The Epidemiology of Diabetes in the Manitoba-Registered First Nation Population

Abstract

OBJECTIVE -This study provides an overview of the epidemiology of diabetes in the Manitoba First Nation population. RESEARCH DESIGN AND METHODS -The study uses data derived from the population-based Manitoba Diabetes Database to compare the demographic and geographic patterns of diabetes in the Manitoba First Nation population to the non-First Nation population.RESULTS -Although the prevalence of diabetes rose steadily in both the First Nation and the non-First Nation populations between 1989 and 1998, the epidemiological pattern of diabetes in these two populations differed significantly. The First Nation population was observed to have age-standardized incidence and prevalence rates of diabetes up to 4.5 times higher than those found in the non-First Nation population. The sex ratio and the geographic patterning of diabetes incidence and prevalence in the two study populations were reversed.CONCLUSIONS -The results of the study suggest that diabetes prevalence will likely continue to rise in the Manitoba First Nation population into the foreseeable future, and that the impact of this rising diabetes prevalence can only be effectively managed through a populationbased public health approach focusing on primary and secondary prevention. The dramatically higher rates of diabetes in Manitoba First Nation population as compared with the non-First Nation population highlight the urgency of this activity. These prevention efforts need to be supported by further research into the reasons for the unique epidemiological patterns of diabetes incidence and prevalence in the First Nation population observed in this study. These include investigating why First Nation populations living in the Northern areas of the province seem to be protected from developing high rates of diabetes and why First Nation women experience much higher rates of the disease. Diabetes Care 26:1993-1998, 2003D iabetes is increasingly responsible for substantial morbidity and mortality in Canada's First Nation populations. Planning and implementing effective primary and secondary intervention programs to deal with this disease and its devastating effects in First Nation people requires accurate populationbased data on the temporal trends and geographic distribution of diabetes (1).This study uses Manitoba Health administrative databases to examine trends in the incidence and prevalence of diabetes among Registered First Nation adults in Manitoba from 1989 to 1998. Comparisons are made to the non-First Nation adult population to highlight the magnitude of the diabetes epidemic in First Nation people. The geographic variation in diabetes rates across Manitoba is also examined.The study was conducted in the Canadian province of Manitoba. Manitoba has a population of 1.14 million people, of whom more than one-half (645,000) reside in the City of Winnipeg, the provincial capital. The majority of Manitobans are of European descent, whereas ϳ10% of the population is self-identified as having Aboriginal ancestry (2). Manitoba has a universal health insuranc...

Epidemiology of diabetes mellitus among First Nations and non-First Nations adults

“…These observations suggest fundamental differences between populations in the mechanisms underlying diabetes; this has widespread implications that are probably also relevant to other indigenous and developing populations. 1 Our findings are consistent with reports that used similar methods 8,9 to show higher prevalence of diabetes among First Nations people than among non-First Nations people in neighbouring provinces. This difference appears to be at least partly because of higher rates of overweight and obesity among First Nations people.…”

“…5,6 Although an increased prevalence of diabetes among First Nations people has also been documented in other Canadian provinces, 3 only recently have consistent diabetes case definitions applied to health care system administrative databases been used to compare differences between large populations of First Nations and non-First Nations people. [7][8][9] We sought to describe the epidemiology of diabetes in Saskatchewan from 1980 to 2005. We reasoned that finding ethnicity-based differences in trends and patterns of type 2 diabetes over the longest period reported for a Canadian jurisdiction would help to clarify the underlying mechanisms behind known disparities and translate into more effective diabetes prevention and management initiatives.…”

Lifetime risk of diabetes among First Nations and non–First Nations people

“…These findings are consistent with population-based diabetes reports showing higher incidence and prevalence of diabetes among First Nations people than among non-First Nations people. 24,29,30 Dyck and associates 24 reported that the incidence and prevalence of diabetes were more than 4 times higher among First Nations women than among nonFirst Nations women, and more than 2.5 times higher among First Nations men than among nonFirst Nations men. The reasons that have been attributed to these differences include genetic susceptibility, [31][32][33][34] dietary acculturation, 34,35 adoption of sedentary lifestyle 34,36 and increasing prevalence of obesity and metabolic syndrome.…”

Characteristics and prevalence of the metabolic syndrome among three ethnic groups in Canada

“…These observed prevalence rates may underestimate the current prevalence of the syndrome in Native Canadian populations, as over the past decade the prevalence of obesity and diabetes in Aboriginal population has been steadily increasing. 9,54 Given the diverse nature of these populations, careful consideration should be given to developing culturally appropriate community-based prevention strategies aimed at reducing the frequency of this syndrome. 55,56 …”