Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study

• Published in: The Lancet Planetary Health
• Main Authors: Sonia S Anand, ProfMD, Sylvia Abonyi, PhD, Laura Arbour, ProfMD, Kumar Balasubramanian, MSc, Jeffrey Brook, PhD, Heather Castleden, PhD, Vicky Chrisjohn, Ida Cornelius, RN, Albertha Darlene Davis, RN, Dipika Desai, MSc, Russell J de Souza, ScD, Matthias G Friedrich, ProfMD, Stewart Harris, ProfMD, James Irvine, MD, Jean L'Hommecourt, Randy Littlechild, Lisa Mayotte, RN, Sarah McIntosh, MSc, Julie Morrison, Med, Richard T Oster, PhD, Manon Picard, BSc, Paul Poirier, ProfMD, Karleen M Schulze, MMath, Ellen L Toth, ProfMD
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier 2019
• Subjects: Environmental sciences; GE1-350; Canada; First Nations
• Online Access: https://doi.org/10.1016/S2542-5196(19)30237-2; https://doaj.org/article/18f929a6ac4c46d3b216681383db3596

Summary: Background: Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada. Methods: Men and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis. Findings: The mean INTERHEART risk score of all communities was 17·2 (SE 0·2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0·0001). Socioeconomic advantage (–1·4 score, 95% CI −2·5 to −0·3; p=0·01), trust between neighbours (–0·7, −1·2 to −0·3; p=0·003), higher education level (–1·9, −2·9 to −0·8, p<0·001), and higher social support (–1·1, −2·0 to −0·2; p=0·02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2·2, 0·3 to 4·1, p=0·02), taking prescription medication (3·5, 2·8 to 4·3; p<0·001), and inability to afford prescription medications (1·5, 0·5 to 2·6; p=0·003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. ...