratio for Gr 1 for specific treatments (95% CI) Length of stay (days) (p<0.05)	Gr 1: 7.2%; Gr 2: 1.6% Gr 1: 7.1%; Gr 2: 7.4% Transparenteral nutrition: 0.77 (0.60-1.00) Blood transfusion 1.07 (0.78-1.46) Surfactant 0.78 (0.57-1.06) Assisted ventilation 0.86 (0.67-1.09) Surgery 0.73 (0.54-0.99) Antenatal steroids 1.04 (0.81-1.34) Incubator 0.85 (0.65-1.12) Gr 1: 4.5 days; Gr 2: 2.9 days	19/22
Stammers (2014, Pediatr Blood Cancer) (81)	Manitoba Retrospective	Cancer complications Hospitalisation	First Nations people (Gr 1) Non-First Nations people (Gr 2) <15 y.o. F/M	Risk ratios for hospital admission days for treatment complications for Gr 1 (95% CI; p)	Low risk: 0.853 (0.27-1.55; p= 0.371) Intermediate/High risk: 1.140 (0.52-2.48; p=0.748)	18/22
Thanh (2015, J Pediatr) (125)	Alberta Retrospective	Health care utilisation for low birth-weight population	Indigenous people (Gr 1) Alberta’s population (Gr 2) <1 y.o. F/M	Health services use cost coefficient	Gr 1: 1560 (1359-1762; p <0.001)	18/22
Thomson (1994, Can Fam Physician) (86)	Saskatchewan, Ontario Retrospective	Acute otitis media Hospitalisation	First Nations people (Gr 1) Ontario and Saskatchewan’s general population (Gr 2) <5 y.o. F/M	Hospitalisation rates/100 for otitis media (Gr 1/Gr 2) Relative risk of hospitalisations for otitis media for Gr 1 (95% CI) Hospitalisation rates/100 for upper respiratory tract infection (Gr 1/Gr 2) Relative risk of hospitalisation for upper respiratory infection for Gr 1 (95% CI)	Boys 1-4 y.o.: 6.7/1.1; Girls 1-4 y.o.: 5.6/0.8 0-1 y.o.: 2.1/0.3 Boys 1-4 y.o.: 6.1 (5.1-7.3); Girls 1-4 y.o.: 6.7 (5.4-8.2) 0-1 y.o.: 6.1 (0.6-67.0) Boys 1-4 y.o.: 24.7/5.2; Girls 1-4 y.o.: 22.9/3.8 Saskatchewan’s boys 0-1 y.o.: 27.1/4.8 Saskatchewan’s girls 0-1 y.o.: 27.4/3.1 Ontario’s 0-1 y.o.: 5.2/0.7 Boys 1-4 y.o.: 4.7 (4.3-5.1); Girls 1-4 y.o.: 6.1 (5.6-6.7) Saskatchewan’s boys 0-1 y.o.: 5.7 (4.8-6.7) Saskatchewan’s girls 0-1 y.o.: 8.9 (7.4-10.6) Ontario’s 0-1 y.o.: 7.7 (1.5-38.9)	12/22

Table

GASTROINTESTINAL DISEASES (n = 4)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Beres (2010, J Pediatr Surg) (123)	Northern Canada Retrospective	Appendicitis Hospitalisation, Surgery	Northern Indigenous people (Gr 1) Local population (Gr 2) Children F/M	Type of appendectomy (%) (p=0.02) Length of stay (days) (p = 0.98) Intervals between arrival and operating room Mean operative time	Laparoscopic: Gr 1: 57%; Gr 2: 73% Open: Gr 1: 43%; Gr 2: 27% Gr 1: 2.9 ± 2.0; Gr 2: 2.9 ± 3.0 Gr 1: 10.3h; Gr 2: 7.0h (p = 0.0002) Gr 1: 49.0 ± 20.2 min; Gr 2: 54.5 ± 17.6 min	15/22
Carey (1977, Can Assoc Radiol J) (124)	Ontario Case reports	Lead shot appendicitis Hospitalisation	Inuit people 56 and 57 y.o. F/M	Type of treatment	CASE 1: Rectal suppositories to clear the lead shot (no effect). Sigmoidoscopy to evacuate the lead shot (no success). Laparotomy to remove the appendix, 3 lead shots, to mobilise lead shots through the rectum. 2 weeks after the surgery, enemas, purgatives and repeated sigmoidoscopy were done to dislodge the lead shots still present (no success). Another surgery was done to remove the rest of the lead shots. CASE 2: Catheterisation of bladder (wrong diagnosis of urinary retention). Sigmoidoscopy (no success). Barium examination of the colon. Open appendicectomy for peritonitis.	7/13
Cohen (1989, Am J Public Health) (120)	Manitoba Retrospective	Gall bladder diseases Hospitalisation, Surgery	First Nations (Gr 1) Non-First Nations (Gr 2) All ages F/M	% of patients who received their operation from a general practitioner	Gr 1: 34.2%; Gr 2: 18%	14/22
Harper (2015, Int J Circumpol Heal) (29)	Labrador and Nunavut Cross-sectional	Acute gastrointestinal illness Primary care visits	Inuit people All ages Male/Female	% of patients who visited clinic or hospital (95% CI) Reasons for not seeking care Rigolet/Iqaluit	Rigolet: 4.8% (1.5-14.4) Iqaluit: 16.9% (11.2-24.7) Illness not serious enough: 82%/50%; Would not make a difference: 2%/10%; Dislikes or distrusts doctors or nurses: 2%/3%; On the land: 5%/1%; Language barriers: 0%/0%	16/22

