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

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dc.contributor.authorAnand, Sonia S.
dc.contributor.authorAbonyi, Sylvia
dc.contributor.authorArbour, Laura
dc.contributor.authorBalasubramanian, Kumar
dc.contributor.authorBrook, Jeffrey
dc.contributor.authorCastleden, Heather
dc.contributor.authorChrisjohn, Vicky
dc.contributor.authorCornelius, Ida
dc.contributor.authorDavis, Albertha Darlene
dc.contributor.authorDesai, Dipika
dc.contributor.authorde Souza, Russell J.
dc.contributor.authorFriedrich, Matthias G.
dc.contributor.authorHarris, Stewart
dc.contributor.authorIrvine, James
dc.contributor.authorL’Hommecourt, Jean
dc.contributor.authorLittlechild, Randy
dc.contributor.authorMayotte, Lisa
dc.contributor.authorMcIntosh, Sarah
dc.contributor.authorMorrison, Julie
dc.contributor.authorOster, Richard T.
dc.contributor.authorPicard, Manon
dc.contributor.authorPictou Landing First Nation
dc.contributor.authorPoirier, Paul
dc.contributor.authorSchulze, Karleen M.
dc.contributor.authorToth, Ellen L.
dc.date.accessioned2020-01-27T00:01:41Z
dc.date.available2020-01-27T00:01:41Z
dc.date.copyright2019en_US
dc.date.issued2019
dc.description.abstractSummary 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.reviewstatusRevieweden_US
dc.description.scholarlevelFacultyen_US
dc.description.sponsorshipThis 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.identifier.citationAnand, 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)30237-2en_US
dc.identifier.urihttps://doi.org/10.1016/S2542-5196(19)30237-2
dc.identifier.urihttp://hdl.handle.net/1828/11514
dc.language.isoenen_US
dc.publisherThe Lancet Planet Healthen_US
dc.subjectIsland Medical Program
dc.subject.departmentSchool of Medical Sciences
dc.titleExplaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based studyen_US
dc.typeArticleen_US

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