Abstract
BackgroundAboriginal peoples in Canada (First Nations, Metis and Inuit) are experiencing an epidemic of diabetes and its complications but little is known about the influence of factors attributed to colonization. The purpose of this study was to investigate the possible role of discrimination, residential school attendance and cultural disruption on diabetes occurrence among First Nations adults.MethodsThis 2012/13 cross sectional survey was conducted in two Saskatchewan First Nations communities comprising 580 households and 1570 adults. In addition to self-reported diabetes, interviewer-administered questionnaires collected information on possible diabetes determinants including widely recognized (e.g. age, sex, lifestyle, social determinants) and colonization-related factors. Clustering effect within households was adjusted using Generalized Estimating Equations.ResultsResponses were obtained from 874 (55.7 %) men and women aged 18 and older living in 406 (70.0 %) households. Diabetes prevalence was 15.8 % among women and 9.7 % among men. In the final models, increasing age and adiposity were significant risk factors for diabetes (e.g. OR 8.72 [95 % CI 4.62; 16.46] for those 50+, and OR 8.97 [95 % CI 3.58; 22.52] for BMI 30+) as was spending most time on-reserve. Residential school attendance and cultural disruption were not predictive of diabetes at an individual level but those experiencing the most discrimination had a lower prevalence of diabetes compared to those who experienced little discrimination (2.4 % versus 13.6 %; OR 0.11 [95 % CI 0.02; 0.50]). Those experiencing the most discrimination were significantly more likely to be married and to have higher incomes.ConclusionsKnown diabetes risk factors were important determinants of diabetes among First Nations people, but residential school attendance and cultural disruption were not predictive of diabetes on an individual level. In contrast, those experiencing the highest levels of discrimination had a low prevalence of diabetes. Although the reasons underlying this latter finding are unclear, it appears to relate to increased engagement with society off-reserve which may lead to an improvement in the social determinants of health. While this may have physical health benefits for First Nations people due to improved socio-economic status and other undefined influences, our findings suggest that this comes at a high emotional price.
Highlights
Aboriginal peoples in Canada (First Nations, Metis and Inuit) are experiencing an epidemic of diabetes and its complications but little is known about the influence of factors attributed to colonization
Known diabetes risk factors were important determinants of diabetes among First Nations people, but residential school attendance and cultural disruption were not predictive of diabetes on an individual level. Those experiencing the highest levels of discrimination had a low prevalence of diabetes
The reasons underlying this latter finding are unclear, it appears to relate to increased engagement with society off-reserve which may lead to an improvement in the social determinants of health
Summary
Aboriginal peoples in Canada (First Nations, Metis and Inuit) are experiencing an epidemic of diabetes and its complications but little is known about the influence of factors attributed to colonization. Aboriginal peoples in Canada (First Nations, Inuit and Metis) are experiencing an epidemic of type 2 diabetes (T2DM) [1, 2] Compared to their nonAboriginal counterparts, First Nations people have higher rates of diabetes [2] but are more likely to develop diabetes if female [2], as younger adults [2], and during childhood and adolescence [3]. While genetic factors contribute to the risk for T2DM [9], they cannot explain the rapid world-wide emergence of diabetes over the past few decades in diverse populations that include many Indigenous groups [10] Instead, this pandemic has paralleled recent changes in environmental and possibly epigenetic factors [11] – these have been attributed to unprecedented disruptions in traditional lifestyles that have occurred in virtually all human populations, since the middle of the past century [12]. There is mounting evidence that increasing rates of childhood obesity and T2DM are partly driven by an increased incidence of diabetic pregnancies among First Nations women – women with gestational diabetes [15] and their children [16] have a higher risk for T2DM
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