Incidence and outcomes of critical illness in indigenous peoples: a systematic review and meta-analysis

Samantha L Bowker; Kienan Williams; Auriele Volk; Leonard Auger; Alika Lafontaine; Paige Dumont; Aireen Wingert; Amanda Davis; Liza Bialy; Erica Wright; Richard T Oster; Sean M Bagshaw

doi:10.1186/s13054-023-04570-y

Incidence and outcomes of critical illness in indigenous peoples: a systematic review and meta-analysis

Crit Care. 2023 Jul 13;27(1):285. doi: 10.1186/s13054-023-04570-y.

Authors

Samantha L Bowker^{1

2}, Kienan Williams³, Auriele Volk^{4

5}, Leonard Auger⁵, Alika Lafontaine⁵, Paige Dumont⁵, Aireen Wingert⁶, Amanda Davis³, Liza Bialy⁶, Erica Wright⁶, Richard T Oster³, Sean M Bagshaw^{7

8}

Affiliations

¹ Critical Care Strategic Clinical Network™, Alberta Health Services, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.
² Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124E Clinical Science Building, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.
³ Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB, T2W 1S7, Canada.
⁴ Indigenous Medical and Dental Students Association, Faculty of Medicine and Dentistry, University of Alberta, Katz Group Centre for Pharmacy and Health Research, 1-002, Edmonton, AB, T6G 2E1, Canada.
⁵ Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.
⁶ Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
⁷ Critical Care Strategic Clinical Network™, Alberta Health Services, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada. bagshaw@ualberta.ca.
⁸ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124E Clinical Science Building, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada. bagshaw@ualberta.ca.

Abstract

Background: Indigenous Peoples experience health inequities and racism across the continuum of health services. We performed a systematic review and meta-analysis of the incidence and outcomes of critical illness among Indigenous Peoples.

Methods: We searched Ovid MEDLINE/PubMed, Ovid EMBASE, Google Scholar, and Cochrane Central Register of Controlled Trials (inception to October 2022). Observational studies, case series of > 100 patients, clinical trial arms, and grey literature reports of Indigenous adults were eligible. We assessed risk of bias using the Newcastle-Ottawa Scale and appraised research quality from an Indigenous perspective using the Aboriginal and Torres Strait Islander Quality Assessment Tool. ICU mortality, ICU length of stay, and invasive mechanical ventilation (IMV) were compared using risk ratios and mean difference (MD) for dichotomous and continuous outcomes, respectively. ICU admission was synthesized descriptively.

Results: Fifteen studies (Australia and/or New Zealand [n = 12] and Canada [n = 3]) were included. Risk of bias was low in 10 studies and moderate in 5, and included studies had minimal incorporation of Indigenous perspectives or consultation. There was no difference in ICU mortality between Indigenous and non-Indigenous (RR 1.14, 95%CI 0.98 to 1.34, I² = 87%). We observed a shorter ICU length of stay among Indigenous (MD - 0.25; 95%CI, - 0.49 to - 0.00; I² = 95%) and a higher use for IMV among non-Indigenous (RR 1.10; 95%CI, 1.06 to 1.15; I² = 81%).

Conclusion: Research on Indigenous Peoples experience with critical care is poorly characterized and has rarely included Indigenous perspectives. ICU mortality between Indigenous and non-Indigenous populations was similar, while there was a shorter ICU length of stay and less mechanical ventilation use among Indigenous patients. Systematic Review Registration PROSPERO CRD42021254661; Registered: 12 June, 2021.

Keywords: Critical care; Critical illness; Epidemiology; Health outcomes; Indigenous peoples; Systematic review.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Critical Care
Critical Illness* / epidemiology
Critical Illness* / therapy
Humans
Incidence
Indigenous Peoples
Respiration, Artificial*