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Places of death and places of care for Indigenous Peoples in Ontario: a retrospective cohort study

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Abstract

Objectives

Most people, including Indigenous people in Ontario, wish to die in their communities. How often Indigenous people in Ontario die in their preferred settings is unknown. This study aims to describe the places of care and death for Indigenous people in Ontario who received provincially funded home care services.

Methods

We conducted a retrospective cohort study using linked health administrative databases housed at ICES. We used a population-based cohort of Indigenous and non-Indigenous people in Ontario who died between April 1, 2010 and March 31, 2015 to describe characteristics of people, places of death, and places of care.

Results

Indigenous decedents were on average 8.8 years younger, had more chronic diseases, and lived in lower income neighbourhoods compared with their non-Indigenous counterparts. Indigenous decedents spent nearly 8 more days in acute care in the last year of life and more died in acute care (56.1% versus 46.1%). When controlling for covariates, Indigenous decedents received 1.9 fewer home care nursing hours and 5 fewer personal support worker hours and showed decreased odds (OR 0.72) of receiving a palliative physician visit in the last 90 days of life. Among Indigenous decedents, a palliative physician visit lowered odds of dying in acute care by 50% and total days in acute care by 18%.

Conclusion

Our study identified a gap in end-of-life care for Indigenous Peoples in Ontario receiving provincially funded home care. Without continued efforts to address challenges that perpetuate health inequalities, we expect many Indigenous people will continue to die in acute care away from their people, families, and culturally relevant supports.

Résumé

Objectifs

La plupart des gens, y compris les personnes autochtones en Ontario, souhaitent mourir dans leur milieu. On ignore à quelle fréquence les personnes autochtones de l’Ontario meurent dans le milieu de leur choix. Notre étude vise à décrire les lieux de soins et de décès des personnes autochtones en Ontario ayant reçu des services de soins à domicile financés par la province.

Méthode

Nous avons mené une étude de cohorte rétrospective à l’aide de bases de données administratives sur la santé reliées entre elles hébergées à l’ICES. Nous avons utilisé une cohorte populationnelle des personnes autochtones et non autochtones en Ontario décédées entre le 1er avril 2010 et le 31 mars 2015 pour décrire les caractéristiques de ces personnes, leurs lieux de décès et leurs lieux de soins.

Résultats

Les défunts autochtones étaient en moyenne 8,8 ans plus jeunes, avaient davantage de maladies chroniques et vivaient dans des quartiers à plus faible revenu que les défunts non autochtones. Les défunts autochtones avaient passé près de 8 jours de plus dans des milieux de soins de courte durée au cours de leur dernière année de vie et ont été plus nombreux à mourir dans des milieux de soins de courte durée (56,1 % c. 46,1 %). Après avoir apporté des ajustements pour tenir compte des effets de covariables, nous avons constaté que les défunts autochtones ont reçu 1,9 fois moins d’heures de soins infirmiers à domicile et 5 fois moins d’heures de préposés aux services de soutien à la personne et qu’ils ont présenté une probabilité plus faible (RC 0,72) de recevoir la visite d’un médecin en soins palliatifs au cours de leurs 90 derniers jours de vie. Chez les défunts autochtones, la visite d’un médecin en soins palliatifs réduisait de 50 % la probabilité de mourir dans un milieu de soins de courte durée et de 18 % le nombre total de jours passés dans un milieu de soins de courte durée.

Conclusion

Notre étude a décelé une lacune dans les soins de fin de vie aux personnes autochtones de l’Ontario qui reçoivent des soins à domicile financés par la province. Si l’on ne fait pas continuellement des efforts pour aborder les difficultés qui perpétuent les inégalités en santé, on peut s’attendre à ce que de nombreuses personnes autochtones continuent de mourir dans des milieux de soins de courte durée, loin de leurs peuples, de leurs familles et sans recevoir de soins culturellement appropriés.

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Acknowledgements

The authors would like to acknowledge the in-kind support of the Canadian Indigenous Nurses Association.

Funding

This study was funded by the Centre for Individualized Health at the Bruyère Research Institute. This study was supported by ICES, which is funded by an annual grant from the MOHLTC. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

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Correspondence to Sarah Funnell.

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Funnell, S., Walker, J., Letendre, A. et al. Places of death and places of care for Indigenous Peoples in Ontario: a retrospective cohort study. Can J Public Health 112, 685–696 (2021). https://doi.org/10.17269/s41997-021-00482-y

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