Epidemiology of diabetes mellitus among First Nations and non-First Nations adults

The authors astutely noted a change in the incidence in diabetes when the First Nations cohort was substantially expanded with urban First Nations women due to the passage of Bill C-31. Attribution was no doubt correctly ascribed.

However, the incidence of diabetes as measured per 1,000 did appear to change significantly according to the data provided as denominator change would not affect per 1,000 rates. Is this not the case?

The result would rather seem to suggest that for some reason urban First Nations women may have a lower incidence of diabetes than counterparts in rural settings. Certainly income level has been connected to mortality as a result of diabetes (CMAJ 2010) and income to health for decades. Not surprisingly, overall health status of urban Aboriginal populations has been flagged as significantly different from non- Aboriginal populations (Am J Public Health 2006 96 (8)) and so there appears to be a dual effect: being First Nations and urban versus rural dwelling.

These disparities in urban-rural Aboriginal populations call for further investigation perhaps related to educational achievement and necessary concurrent freedom from addictive behaviours prevalent in some communities. Such research is critical to ensuring Aboriginal peoples ultimately achieve equity in health status and education.

KM Butler DVM

Conflict of Interest:

None declared