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: Anand, Sonia S., Abonyi, Sylvia, Arbour, Laura, Balasubramanian, Kumar, Brook, Jeffrey, Castleden, Heather, Chrisjohn, Vicky, Cornelius, Ida, Davis, Albertha Darlene, Desai, Dipika, de Souza, Russell J., Friedrich, Matthias G., Harris, Stewart, Irvine, James, L’Hommecourt, Jean, Littlechild, Randy, Mayotte, Lisa, McIntosh, Sarah, Morrison, Julie, Oster, Richard T., Picard, Manon, Pictou Landing First Nation, Poirier, Paul, Schulze, Karleen M., Toth, Ellen L.
• Format: Article in Journal/Newspaper
• Language: English
• Published: The Lancet Planet Health 2019
• Subjects: Canada; First Nations
• Online Access: http://hdl.handle.net/1828/11514; https://doi.org/10.1016/S2542-5196(19)30237-2

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. Communities ...