Indigenous Canadians face higher rates of death, complications after surgery, study shows

New research published in the Canadian Medical Association Journal (CMAJ) has found Indigenous people in Canada have higher rates of death and complications after surgery, and lower rates of surgery than other populations.

The study’s authors say it is a first step in providing hard scientific proof to support decades of Indigenous anecdotal evidence.  

“Unfortunately, it’s not a surprise,” the study’s co-author, Dr. Nadine Caron, told CBC News. “It’s really started a baseline level of data to say some of the suspicions that we had are starting to be validated.”  

The team looked at 28 studies that compared surgical outcomes for a range of procedures in Indigenous people with outcomes among non-Indigenous people in Canada.

Caron, Canada’s first female Indigenous general surgeon, is a member of a research team investigating Indigenous disparities in Canada’s health-care system. (Courtesy of Dr. Caron)

Combined, the studies included 1.9 million patients, of whom 10.2 per cent (202,056) identified as Indigenous. Few of the studies specifically addressed Inuit or Métis populations.

The study found, specifically, Indigenous people were less likely to undergo life-saving surgery, including cardiac surgery and caesarean sections; and experienced longer wait times for kidney transplants.

The research indicated that Indigenous people had a 30 per cent increased risk of death after surgery and were less likely to undergo surgeries such as joint replacements that improve quality of life.

“Understanding surgical outcomes and access to surgical services is a vital step toward addressing colonialism and structural racism within health care, so we can identify the gaps and determine what needs to be improved,” Caron said.

‘I didn’t feel cared about’

Caron said the research was inspired by people who have been courageous in sharing their health-care stories, including April Green, a member of the Gitxsan Nation in northwestern B.C.

Green says she went to a local emergency room five times, complaining of chest pain and shortness of breath.

“They sent me home five times. The fifth time I went there I coughed up blood and they finally took me in,” she told CBC’s Daybreak North host Carolina de Ryk.

Green says she was diagnosed with pneumonia, and was transported to the regional hospital in Prince George for three months of treatment.

“It was a very scary experience. I almost died,” Green says. “I definitely feel there is racism that happens in emergency rooms and hospitals.”

Lack of data limits answers

While the study’s authors identified disparities in surgical outcomes, they say a lack of medical data hampers further research into the cause of disparities.  

The lead author of the study, Dr. Jason McVicar, a Métis anesthesiologist at the Ottawa Hospital and assistant professor at the University of Ottawa, urged the medical community to expand research into Indigenous health.

“This study tells Canadians two things. We need better data, and the data we have tell us that we need to do better,” he said  “Better quality research by Indigenous investigators and real-time outcome monitoring for Indigenous patients are essential to eliminating structural racism in the health care system.”

Caron, Canada’s first female Indigenous general surgeon, praised the research team’s diversity and inclusiveness, which included Métis, Inuit and various First Nations’ health workers.  

“Indigenous people are really coming into leadership roles, where we can start to drive the questions ourselves and advocate for our populations,” she said.  

“What we need to do is take the step forward and start to pose specific questions and do some robust research, led by Indigenous researchers.”

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