End Stage Renal Disease Among People with Diabetes: A Comparison of First Nations People and Other Saskatchewan Residents from 1981 to 2005

Objective: Since First Nations people (FN) with diabetes experience higher rates of end-stage renal disease (ESRD) than others, we aimed to better understand these disparities by comparing the epidemiology of ESRD between FN and other Saskatchewan residents (OSK) with diabetes over a prolonged period. Methods: We used healthcare system administrative databases to determine ESRD rates, distribution and mortality by ethnicity, age and sex among total diabetes populations in Saskatchewan from 1981 to 2005. Results: Although similar initially, ESRD incidence among FN with diabetes peaked at levels 3 to 4 times higher than OSK with diabetes by 1991 to 1996. Differences in ESRD prevalence between diabetes populations were less pronounced. OSK men with diabetes experienced higher ESRD rates than OSK women with diabetes, while sex differences among FN were variable. FN with diabetes and ESRD were younger than OSK at diabetes diagnosis and experienced a longer time from diabetes to ESRD diagnosis. However, survival of FN adults with diabetes after ESRD diagnosis was reduced compared to others. Conclusions: Ethnicity-based disparities in ESRD incidence among people with diabetes remain pronounced, particularly among women. Differential mortality pre-ESRD may contribute to these differences, because FN are younger at diabetes diagnosis. This favours longer survival and increased exposure to the metabolic consequences of diabetes.