Intersections of Class and Colonisation: Access to Dental Care for Indigenous Peoples in Canada.

BackgroundIndigenous peoples in Canada have higher prevalence of modifiable risk factors for Alzheimer’s disease (AD). The relative importance of these risk factors on AD risk management is poorly understood.MethodsRelative risks from literature and prevalence of risk factors from Statistics Canada or the First Nations Regional Health Survey were used to determine projected population attributable risk (PAR) associated with modifiable risk factors for AD (low education and vascular risk factors) among on- and off-reserve Indigenous and non-Indigenous people in Canada using the Levin formula.ResultsPhysical inactivity had the highest PAR for AD among Indigenous and non-Indigenous peoples in Canada (32.5% [10.1%–51.1%] and 30.5% [9.2%–48.8%] respectively). The PAR for most modifiable risk factors was higher among Indigenous peoples in Canada, particularly among on-reserve groups. The greatest differences in PAR were for low educational attainment and smoking, which were approximately 10% higher among Indigenous peoples in Canada. The combined PAR for AD for all six modifiable risk factors was 79.6% among on-reserve Indigenous, 74.9% among off-reserve Indigenous, and 67.1% among non-Indigenous peoples in Canada. (All differences significant to p < .001.)ConclusionsModifiable risk factors are responsible for the most AD cases among Indigenous peoples in Canada. Further research is necessary to determine the prevalence of AD and the impact of risk factor modification among Indigenous peoples in Canada.

BACKGROUND:For Indigenous Peoples in Canada, birthing on or near traditional territories in the presence of family and community is of foundational cultural and social importance. We aimed to evaluate the association between Indigenous identity and distance travelled for birth in Canada.METHODS:We obtained data from the Maternity Experiences Survey, a national population-based sample of new Canadian people aged 15 years or older who gave birth (defined as mothers) and were interviewed in 2006–2007. We compared Indigenous with non-Indigenous Canadian-born mothers and adjusted for geographic and sociodemographic factors and medical complications of pregnancy using multivariable logistic regression. We categorized the primary outcome, distance travelled for birth, as 0 to 49, 50 to 199 or 200 km or more.RESULTS:We included 3100 mothers living in rural or small urban areas, weighted to represent 31 100 (1800 Indigenous and 29 300 non-Indigenous Canadian-born mothers). We found that travelling 200 km or more for birth was more common among Indigenous compared with non-Indigenous mothers (9.8% v. 2.0%, odds ratio [OR] 5.45, 95% confidence interval [CI] 3.52–8.48). In adjusted analyses, the association between Indigenous identity and travelling more than 200 km for birth was even stronger (adjusted OR 16.44, 95% CI 8.07–33.50) in rural regions; however, this was not observed in small urban regions (adjusted OR 1.04, 95% CI 0.37–2.91).INTERPRETATION:Indigenous people in Canada experience striking inequities in access to birth close to home compared with non-Indigenous people, primarily in rural areas and independently of medical complications of pregnancy. This suggests inequities are rooted in the geographic distribution of and proximal access to birthing facilities and providers for Indigenous people.

There is limited data regarding disclosure of gambling problems by patients, and awareness of gambling related symptoms and treatment options amongst GPs. A recent UK study determined the extent of gambling problems among patients attending GP services, and reported a gambling disorder in 5% of patients. Whilst reinforcing the potential for GP practices to be used for disorder detection, the study did not specially measure GPs awareness of both gambling disorder symptoms, or established care pathways for those experiencing the disorder4. To this end, data was collected via an online survey from 85 UK GPs (34 female)., from across the UK Respondents had been a GP for an average of 14.67 years (s.d. 9.58, range 1-40 years).

BackgroundThe impact of socioeconomic status on disease is becoming increasingly apparent. However, the relationship between gestational diabetes mellitus (GDM) and socioeconomic status (SES) has been less studied and remains inconsistent. The aim of this study was to investigate the relationship between SES and GDM.MethodsAll participants were selected from a prospective study on maternal and infant health in Zunyi City, China, between 2020 and 2022. Data on educational attainment, occupation, and household income were collected through standard questionnaires administered during face-to-face interviews. Logistic regression models were used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs), evaluating the association between GDM and SES—a composite measure comprising educational attainment, occupational status, and household monthly income.ResultsAmong 5,868 participants, 690 women (11.8%) were diagnosed with GDM. After adjusting for potential confounders, no significant association was observed between educational attainment and GDM prevalence. Compared to public sector employees, women engaged in private sector occupations, freelancing, or farming exhibited a lower GDM risk. Household monthly income demonstrated a significant positive correlation with GDM incidence. Stratified analyses revealed distinct age-related patterns: higher education attainment was associated with reduced GDM risk in women aged >35 years, while occupational influences on GDM were more pronounced in this age group. Conversely, income effects were stronger among women aged ≤35 years. BMI stratification further indicated that occupational factors predominantly affected GDM risk in underweight women (BMI <18.5 kg/m2), whereas income exhibited stronger associations in women with BMI ≥18.5 kg/m2.ConclusionOur study revealed a significant association SES and GDM development. Among household income and occupation emerged as stronger predictor of GDM to educational attainment in Zunyi City, Guizhou province, China.

