Cardiovascular Disease Among Crees Living with Diabetes in Eeyou Istchee in Northern Quebec

Abstract

Cree aboriginals aged 20 years and over in northern Quebec experience a high prevalence of diabetes (21.4%), especially in younger age groups, but little is known about their cardiovascular comorbidities and health service utilization outside the region. Information on cardiovascular disease (CVD) was obtained by linking the Quebec hospital discharge database with the Cree Diabetes Information System (CDIS) through health insurance numbers. Individuals were considered to have the disease if CVD was recorded in any diagnosis field of a discharge abstract during the study period (1996 to 2009). The proportion of individuals hospitalized with CVD at 10 years following a diabetes diagnosis was calculated using Kaplan-Meier survival estimates. Among the 1930 Cree adults with diabetes, 15% have been hospitalized with ischemic heart disease (IHD), including myocardial infarction, and 8% have been hospitalized with heart failure (HF) over the 13-year study period. Presence of IHD and HF increased with age, respectively, from 7.8% and 1.7% among those aged 40 to 59 years to 32.2% and 20.6% among cases ≥60 years. At 10 years following a diabetes diagnosis, the proportions of individuals hospitalized with IHD and HF, respectively, were 15% and 3% in the Crees diagnosed with diabetes at 40 to 59 years of age, compared with 47% and 28% in those diagnosed at ≥60 years. Crees with diabetes in northern Quebec experience an important cardiovascular burden, even at young ages. The extent of this is a wake-up call for a systematic, comprehensive approach targeting health promotion, prevention and chronic disease management in this northern region.