Chronic Diseases among Canada s Aboriginal Populations: Will it get worse before it gets better?

Transcription

1 Chronic Diseases among Canada s Aboriginal Populations: Will it get worse before it gets better? Kue Young, CM, MD, FRCPC, DPhil, FCAHS Professor and TransCanada Chair in Aboriginal Health Dalla Lana School of Public Health University of Toronto

2 Why are chronic diseases relevant to Aboriginal people? Aboriginal population undergoing health transition: shift from infectious to chronic diseases; Increasing important causes of mortality, morbidity, disability, and reduced quality of life; Serious social and economic impact Likely to get worse before getting better

3 Who Are Aboriginal People? Constitution Act of Canada defines three groups: First Nations, Inuit and Métis According to 2006 Census (based on self report): 1,172,790 (4% of population) consider themselves as Aboriginal: 698,025 First Nation (North American Indian) 389,785 Métis 50,485 Inuit Diversity of cultural/linguistic/tribal groups

4 Where are they located? Aboriginal people constitute 15% of the provincial population of Manitoba and Saskatchewan; 35% of Yukon; 50% of the Northwest Territories, and 85% of Nunavut But, almost 40% of all Aboriginal people live in Ontario and British Columbia 54% live in urban areas. In Winnipeg, Regina and Saskatoon, Aboriginal people account for 9-10% of the total population

5 Aboriginal communities Language families Population size

6 What do we know about chronic diseases in Aboriginal people? Sources of data: Vital Statistics mortality databases Health Services Utilization Drug Expenditures Disease Registries Health Surveys But large gaps!

7 Deficiencies Ethnic identifiers generally lacking in vital stats and health care databases Some data available based on geographical residence codes Matching (electronically or manually) to known list of Aboriginal people No national picture available! Not all Aboriginal groups covered [especially lacking for Metis]

8 Canada All others, 12% Respiratory, 10% Digestive, 4% Endocrine, 4% Injuries, 6% Ciculatory, 36% Distribution of causes of death by ICD-10 chapters: Cancer, 29% First Nations First Nations vs Canada All others, 23% Injuries, 23% Respiratory, 6% Digestive, 6% Endocrine, 5% Circulatory, 23% Source: FNIHB 2004 Cancer, 15%

9 Ratio: First Nation/Canada Ratio of age-standardized mortality rates by selected causes, First Nations:Canada Digestive Endocrine Respiratory Injuries Cancer Circulatory Source: FNIHB 2004

10 ASMR (per ) Age-standardized mortality rate (per Age-standardized mortality rates Male FN Canada Female s Male FN Canada Female All Circulatory Diseases Ischemic heart disease Stroke All Circulatory Diseases Ischemic heart disease Stroke s 0 All Circulatory Diseases Ischemic heart disease Stroke All Circulatory Diseases Ischemic heart disease Stroke

11 Rate per 100,000 Age-specific hospitalization rate for cardiovascular diseases First Nations-M First Nations-F Canada-M Canada-F Age Group

12 Emergency room visits for asthma/copd in Alberta [Sin et al 2002] Hospital admissions for ischemic heart disease in Ontario [Shah et al 2000]

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14 Claimants per 100,000 clients Mean annual utilization rate for selected drug classes, First Nations 12,000 10,000 8,000 Cardiovascular Respiratory 6,000 Diabetic 4,000 2,000 Antineoplastics / / / / /2004 Source: FNIHB 2004

15 Ratio of age-standardized incidence rates of cancer, First Nations: Ontario All sites Ratio FN:ON Oral cavity Eosphagus Stomach MALE Colon/rectum Gallbladder Pancreas Lung Prostate Bladder Kidney CNS Non-Hodgkin's lymphoma Multiple myeloma Leukemia Source: Marrett and Chaudhry (2003)

16 Ratio of age-standardized incidence rates of cancer, First Nations: Ontario All sites Oral cavity Stomach Colon/rectum FEMALE Gallbladder Pancreas Lung Breast Uterus Cervix Ovary Bladder Kidney CNS Thyroid Non-Hodgkin's lymphoma Multiple myeloma Leukemia Source: Marrett and Chaudhry (2003)

17 Health Surveys Most national surveys exclude reserves and/or northern territories Many smaller-scale regional/community surveys Since 1990s data availability much improved with several national health interview surveys Aboriginal Peoples Survey (APS) First Nations Regional Health Survey (FNRHS) Canadian Community Health Survey (CCHS)

18 Anthropometry and blood pressure measurement in health examination surveys

19 Health interview surveys Leisure-time physical activity Proportion of diet from hunting/fishing

20 Crude prevalence of self-reported chronic conditions, First Nations Prevalence (%) Hypertension Arthritis/Rheumatism Diabetes Asthma Heart Problems APS-1 FNRHS-1 APS-2 CCHS Cancer

21 Prevalence (%) Age-specific prevalence of self-reported diabetes: First Nations and Canada MALE First Nations 1997 First Nations Canada FEMALE Age Group

22 Percent Selected socioeconomic health determinants: Aboriginal people and all Canadians All Canadians Total Aboriginal First Nations Metis Inuit % income < $10,000 % adults unemployed % adults < high school graduation Source: Statcan 2001 Census

23 Association of education and chronic disease: First Nations Source: FNIRHS-1

24 Prevalence (%) Age-specific prevalence of smoking: First Nations and all Canadians First Nations Canada All ages Age Group

25 Health care utilization associated with complications of diabetes in Ontario Rate (per 1000 per year) Hosp for infectious disease Hosp for unstable angina Hosp for acute myocardial infarction Hosp for congestive heart failure Chronic renal dialysis Non-traumatic lower extremity amputation Non-FN, Non-DM Non-FN, DM FN, Non-DM FN, DM Stroke hospitalization Source: Shah et al (2003) in ICES Atlas

26 $ per person Health care costs associated with diabetes in Manitoba Non-FN, Non-DM Non-FN, DM FN, Non-DM FN, DM Hospitalization Personal care home Professional services Outpatient dialysis Source: Jacobs et al (2000)

27 Primary Prevention Projects Kahnawake [urban] and Sandy Lake [remote] Incorporate Aboriginal learning styles, cultural practices and traditional knowledge School-based programs; community activities; supportive environment Participatory research Outcome measures: obesity, physical activity, Δ in eating habits

28 Messages Chronic diseases an emerging health problem among Aboriginal people with substantial health and social impact Still major gaps in basic surveillance of chronic disease and risk factors hamper efforts at prevention and control BUT We don t need perfect data before taking action! Urgent action needed now! Addressing social determinants important in long term while health systems interventions are needed for immediate short term

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