Chapter 2 – Prevalence of Predialysis Kidney Disease in Disadvantaged Populations in Developed Countries: Canada

Chapter 2 – Prevalence of Predialysis Kidney Disease in Disadvantaged Populations in Developed Countries: Canada

Summary

Canada is a geographically large, high-income country with a population of approximately 35 million. Canada’s population is ethnically diverse and is growing annually due to strong immigration policies. Canadians enjoy a health system that is based on the principle of universality and is made up of a series of socialized health plans that differ by the province where a person lives. In addition, a person who lives in Canada (e.g., rural vs. urban) has an impact on health status. Rural Canadians have poorer health status relative to other Canadians, which includes lifestyle-related illnesses, injuries, cardiovascular diseases, poisoning, infant mortality, and life expectancy. There are many people and communities in Canada that are considered vulnerable and at risk. These populations are very heterogeneous and predominantly consist of people living in rural and remote parts of Canada, those who are homeless or with intermittent shelter, Aboriginal peoples, immigrants and refugees, isolated seniors, and the poor, including both low-income individuals and families. Although we can classify these groups of Canadians as “disadvantaged,” the level of disadvantage and health disparities that come with this classification are harder to quantify. Moreover, understanding how these groups experience relative disadvantage within Canadian society and within the health system is challenging, especially with respect to predialysis kidney disease prevalence and care. With respect to chronic kidney disease (CKD), Canada ostensibly has a comprehensive system of nephrology care that is guideline-driven and embedded in both specialized (secondary and tertiary) and within a network of provincial primary health care systems. Despite the availability of nephrology care, challenges exist with respect to identification of risk factors for CKD in these disadvantaged groups. As these populations are often marginalized from the mainstream health care system, provision of preventive services is challenging. In the context of CKD, the data are limited for these populations; however, current evidence suggests that these disadvantaged populations experience disparate outcomes related to CKD and other health domains. Unlike other disadvantaged populations, there is marginally more evidence regarding predialysis CKD prevalence and outcomes among Aboriginal Canadians. This population may have been the subject of more research due to the disproportionally high burden of end-stage kidney disease requiring dialysis and transplantation. Evidence suggests that this disparity may be mostly driven by the lack of Aboriginals receiving the appropriate predialysis care. In the context of CKD, and particularly in predialysis CKD, the data are limited for these populations; however, current evidence suggests that these disadvantaged populations experience disparate outcomes related to CKD and other health domains.

Keywords

  • dialysis; 
  • chronic kidney disease; 
  • Aboriginal; 
  • immigrant; 
  • refugee; 
  • disadvantaged population; 
  • health disparities
JOURNAL: Chronic Kidney Disease in Disadvantaged Populations
PAGES: 7-14
PUBLICATION DATE: 2017