First Nations Pneumonia Admissions: Different Patients or Different Attitudes?

Abstract

In this issue of the Canadian Respiratory Journal, Marrie et al (pages 336-342) present a database study of hospital admissions among First Nation Aboriginals (FNAs) in Alberta that is fascinating, at least to me. They captured all hospital admissions for "status" FNAs from 1997 to 1999, along with data on where and how long they were hospitalized, the severity of the pneumonia, the number of comorbidities present, whether they were readmitted and the costs involved. They compared these finding with a group of age- and sex-matched non-FNAs who were also hospitalized for pneumonia. There are, of course, weaknesses in the study that commonly occur in most exercises using administrative databases. Pneumonia is a hospital record diagnosis (there is no information about chest x-rays, sputum cultures, etc). Pneumonia severity assessment relies on information regarding hospital transfers, intensive care unit admissions and events such as shock, artificial ventilation and death (there is no information available to apply an accepted grading system) (1). Further, "status" FNAs were probably not entirely representative of FNAs in general; indeed, some nonstatus FNAs may well have been included in the control group. However, I strongly doubt that these or similar objections are substantial enough to greatly influence the findings of Marrie et al.