CMAJ • October 12, 2004; 171 (8). doi:10.1503/cmaj.1031624.
© 2004 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Fracture risk among First Nations people: a retrospective matched cohort study

William D. Leslie, Shelley Derksen, Colleen Metge, Lisa M. Lix, Elizabeth A. Salamon, Pauline Wood Steiman and Leslie L. Roos

Department of Medicine (Leslie, Salamon), Manitoba Centre for Health Policy, Department of Community Health Sciences (Derken, Metge, Lix, Roos), University of Manitoba, and Four Arrows Health Authority, Island Lake Tribal Council (Wood Steiman), Winnipeg, Man.

Background: Canadian First Nations people have unique cultural, socioeconomic and health-related factors that may affect fracture rates. We sought to determine the overall and site-specific fracture rates of First Nations people compared with non-First Nations people.

Methods: We studied fracture rates among First Nations people aged 20 years and older (n = 32 692) using the Manitoba administrative health database (1987–1999). We used federal and provincial sources to identify ethnicity, and we randomly matched each First Nations person with 3 people of the same sex and year of birth who did not meet this definition of First Nations ethnicity (n = 98 076). We used a provincial database of hospital separations and physician billing claims to calculate standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for each fracture type based on a 5-year age strata.

Results: First Nations people had significantly higher rates of any fracture (age- and sex-adjusted SIR 2.23, 95% CI 2.18–2.29). Hip fractures (SIR 1.88, 95% CI 1.61–2.14), wrist fractures (SIR 3.01, 95% CI 2.63–3.42) and spine fractures (SIR 1.93, 95% CI 1.79–2.20) occurred predominantly in older people and women. In contrast, craniofacial fractures (SIR 5.07, 95% CI 4.74–5.42) were predominant in men and younger adults.

Interpretation: First Nations people are a previously unidentified group at high risk for fracture.




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