Access to cancer care among Indigenous peoples in Canada: A scoping review

ObjectiveTo quantify the impact of household income, and physical and mental health in adolescence on education attainment, household income and health status in adulthood.DesignPath analysis and regression models using waves...

The effect of remittances on the labor supply decisions of recipients remains a subject of contention. To contribute to the debate, we investigate how the educational attainment and household income of remittance recipients shape their decisions to work. Using data from the 2018–2019 living standard measurement survey for over 61,000 Nigerians and applying the instrumental variable probit and Tobit techniques, we find that remittances are associated with an occupational switch from agriculture to nonagricultural (paid jobs and nonfarm enterprises) works. Specifically, the results show that remittance recipients are more likely to exit or reduce the hours worked on the farm, regardless of educational attainment and household income status. On the other hand, remittances promote labor supply to paid jobs and nonfarm enterprises, especially among the less educated in Northern Nigeria. In terms of household income, the positive effect of remittances on nonfarm jobs only holds for individuals in the top income quartile, regardless of their region of residence. Our findings are robust to alternative estimation techniques and hold important cues for policymakers.

BackgroundIt was reported that educational attainment and household income are associated with oropharyngeal cancer. However, whether such an association is causal is still unknown.MethodsThe Mendelian randomization (MR) design was performed to disentangle their causal relationship. Initially, genetic variants proxied for educational attainment and household income were extracted from the largest genome-wide association studies (GWAS), and two oropharyngeal GWAS datasets were used in the discovery and validation stages separately. A reverse MR analysis was carried out to judge whether oropharyngeal cancer affects educational attainment and household income. The results from the two stages were combined using meta-analysis. The heterogeneity and horizontal pleiotropy were appraised using several methods.ResultsAll selected genetic variants were valid. In the discovery stage, genetically elevated years of education might decrease the risk of oropharyngeal cancer (IVW OR = 0.148 [0.025, 0.872], p-value = 0.035), while such a result became insignificant in the validation stage (IVW p-value >0.05). Household income cannot change the risk of oropharyngeal cancer at both stages. The reverse MR suggested that oropharyngeal cancer should slightly alter household income (IVW OR = 1.001 [1.000, 1.003], p-value = 0.036) in the discovery set, but the result cannot be replicated in the validation stage. The meta-analysis did not find any significant results either. The results were also assessed by sensitivity analyses, and there was no heterogeneity or horizontal pleiotropy in the analyses. The statistical powers were all above 80% at the discovery stage.ConclusionsThere should be no causal association between educational attainment, household income, and oropharyngeal cancer.

Sexual violence during youth has serious consequences for short- and long-term health and wellbeing. It is not well understood how risk of sexual violence varies across intersecting social identities. This study aims to investigate disparities in sexual violence experienced amongst adolescents, at the intersections of sex, race and ethnicity, and sexual orientation. Data were extracted from the 2023 National Youth Risk Behavior Survey, a biennial school-based cross-sectional study conducted across the United States. A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was carried out, defining 40 intersectional strata by sex, race and ethnicity, and sexual orientation. Three outcomes were evaluated: (i) ever having forced sexual intercourse, (ii) any sexual violence in the past year, (iii) dating sexual violence in the past year. There was substantial between-stratum heterogeneity in predicted probabilities of forced intercourse and sexual violence. The highest risk strata overwhelmingly comprised non-heterosexual individuals and females, whilst the lowest risk strata comprised heterosexual individuals and males. Fixed effects of sex, race and ethnicity, and sexual orientation explained 82.4% to 86.8% of the between-stratum variance, but residual variance remained. The median odds ratio (MOR) indicated that risk of ever having had forced intercourse could double depending on intersectional identity (MOR: 2.04; 95% CI: 1.73 to 2.54). Findings support the hypothesis that risk is concentrated in multiply marginalized groups. Intersectional multilevel modelling revealed stark inequalities in adolescent sexual violence risk that are not fully explained by additive effects.

