Jennifer D Walker1, Morgan Slater2, Carmen R Jones2, Baiju R Shah2, Eliot Frymire2, Shahriar Khan2, Kristen Jacklin2, Michael E Green2. 1. School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; ICES Central (Walker, Shah), Toronto, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; ICES Queen's (Frymire, Khan, Green), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn. jenniferwalker@laurentian.ca. 2. School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; ICES Central (Walker, Shah), Toronto, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; ICES Queen's (Frymire, Khan, Green), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.
Abstract
BACKGROUND: Diabetes mellitus is an established health concern in First Nations communities and is associated with complex influences of colonization. This study, a partnership between First Nations and academic researchers, was undertaken to determine patterns of diabetes prevalence, incidence and mortality in Ontario. METHODS: Using health services and population data from Ontario for 1995 to 2014, linked with the federal Indian Register, we calculated age- and sex-adjusted annual estimates of diabetes prevalence, incidence and mortality for First Nations people (living within and outside First Nations communities) and other people in Ontario. We also examined age- and sex-specific crude diabetes prevalence. RESULTS: Between 1995 and 2014, the prevalence of diabetes increased and the incidence decreased somewhat in all populations. Both prevalence and incidence were substantially higher among First Nations people than among other people in Ontario. In particular, First Nations women had higher prevalence than other women (4.2% v. 1.6% for ages 20-34 yr and 17.6% v. 6.0% for ages 35-49 yr). The lifetime risk of diabetes was higher among First Nations people than among other people in Ontario (57.0%, 95% confidence interval [CI] 56.3%-57.6% v. 44.5%, 95% CI 44.4%-44.6%). Over time, all-cause mortality for those with diabetes declined but remained consistently higher for First Nations people than for other people in Ontario. INTERPRETATION: Diabetes is more common among First Nations people than among other people in Ontario, particularly at younger ages and in women. First Nations-led approaches to address the high prevalence of diabetes in younger First Nations women have the potential to improve metabolic health across generations.
BACKGROUND:Diabetes mellitus is an established health concern in First Nations communities and is associated with complex influences of colonization. This study, a partnership between First Nations and academic researchers, was undertaken to determine patterns of diabetes prevalence, incidence and mortality in Ontario. METHODS: Using health services and population data from Ontario for 1995 to 2014, linked with the federal Indian Register, we calculated age- and sex-adjusted annual estimates of diabetes prevalence, incidence and mortality for First Nations people (living within and outside First Nations communities) and other people in Ontario. We also examined age- and sex-specific crude diabetes prevalence. RESULTS: Between 1995 and 2014, the prevalence of diabetes increased and the incidence decreased somewhat in all populations. Both prevalence and incidence were substantially higher among First Nations people than among other people in Ontario. In particular, First Nations women had higher prevalence than other women (4.2% v. 1.6% for ages 20-34 yr and 17.6% v. 6.0% for ages 35-49 yr). The lifetime risk of diabetes was higher among First Nations people than among other people in Ontario (57.0%, 95% confidence interval [CI] 56.3%-57.6% v. 44.5%, 95% CI 44.4%-44.6%). Over time, all-cause mortality for those with diabetes declined but remained consistently higher for First Nations people than for other people in Ontario. INTERPRETATION:Diabetes is more common among First Nations people than among other people in Ontario, particularly at younger ages and in women. First Nations-led approaches to address the high prevalence of diabetes in younger First Nations women have the potential to improve metabolic health across generations.
Authors: Kristen M Jacklin; Rita I Henderson; Michael E Green; Leah M Walker; Betty Calam; Lynden J Crowshoe Journal: CMAJ Date: 2017-01-23 Impact factor: 8.262
Authors: D Dabelea; R L Hanson; R S Lindsay; D J Pettitt; G Imperatore; M M Gabir; J Roumain; P H Bennett; W C Knowler Journal: Diabetes Date: 2000-12 Impact factor: 9.461
Authors: David J T Campbell; Paul E Ronksley; Brenda R Hemmelgarn; Jianguo Zhang; Cheryl Barnabe; Marcello Tonelli; Braden Manns Journal: Open Med Date: 2012-12-11
Authors: Baiju R Shah; Morgan Slater; Eliot Frymire; Kristen Jacklin; Roseanne Sutherland; Shahriar Khan; Jennifer D Walker; Michael E Green Journal: CMAJ Open Date: 2020-05-05
Authors: Michael E Green; Baiju R Shah; Morgan Slater; Shahriar Khan; Carmen R Jones; Jennifer D Walker Journal: CMAJ Date: 2020-08-17 Impact factor: 8.262
Authors: Sarah A Stotz; Kristie McNealy; Rene L Begay; Kristen DeSanto; Spero M Manson; Kelly R Moore Journal: Curr Diab Rep Date: 2021-11-07 Impact factor: 5.430