First Nations status and emergency department triage scores in Alberta: A retrospective cohort study.
Open accessAbstract
BACKGROUND: Previous studies have found that race is associated with emergency department triage scores, raising concerns about potential health care inequity. As part of a project on quality of care for First Nations people in Alberta, we sought to understand the relation between First Nations status and triage scores. METHODS: We conducted a population-based retrospective cohort study of health administrative data from April 2012 to March 2017 to evaluate acuity of triage scores, categorized as a binary outcome of higher or lower acuity score. We developed multivariable multilevel logistic mixed-effects regression models using the levels of emergency department visit, patient (for patients with multiple visits) and facility. We further evaluated the triage of visits related to 5 disease categories and 5 specific diagnoses to better compare triage outcomes of First Nations and non-First Nations patients. RESULTS: First Nations status was associated with lower odds of receiving higher acuity triage scores (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.92-0.94) compared with non-First Nations patients in adjusted models. First Nations patients had lower odds of acute triage for all 5 disease categories and for 3 of 5 diagnoses, including long bone fractures (OR 0.82, 95% CI 0.76-0.88), acute upper respiratory infection (OR 0.90, 95% CI 0.84-0.98) and anxiety disorder (OR 0.67, 95% CI 0.60-0.74). INTERPRETATION: First Nations status was associated with lower odds of higher acuity triage scores across a number of conditions and diagnoses. This may reflect systemic racism, stereotyping and potentially other factors that affected triage assessments.
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People who have negative health care experiences or anticipate such experiences, including from stigma and discrimination, are deterred from accessing care.
“people who have negative health care experiences or who anticipate such experiences, including experiences arising from stigma and discrimination, are deterred from accessing care [4, 8–10].”
From Using a health equity lens to measure patient experiences of care in diverse health care settings (2024) · cites this paper as [8]
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- Authors
- McLane, P., Barnabe, C., Mackey, L., Bill, L., Rittenbach, K., Holroyd, B. R., Bird, A., Healy, B., Janvier, K., Louis, E., & Rosychuk, R. J.
- Affiliations
- Alberta Health Services (CA)
- Corresponding author
- McLane, Patrick
- ORCID
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Impact Inc.
- Published
- 2022-01-16
- Volume
- 194
- Issue
- 2
- Pages
- E37-E45
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC8900783
- OpenAlex
- W4206811575
- Cited by
- 49
- References
- 44
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 13 · 2023: 15 · 2022: 9
- FWCI
- 12.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Canadian Medical Association Journal (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (156176)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Health › Indigenous Health, Education, and Rights
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- First Nations, emergency department triage, racial disparities in health care, health care inequities, systemic racism, stereotyping, long bone fractures, upper respiratory tract infection, anxiety disorders, Alberta
- MeSH terms
- Indigenous Canadians, Systemic Racism, Adult, Alberta, Emergency Service, Hospital, Female, Health Services Accessibility, Humans, Male, Middle Aged, Retrospective Studies, Stereotyping, Triage, Outcome Assessment, Health Care, Patient Acuity, Social Determinants of Health
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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