Diabetes and Adverse Outcomes in a First Nations Population: Associations With Healthcare Access, and Socioeconomic and Geographical Factors
Section snippets
INTRODUCTION
Inequalities in health status of Aboriginal peoples are well documented throughout the world (1) and are also mirrored in population-based comparisons in the province of Manitoba, Canada. Manitoba First Nations people have a life expectancy that is 8 years lower than other Manitobans, both for males (68.4 vs. 76.1 years) and females (73.2 vs. 81.4 years) (2). One of the major health concerns of Canadian First Nations people is type 2 diabetes (also known as adult-onset or noninsulin-dependent
Geographical regions and population counts
In this study, diabetes-related indicators are compared by the 9 tribal council areas (see Figure 1 for location and population size—7 political tribal council geographical areas, plus 2 virtual tribal council areas: "Independent First Nations North" (a contingent geographical area of 3 northern independent/unaffiliated First Nations band communities); and "Independent First Nations South" (a non-contingent virtual "area" of 5 First Nations communities found within other southern tribal council
Diabetes prevalence
The overall age- and sex-adjusted diabetes prevalence for Manitoba Registered First Nations people living on-reserve was 203 per thousand (i.e. 20.3% of the population aged 20 to 79). The crude, unadjusted rate was 150 per thousand, translating to 3582 people with diabetes out of a total Registered First Nations population of 23 844. Age- and sexadjusted diabetes prevalence varied from 149 per thousand in Keewatin Tribal Council to 249 per thousand in the southern Dakota Ojibway Tribal Council (
DISCUSSION
This study had 2 objectives: namely, to determine prevalence of diabetes and rates of lower limb amputation with diabetes comorbidity, and to determine associations between these 2 outcomes and various determinants of health and healthcare access. For the second objective, the limitations of using ecologic data must be underscored. Aggregate group rates, not individual outcomes, have been used to calculate the hypothesized associations, and therefore extreme caution must be exercised in making
AUTHOR CONTRIBUTIONS
PJM was principal investigator, overseeing the conceptualization and design of the study, data acquisition, and analysis and interpretation of the data, as well as being the primary author of the manuscript. JO contributed to the acquisition of data, and MM contributed to the writing of the draft article. BM, JO and MM contributed to the analysis and interpretation of data and to the revision of the draft article for important intellectual content. All authors have seen and approved the final
AUTHOR DISCLOSURES
No dualities of interest declared.
ACKNOWLEDGMENTS
This work was supported as part of a project on First Nations health, one of several projects undertaken each year under contract to Manitoba Health by the Manitoba Centre for Health Policy, a unit of the University of Manitoba's Department of Community Health Sciences. The working group for the study was the Health Information Research Committee of the Assembly of Manitoba Chiefs from 1999 to 2002, comprised of the health directors of each tribal council and independent First Nations
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