EQUITY OF ACCESS TO ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND ROTATOR CUFF REPAIR FOR INDIGENOUS PEOPLES: A PROVINCIAL COHORT STUDY
Bibliographic record
Abstract
For decades there have been repeated calls to address health inequities experienced by Canada's Indigenous peoples (First Nations, Inuit, and Metis). In 2015, the Truth and Reconciliation Committee (TRC) stated that closing the health gap between Indigenous and non-Indigenous people is critical to the reconciliation process. The purpose of this study was to evaluate access to care with respect to two commonly performed orthopaedic surgeries, anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR). Approvals were obtained from the First Nations Health & Social Secretariat of Manitoba (FNHSSM), Manitoba Inuit Association (MIA), and Manitoba Metis Federation (MMF) to undertake this study. This was a retrospective population-based cohort study comparing Indigenous and non-Indigenous peoples with respect to operative (ACLR, RCR) versus non-operative management (2015–2020). For those that underwent surgery, time from diagnosis by a primary care physician to orthopedic surgery consult (time to consult) and from consult to surgery (time to surgery) (1990–2020) were compared between groups. Data collated through the Manitoba Centre for Health Policy was utilized. For each procedure, logistic regression was performed using surgery as the dependent variable and Indigenous status as the independent variable. Kaplan-Meier survival curves were generated to compare time to consult and time to surgery for Indigenous versus non-Indigenous patients. Between 2015–2020, 91 Indigenous patients and 1363 non-Indigenous patients underwent ACLR, while 126 and 789 patients with the same diagnostic codes, respectively, did not. The odds of non-Indigenous patients undergoing surgery is 2.39 times (95% CI 0.79) that of Indigenous patients (p 0.001) but not for time to surgery (p=0.50). 299 Indigenous and 6496 non-Indigenous patients underwent RCR in the same time frame. Mean time to consult was 1.16 (95% CI 0.29) years and 1.04 (95% CI 0.01) years, for Indigenous compared to non-Indigenous patients, respectively. Mean time to surgery was 0.58 (95% CI 0.06) and 0.54 (95% CI 0.01) years, respectively. Survival curves were different for time to consult (p>0.02) but not for time to surgery (p=0.08). Indigenous patients diagnosed with ACL and RC tears experience longer wait times to consult a surgeon and are less likely to undergo surgical reconstruction for these injuries than non-Indigenous patients. This study is consistent with other reports that show access to care for Indigenous patients is a pervasive issue throughout the Canadian health care system. Such evidence can be utilized to formulate a plan that aligns with the health-care related TRC calls to action.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".