Diabetes and Adverse Outcomes in a First Nations Population: Associations With Healthcare Access, and Socioeconomic and Geographical Factors

Abstract

ABSTRACT OBJECTIVE For Aboriginal on-reserve First Nations populations of Manitoba, Canada, this study explores (i) diabetes and amputation patterns; and (ii) their ecologic associations with geography, income and access to healthcare. RESEARCH DESIGN AND METHODS De-identified administrative claims data in the Population Health Research Data Repository were linked to federal Status Verification System files for 1995 to 1999 (n=48 036 First Nations; 1 054 422 other Manitobans). Directly standardized rates were determined for ages 20 to 79 using International Classification of Diseases, 9th Revision, Clinical Modification codings: (i) treatment prevalence of diabetes, using physician and hospital billing claims with diagnosis 250; (ii) lower limb amputation with diabetes comorbidity (diagnosis 250) using hospitalization procedure codes 84.40 and 84.45 to 84.48. Ecologic correlations at the tribal council level, consisting of 9 First Nations on-reserve groupings, examined associations of diabetes indicators, average household income (1996 Statistics Canada census), ambulatory consult rates and geography (north vs. south). RESULTS Comparing First Nations with other Manitobans, rates of diabetes (203 vs. 45 per thousand) and amputation (3.39 vs. 0.19 per thousand) were higher. For on-reserve First Nations, diabetes varied by tribal council (149 to 249 per thousand) and was associated with income (r=—0.82, p=0.007) and geography (north 186.8, south 227.9, p CONCLUSION Among First Nations, diabetes prevalence is associated with socioeconomic (income) and geographic gradients, whereas the adverse outcome of amputation is associated with healthcare access (consult rates). Even within universally insured industrialized countries, First Nations barriers to healthcare must be addressed.