Access to Cardiovascular Care for Indigenous Peoples in Canada: A Rapid Review

Background:Substantial health inequities exist for Indigenous Peoples in Canada. The remote and distributed population of Canada presents unique challenges for access to and use of surgery. To date, the surgical outcome data for Indigenous Peoples in Canada have not been synthesized.Methods:We searched 4 databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Métis identity with non-Indigenous people in Canada. Independent reviewers completed all stages in duplicate. Our primary outcome was mortality; secondary outcomes included utilization rates of surgical procedures, complications and hospital length of stay. We performed meta-analysis of the primary outcome using random effects models. We assessed risk of bias using the ROBINS-I tool.Results:Twenty-eight studies were reviewed involving 1 976 258 participants (10.2% Indigenous). No studies specifically addressed Inuit or Métis populations. Four studies, including 7 cohorts, contributed adjusted mortality data for 7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher rate of death after surgery than non-Indigenous patients (pooled hazard ratio 1.30, 95% CI 1.09–1.54; I2 = 81%). Complications were also higher for Indigenous Peoples, including infectious complications (adjusted OR 1.63, 95% CI 1.13–2.34) and pneumonia (OR 2.24, 95% CI 1.58–3.19). Rates of various surgical procedures were lower, including rates of renal transplant, joint replacement, cardiac surgery and cesarean delivery.Interpretation:The currently available data on postoperative outcomes and surgery utilization rates for Indigenous Peoples in Canada are limited and of poor quality. Available data suggest that Indigenous Peoples have higher rates of death and adverse events after surgery, while also encountering barriers accessing surgical procedures. These findings suggest a need for substantial re-evaluation of surgical care for Indigenous Peoples in Canada to ensure equitable access and to improve outcomes. Protocol registration:PROSPERO-CRD42018098757

Homelessness among Indigenous peoples in Canada: The impacts of child welfare involvement and educational achievement

BackgroundThe health-care-seeking process while experiencing marital violence can be significantly influenced by one’s socioeconomic status, which limits the availability of resources and opportunities for accessing those resources. This study exploratorily examined the effects of socioeconomic factors on the association between marital violence and health care utilization in Japan.MethodsCross-sectional data on 2,984 male and female community residents aged 25 to 50 years was obtained from the first wave of Japanese Study of Stratification, Health, Income, and Neighborhood (J-SHINE) conducted between 2010 and 2011. Multiple logistic regression analysis was conducted to examine the association between marital violence and health care utilization. Interaction terms were used to examine the moderating effect of educational attainment, household income, and employment status on the association. Mediation analysis was conducted to estimate the magnitude of mediating effects of mastery, social support, and health literacy in relation to the moderating effect of socioeconomic factors.ResultsHealth care utilization in Japan was more prevalent among those who experienced marital violence (69.4 vs. 65.1%). The association between marital violence and health care utilization differed by employment status at a 0.10 level, while educational attainment and household income did not have substantial influence on health care utilization in the presence of marital violence. None of the psychosocial resources (mastery, health literacy, instrumental support, and informational support) explained the differential association by employment status.ConclusionsThis study highlights the increased health care needs of those experiencing marital violence in Japan. The health care needs of the unemployed are potentially unmet in the presence of marital violence. Removing barriers to health care experienced by the unemployed may be an effective strategy for connecting survivors to needed supports and care.

The health-care-seeking process while experiencing marital violence can be significantly influenced by one’s socioeconomic status, which limits the availability of resources and opportunities for accessing those resources. This study exploratorily examined the effects of socioeconomic factors on the association between marital violence and health care utilization in Japan. Cross-sectional data on 2,984 male and female community residents aged 25 to 50 years was obtained from the first wave of Japanese Study of Stratification, Health, Income, and Neighborhood (J-SHINE) conducted between 2010 and 2011. Multiple logistic regression analysis was conducted to examine the association between marital violence and health care utilization. Interaction terms were used to examine the moderating effect of educational attainment, household income, and employment status on the association. Mediation analysis was conducted to estimate the magnitude of mediating effects of mastery, social support, and health literacy in relation to the moderating effect of socioeconomic factors. Health care utilization in Japan was more prevalent among those who experienced marital violence (69.4 vs. 65.1%). The association between marital violence and health care utilization differed by employment status at a 0.10 level, while educational attainment and household income did not have substantial influence on health care utilization in the presence of marital violence. None of the psychosocial resources (mastery, health literacy, instrumental support, and informational support) explained the differential association by employment status. This study highlights the increased health care needs of those experiencing marital violence in Japan. The health care needs of the unemployed are potentially unmet in the presence of marital violence. Removing barriers to health care experienced by the unemployed may be an effective strategy for connecting survivors to needed supports and care.

There is inconclusive evidence on the value of regular dental attendance. This study explored the relationship between long-term patterns of dental attendance and caries experience. We used retrospective data from 3,235 adults, ≥ 16 yrs of age, who participated in the Adult Dental Health Survey in the UK. Participants were classified into four groups (always, current, former, and never regular-attenders) based on their responses to three questions on lifetime dental-attendance patterns. The association between dental-attendance patterns and caries experience, as measured using the decayed, missing, or filled teeth (DMFT) index, was tested in negative binomial regression models, adjusting for demographic (sex, age, and country of residence) and socio-economic (educational attainment, household income, and social class) factors. A consistent pattern of association between long-term dental attendance and caries experience was found in adjusted models. Former and never regular-attenders had a significantly higher DMFT score and numbers of decayed and missing teeth, but fewer filled teeth, than always regular-attenders. No differences in DMFT or its components were found between current and always regular-attenders. The findings of this study show that adults with different lifetime trajectories of dental attendance had different dental statuses.