Unmet health needs and discrimination by healthcare providers among Indigenous people with multimorbidity - A Respondent-Driven Sampling study of an urban Indigenous population in Toronto, Canada
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Background: Inequality in health between Indigenous and non-Indigenous people in Canada persists. Despite the growth in Indigenous peoples of Canada living in urban areas, information on the health of urban Indigenous people is scarce. The “Our Health Counts Toronto” study attempts to fill this knowledge gap for the urban Indigenous population (including First Nations, Inuit and Métis) living in the city of Toronto, Ontario, Canada. Aim: The aim of this study is to assess factors associated with having unmet health needs including disease burden (multimorbidity), and experience of discrimination by a healthcare provider. Method: Respondent-Driven Sampling (RDS) methodology, developed specifically to identify hard-to-reach populations, was used for the recruitment of a self-identified adult urban Indigenous population. Health information was collected through a total of 940 interviews conducted, with a final sample of 836 interviews utilized. Respondents were asked if they had ever experienced discrimination by a healthcare provider and if they had an unmet health need in the 12 months prior to the study. Respondents were classified as multimorbid if they indicated two or more conditions from a list of 13 chronic conditions. Data was analysed to assess the relationship between multimorbidity and having unmet health needs and the relationship between experience of discrimination by a healthcare provider and having unmet health needs. Stratified analysis was conducted based on information on: Indigenous identity; gender; age; education; employment; food security; mobility; income; and access to a regular healthcare provider. Results: The RDS-adjusted prevalence of self-reported unmet health needs in the urban Indigenous population was 27.27% (19.05-35.49 95%C.I.). The RDS-adjusted prevalence of multimorbidity was 61.66% (53.87-69.46 95%C.I.). The RDS-adjusted prevalence of discrimination by a healthcare provider was 28.47% (20.40-36.54 95%C.I.). Both multimorbidity and discrimination be a healthcare provider were independently associated with self-reported unmet health needs, OR 2.45 (1.11-5.41 95%C.I.) and OR 3.05 (1.27-7.34 95%C.I.) respectively. Conclusion: Unmet health needs are prevalent among urban Indigenous people. Both having multimorbidity and having experienced discrimination by a healthcare provider increase the likelihood of having unmet health needs. The analysis presented reinforces the need for healthcare providers to receive cultural safety training. Measures must be taken to ensure that the needs of urban Indigenous people with multimorbidity are addressed.