Do discrimination, residential school attendance and cultural disruption add to individual-level diabetes risk among Aboriginal people in Canada?

• Main Authors: Dyck, Roland, Karunanayake, Chandima, Janzen, Bonnie, Lawson, Josh, Ramsden, Vivian, Rennie, Donna, Gardipy, P., McCallum, Laura, Abonyi, Sylvia, Dosman, James, Episkenew, Jo-Ann, Pahwa, Punam, on behalf of the First Nations Lung Health Team
• Format: Article in Journal/Newspaper
• Language: English
• Published: BioMed Central Ltd. 2015
• Subjects: Colonization; First Nations; Residential school; Racism; Discrimination; Diabetes mellitus; Social determinants of health; Canada; inuit; Metis
• Online Access: http://www.biomedcentral.com/1471-2458/15/1222

Abstract Background 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. 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. Methods This 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. Results Responses 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. Conclusions 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. 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 .