Sonia S Anand1, Sylvia Abonyi2, Laura Arbour3, Kumar Balasubramanian4, Jeffrey Brook5, Heather Castleden6, Vicky Chrisjohn7, Ida Cornelius7, Albertha Darlene Davis8, Dipika Desai9, Russell J de Souza10, Matthias G Friedrich11, Stewart Harris12, James Irvine13, Jean L'Hommecourt14, Randy Littlechild15, Lisa Mayotte16, Sarah McIntosh17, Julie Morrison18, Richard T Oster19, Manon Picard20, Paul Poirier21, Karleen M Schulze4, Ellen L Toth19. 1. Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Health Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada. Electronic address: anands@mcmaster.ca. 2. Faculty of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada. 3. Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; Division of Biomedical Sciences, University of Victoria, Victoria, BC, Canada. 4. Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada. 5. Dalla Lana School of Public Health and Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, Canada. 6. Department of Geogrophy and Planning, Queens University, Kingston, ON, Canada. 7. Oneida Health Centre, Oneida Nation of the Thames, Southwold, ON, Canada. 8. Six Nations Health Service, Six Nations of Grand River, Ohsweken, ON, Canada. 9. Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada. 10. Department of Health Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada. 11. Department of Medicine and Diagnostic Radiology, McGill University, Montréal, QC, Canada. 12. Department of Family Medicine, Western University, London, ON, Canada. 13. Department of Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada. 14. Fort McKay First Nation, Fort McMurray, AB, Canada. 15. Maskwacis Health Services, Maskwacis First Nation, Maskwacis, AB, Canada. 16. Health Services, Lac La Ronge Indian Band, La Ronge, SK, Canada. 17. Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada. 18. Gitxsan Health Society, Hazelton, BC, Canada. 19. Department of Medicine, University of Alberta, Edmonton, AB, Canada. 20. Health Services, Wendake Reserve, Wendake, QC, Canada. 21. Institut universitaire de cardiologie et de pneumologie de Quebec, Université Laval, QC, Canada.
Abstract
BACKGROUND: Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada. METHODS: Men and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis. FINDINGS: The mean INTERHEART risk score of all communities was 17·2 (SE 0·2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0·0001). Socioeconomic advantage (-1·4 score, 95% CI -2·5 to -0·3; p=0·01), trust between neighbours (-0·7, -1·2 to -0·3; p=0·003), higher education level (-1·9, -2·9 to -0·8, p<0·001), and higher social support (-1·1, -2·0 to -0·2; p=0·02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2·2, 0·3 to 4·1, p=0·02), taking prescription medication (3·5, 2·8 to 4·3; p<0·001), and inability to afford prescription medications (1·5, 0·5 to 2·6; p=0·003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. Communities with difficulty accessing health care, and individuals taking or unable to afford prescription medications, had a higher INTERHEART risk score. INTERPRETATION: Cardiac risk factors are lower in communities with high socioeconomic advantage, greater trust, social support and educational opportunities, and higher where it is difficult to access health care or afford prescription medications. Strategies to optimise the protective factors and reduce barriers to health care in First Nations communities might contribute to improved health and wellbeing. FUNDING: Heart and Stroke Foundation of Canada, Canadian Partnership Against Cancer, Canadian Institutes for Health Research.
BACKGROUND: Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada. METHODS:Men and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis. FINDINGS: The mean INTERHEART risk score of all communities was 17·2 (SE 0·2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0·0001). Socioeconomic advantage (-1·4 score, 95% CI -2·5 to -0·3; p=0·01), trust between neighbours (-0·7, -1·2 to -0·3; p=0·003), higher education level (-1·9, -2·9 to -0·8, p<0·001), and higher social support (-1·1, -2·0 to -0·2; p=0·02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2·2, 0·3 to 4·1, p=0·02), taking prescription medication (3·5, 2·8 to 4·3; p<0·001), and inability to afford prescription medications (1·5, 0·5 to 2·6; p=0·003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. Communities with difficulty accessing health care, and individuals taking or unable to afford prescription medications, had a higher INTERHEART risk score. INTERPRETATION: Cardiac risk factors are lower in communities with high socioeconomic advantage, greater trust, social support and educational opportunities, and higher where it is difficult to access health care or afford prescription medications. Strategies to optimise the protective factors and reduce barriers to health care in First Nations communities might contribute to improved health and wellbeing. FUNDING: Heart and Stroke Foundation of Canada, Canadian Partnership Against Cancer, Canadian Institutes for Health Research.
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