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

Abstract

BackgroundAboriginal 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.MethodsThis 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.ResultsResponses 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.ConclusionsKnown 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 off-reserve which may lead to an improvement in the social determinants of health. While this may have physical health benefits for First Nations people due to improved socio-economic status and other undefined influences, our findings suggest that this comes at a high emotional price.

Diabetes prevalence, incidence and mortality in First Nations and other people in Ontario, 1995–2014: a population-based study using linked administrative data

“…In a previous study of 13 First Nations com munities in Alberta, communities with higher knowledge of Indigen ous language had significantly lower diabetes preva lence. 29 In contrast, Dyck and colleagues 30 found that individual level cultural disruption was not predictive of diabetes risk and that Cree language use was not a protective factor. These complex interactions among land, culture, environment, community, col onial disruption and risk of diabetes are best understood using a framework based on Indigenous determinants of health.…”

Residential schools and the effects on Indigenous health and well-being in Canada—a scoping review

“…Howard [ 31 ] found similar results and suggested that residential schooling contributed to the urbanization of Indigenous peoples in Canada, which has led to diabetes and other problems. Dyck and colleagues also reported that those who attended residential school had a slightly higher prevalence of diabetes than those who did not, although the finding was not statistically significant [ 32 ]. Residential school attendance has also been found to be a positive predictor of obesity among younger Métis boys and girls, but a negative predictor among older girls [ 33 ].…”

Ethnic differences in vascular function and factors contributing to blood pressure

“…Participants were recruited through similar methods from the same communities, with similar health status and characteristics. As social determinants of health, including education, income, and employment are known to influence health outcomes, and disproportionately affect Indigenous Canadians, similarities of these determinants between groups facilitate comparisons while minimizing confounding variables (Rotenberg 2016;Dyck et al 2015). In this investigation, hypertension was only associated with obesity measures and statuses among Europeans.…”

“…Conversely, we identified Indigenous populations experiencing lower hypertension rates than non-Indigenous populations (Foulds and Warburton 2014). Indigenous Canadians also experience greater burdens of social determinants of health and racism (Rotenberg 2016;Dyck et al 2015). Few comparisons of vascular measures among ethnic groups including Indigenous populations have been conducted to date, none evaluating PWV, BRS, or arterial compliance among Indigenous adults (Anand et al 2001;Zhang et al 2013).…”