Table

INFECTIOLOGY-RELATED DISEASES (n = 4)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Dallaire (2006, C J Public Health) (39)	Quebec Retrospective	Acute infections Hospitalisation	Inuit people <5 y.o. F/M	Hospitalisation rates/1000 for Inuit (95% CI) 0-11 months old/12-23 months old/2-4 y.o.	Pneumonia: 198 (145-251)/ 119 (77-160)/ 30 (17-44) Bronchitis/Bronchiolitis: 107 (68-147)/ 23 (5-40)/ 5 (0-10) Upper respiratory tract infections: 28 (8-49)/ 0/ 1 (−1 – 3) Urinary tract infections (female): 17 (−2 – 36)/ 33 (7-60)/ 2 (−2 – 6) Urinary tract infections (male): 18 (−2 – 38)/ 121 (−11 – 35)/ 2 (−2 – 6) Fever NOS: 14 (2-27)/ 3 (−3 – 8)/ 1 (−1 – 3) Acute otitis media: 11 (0-22)/ 3 (−3 – 8)/ 1 (−1 – 3) Pyelonephritis/pyelitis (female): 11 (−6 – 27)/ 6 (−5 – 17)/ 6 (−1 – 12) Cellulitis: 9 (−1 – 18)/ 14 (−1 – 29)/ 8 (1-14) Meningitis: 9 (−1 – 18)/ 6 (−2 – 14)/ 1 (−1 – 3) Laryngitis/Tracheitis: 3 (−3 – 8)/ 9 (−1 – 18)/ 3 (0-6)	17/22
Landy (2010, Int J Infect Dis) (33)	Northern Canada Case report	Gonococcal septic shock, ARDS and Multisystem organ failure Hospitalisation	Indigenous people 36 y.o. Female	Time for transfer to tertiary care Type of treatment Length of stay	13h (because of artic winter and distance) Fluid resuscitation, intubation and vasopressors prior to transfer. Empiric ceftriaxone and vancomycin were administered after blood cultures. Ethanol infusion was started then discontinued when the anion gap became normal. The patient improved with mechanical ventilation, vasopressor support, ceftriaxone, corticosteroids and supportive ICU care. 12 days in ICU, 2 days in general medicine	7/13
Mashru (2017, J Telemed Telecare) (13)	Ontario Descriptive	Infectious diseases Hospitalisation	Sioux community people All ages F/M	Patient satisfaction towards telemedicine consultation	Patient understood how the session would run: 98% Help was available if there were problems: 100% Able to hear specialist comfortably: 98%; Satisfied with picture quality: 94%; Privacy was respected: 100%; Would use telemedicine again: 94%; Would recommend to family/friends: 92%; Overall satisfied with appointment: 98%	15/22
Nicolle (1996, Clin Infect Dis) (76)	Manitoba Retrospective	Acute pyelonephritis Hospitalisation	First Nations people Non-Indigenous people (Gr 2) All ages F/M	Mean hospitalisation rates/10,000 Rate ratios for hospitalisation for Gr 1 patients (95% CI)	Women: 9.01 ± 0.47; Men: 3.24 ± 0.27 First Nations women: 46.11 ± 4.86 First Nations men: 4.76 ± 1.59 Women: 5.12 (4.23-6.20) Men: 1.47 (0.85-2.53)	14/22

Table

OBSTETRICAL AND GYNAECOLOGICAL CONDITIONS (n = 4)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Houd (2004, Int J of Circump Health) (110)	Quebec Retrospective	Delivery Hospitalisation	Inuit people (Gr 1) All ages Female	Perinatal death rate	7/1000	12/22
Lessard (1987, CMAJ) (111)	Northwest Territory, Alberta Retrospective	Delivery Hospitalisation	Inuit people (Gr 1) 14-44 y.o. Female	Stillbirth rate Medical intervention for nulliparous women Medical interventions for multiparous Primary caesarean sections rates	9.7/1000 deliveries Induction: 6%; Augmentation: 4%; Analgesia: 17% Induction: 6%; Augmentation: 1%; Analgesia: 3% Nulliparous: 5.6%; Multiparous: 2.5%	10/22
Oluyomi-Obi (2010, Obstetrics) (112)	Manitoba Case reports	H1N1 Influenza A and pregnancy Admission to ICU	Indigenous people (5/6 patients) 16-29 y.o. Female	Admission to ICU Mortality Quality of care Median length of stay (days)	6 patients 2 women and 1 baby 3/6 patients intubated ECMO 2/6 patients Emergency caesarian delivery: 3/6 20.5	19/22
Van Wagner (2012, Birth) (113)	Quebec Retrospective	Delivery Hospitalisation	Inuit people (Gr 1) All ages Female	Mortality Active management of third stage	1 maternal death, 4 foetal deaths (0.29%), 5 neonatal deaths (0.36%) 49.8%	21/22

Table

NEPHROLOGICAL CONDITIONS (n = 1)
Author (year, journal)	Setting	Topic	Populations’ characteristics	Outcomes	Main results	STROBE
Molnar (2018, Can J Kidney Health Dis) (77)	All provinces except Quebec and Manitoba Retrospective	Complications in dialysis patients Hospitalisation	Indigenous people (Gr 1) Caucasian people (Gr 2) All ages F/M	Adjusted hazard ratio for all-cause hospitalisations (95% CI) Hazard ratio for infection-related hospitalisations (95% CI)	Gr 1: 1.20 (1.12-1.28) Gr 1: 1.30 (1.11-1.53)	18/22