Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study
Summary: 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 cardio...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-12-01
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| Series: | The Lancet Planetary Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2542519619302372 |
| _version_ | 1818282763267080192 |
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| author | Sonia S Anand, ProfMD Sylvia Abonyi, PhD Laura Arbour, ProfMD Kumar Balasubramanian, MSc Jeffrey Brook, PhD Heather Castleden, PhD Vicky Chrisjohn Ida Cornelius, RN Albertha Darlene Davis, RN Dipika Desai, MSc Russell J de Souza, ScD Matthias G Friedrich, ProfMD Stewart Harris, ProfMD James Irvine, MD Jean L'Hommecourt Randy Littlechild Lisa Mayotte, RN Sarah McIntosh, MSc Julie Morrison, Med Richard T Oster, PhD Manon Picard, BSc Paul Poirier, ProfMD Karleen M Schulze, MMath Ellen L Toth, ProfMD |
| author_facet | Sonia S Anand, ProfMD Sylvia Abonyi, PhD Laura Arbour, ProfMD Kumar Balasubramanian, MSc Jeffrey Brook, PhD Heather Castleden, PhD Vicky Chrisjohn Ida Cornelius, RN Albertha Darlene Davis, RN Dipika Desai, MSc Russell J de Souza, ScD Matthias G Friedrich, ProfMD Stewart Harris, ProfMD James Irvine, MD Jean L'Hommecourt Randy Littlechild Lisa Mayotte, RN Sarah McIntosh, MSc Julie Morrison, Med Richard T Oster, PhD Manon Picard, BSc Paul Poirier, ProfMD Karleen M Schulze, MMath Ellen L Toth, ProfMD |
| author_sort | Sonia S Anand, ProfMD |
| collection | DOAJ |
| description | Summary: 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. |
| first_indexed | 2024-12-13T00:26:11Z |
| format | Article |
| id | doaj.art-18f929a6ac4c46d3b216681383db3596 |
| institution | Directory Open Access Journal |
| issn | 2542-5196 |
| language | English |
| last_indexed | 2024-12-13T00:26:11Z |
| publishDate | 2019-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Planetary Health |
| spelling | doaj.art-18f929a6ac4c46d3b216681383db35962022-12-22T00:05:25ZengElsevierThe Lancet Planetary Health2542-51962019-12-01312e511e520Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based studySonia S Anand, ProfMD0Sylvia Abonyi, PhD1Laura Arbour, ProfMD2Kumar Balasubramanian, MSc3Jeffrey Brook, PhD4Heather Castleden, PhD5Vicky Chrisjohn6Ida Cornelius, RN7Albertha Darlene Davis, RN8Dipika Desai, MSc9Russell J de Souza, ScD10Matthias G Friedrich, ProfMD11Stewart Harris, ProfMD12James Irvine, MD13Jean L'Hommecourt14Randy Littlechild15Lisa Mayotte, RN16Sarah McIntosh, MSc17Julie Morrison, Med18Richard T Oster, PhD19Manon Picard, BSc20Paul Poirier, ProfMD21Karleen M Schulze, MMath22Ellen L Toth, ProfMD23Department 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; Correspondence to: Prof Sonia S Anand, Population Health Research Institute, Hamilton, ON L8L 2X2, CanadaFaculty of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, CanadaDepartment of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; Division of Biomedical Sciences, University of Victoria, Victoria, BC, CanadaDepartment of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, CanadaDalla Lana School of Public Health and Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, CanadaDepartment of Geogrophy and Planning, Queens University, Kingston, ON, CanadaOneida Health Centre, Oneida Nation of the Thames, Southwold, ON, CanadaOneida Health Centre, Oneida Nation of the Thames, Southwold, ON, CanadaSix Nations Health Service, Six Nations of Grand River, Ohsweken, ON, CanadaPopulation Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, CanadaDepartment of Health Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, CanadaDepartment of Medicine and Diagnostic Radiology, McGill University, Montréal, QC, CanadaDepartment of Family Medicine, Western University, London, ON, CanadaDepartment of Family Medicine, University of Saskatchewan, Saskatoon, SK, CanadaFort McKay First Nation, Fort McMurray, AB, CanadaMaskwacis Health Services, Maskwacis First Nation, Maskwacis, AB, CanadaHealth Services, Lac La Ronge Indian Band, La Ronge, SK, CanadaDepartment of Medical Genetics, University of British Columbia, Vancouver, BC, CanadaGitxsan Health Society, Hazelton, BC, CanadaDepartment of Medicine, University of Alberta, Edmonton, AB, CanadaHealth Services, Wendake Reserve, Wendake, QC, CanadaInstitut universitaire de cardiologie et de pneumologie de Quebec, Université Laval, QC, CanadaDepartment of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, CanadaDepartment of Medicine, University of Alberta, Edmonton, AB, CanadaSummary: 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.http://www.sciencedirect.com/science/article/pii/S2542519619302372 |
| spellingShingle | Sonia S Anand, ProfMD Sylvia Abonyi, PhD Laura Arbour, ProfMD Kumar Balasubramanian, MSc Jeffrey Brook, PhD Heather Castleden, PhD Vicky Chrisjohn Ida Cornelius, RN Albertha Darlene Davis, RN Dipika Desai, MSc Russell J de Souza, ScD Matthias G Friedrich, ProfMD Stewart Harris, ProfMD James Irvine, MD Jean L'Hommecourt Randy Littlechild Lisa Mayotte, RN Sarah McIntosh, MSc Julie Morrison, Med Richard T Oster, PhD Manon Picard, BSc Paul Poirier, ProfMD Karleen M Schulze, MMath Ellen L Toth, ProfMD Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study The Lancet Planetary Health |
| title | Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study |
| title_full | Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study |
| title_fullStr | Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study |
| title_full_unstemmed | Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study |
| title_short | Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study |
| title_sort | explaining the variability in cardiovascular risk factors among first nations communities in canada a population based study |
| url | http://www.sciencedirect.com/science/article/pii/S2542519619302372 |
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