| Summary: | Degree: Master of Science Abstract: Helicobacter pylori (Hp) infection has an elevated prevalence in northern Indigenous communities in Canada. This thesis investigates social inequities in the Hp-associated disease burden within Indigenous communities in the Northwest Territories and Yukon. I examined how deprivation indicators relate to this disease burden, with particular interest in differences in gender, and in households headed by unpartnered women relative to other households. I used data from projects conducted by the Canadian North Helicobacter pylori (CANHelp) Working Group to address community concerns about Hp-associated risks. I estimated the Canadian Deprivation Index (CDI), a validated predictor of health status, from its 3 components: home ownership; education; and food security. CANHelp Working Group researchers ascertained most variables by interviewing participants as they enrolled in community projects during 2007-2017; I ascertained food security in a subset of participants during 2017- 2018, using the Canadian Government Household Food Security Survey, adapted for Arctic communities. As a disease burden variable, I used the prevalence of Hp infection based on urea breath test screening, histopathology, and/or culture. I constructed a multivariable logistic regression model to estimate odds ratios for the effect of selected variables on Hp prevalence while controlling for the effects of other variables, with a random effects parameter for household to account for clustering of Hp infection in households. Hp prevalence was higher among participants at higher deprivation levels, after adjustment for identified confounding variables. The estimated trend in Hp prevalence with increasing deprivation levels was more notable in members of households led by unpartnered women relative to members of other households, and in men relative to women, though there was insufficient statistical precision to conclude that the observed difference in the trend was beyond what would be expected from random ...
|
|---|