Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study

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dc.contributor.author Anand, Sonia S.
dc.contributor.author Abonyi, Sylvia
dc.contributor.author Arbour, Laura
dc.contributor.author Balasubramanian, Kumar
dc.contributor.author Brook, Jeffrey
dc.contributor.author Castleden, Heather
dc.contributor.author Chrisjohn, Vicky
dc.contributor.author Cornelius, Ida
dc.contributor.author Davis, Albertha Darlene
dc.contributor.author Desai, Dipika
dc.contributor.author de Souza, Russell J.
dc.contributor.author Friedrich, Matthias G.
dc.contributor.author Harris, Stewart
dc.contributor.author Irvine, James
dc.contributor.author L’Hommecourt, Jean
dc.contributor.author Littlechild, Randy
dc.contributor.author Mayotte, Lisa
dc.contributor.author McIntosh, Sarah
dc.contributor.author Morrison, Julie
dc.contributor.author Oster, Richard T.
dc.contributor.author Picard, Manon
dc.contributor.author Pictou Landing First Nation
dc.contributor.author Poirier, Paul
dc.contributor.author Schulze, Karleen M.
dc.contributor.author Toth, Ellen L.
dc.date.accessioned 2020-01-27T00:01:41Z
dc.date.available 2020-01-27T00:01:41Z
dc.date.copyright 2019 en_US
dc.date.issued 2019
dc.identifier.citation Anand, S.S., Abonyi, S., Arbour, L., Balasubramanian, K.,Brook, J., Castleden, H., … Toth, E.L. (2019). Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study. The Lancet Planet Health, 3(12), e511-e520. https://doi.org/10.1016/S2542-5196(19)30237-2 en_US
dc.identifier.uri https://doi.org/10.1016/S2542-5196(19)30237-2
dc.identifier.uri http://hdl.handle.net/1828/11514
dc.description.abstract 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. en_US
dc.description.sponsorship This work was supported by the Heart and Stroke Foundation of Canada (PCS-144022), the Canadian Partnership Against Cancer, and the Canadian Institutes for Health Research (OFM-141086). In-kind or institutional contributions were made from Canadian Institutes for Health Research Foundation grants: SSA; Vascular Biology Imaging Research Group, Sunnybrook Research Institute, University of Toronto; and Population Health Research Institute. en_US
dc.language.iso en en_US
dc.publisher The Lancet Planet Health en_US
dc.title Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study en_US
dc.type Article en_US
dc.description.scholarlevel Faculty en_US
dc.description.reviewstatus Reviewed en_US

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