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Alberta Diabetes Surveillance System (ADSS) - Diabetes Atlas: Diabetes in First Nations

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2007 (Oct) Canadian Diabetes Association Annual Conference, poster presentation by BRAID Research

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Alberta Diabetes Surveillance System (ADSS) - Diabetes Atlas: Diabetes in First Nations

  1. 1. 05101520253020-34 35-49 50-64 65-74 75+Age GroupRateper1000Non-First Nations - 1995First Nations - 1995Non-First Nations - 2004First Nations - 2004Alberta Diabetes Surveillance SystemAlberta Diabetes Surveillance SystemDiabetes in First NationsDiabetes in First NationsEllen L. Toth1*, Brenda Hemmelgarn2, Lynden Crowshoe3, Stephanie U. Vermeulen4, Greg Hugel4, Malcolm King1, Kelli Ralph-Campbell1, Jeffrey A. Johnson4,Department of Medicine, University of Alberta, Edmonton, AB1, Department of Medicine & Community Health Sciences2, Department of Family Medicine,University of Calgary, AB3, Institute of Health Economics, Edmonton, AB4The full ADSS report can be accessed@ www.achord.caABSTRACTABSTRACTThe first Alberta Diabetes Atlas 2007 has been compiled as part of the Alberta DiabetesStrategy 2003-2013. The Atlas includes a chapter on First Nations, comparing incidence andprevalence of diabetes mellitus (DM) among First Nations and non-First Nations people inAlberta between 1995 and 2005.First Nations individuals with diagnosed DM were identified from the Alberta Health CareInsurance Plan Registry, and were defined as anyone residing in Alberta registered under thefederal Indian Act and entitled to Treaty status. The Registry was searched from April 1st,1993 to March 31st, 2005. Any individual with a First Nations or Inuit identifier was classifiedas “First Nations”; all others were classified as “non-First Nations”, including Aboriginal peoplewho were not Registered First Nations (ex. Aboriginal people without Treaty status, Métis).The proportions of First Nations and non-First Nations people with diagnosed DM as ofApril 1st each year were calculated and compared annually for the years 1995 to 2005.Incident DM was defined using NDSS criteria for diabetes: a person with no diabetes claims inthe prior two years. Incident rates for First Nations and non-First Nations people whodeveloped DM in each fiscal year from 1995 to 2004 were compared.Age- and sex-adjusted prevalence and incidence of DM was twice as high among the FirstNations compared to the non-First Nations population. Increased rates remained constantover the 10-year period from 1995 to 2005. Prevalence among First Nations people increasedwith older ages for both males and females, and was higher among First Nations females.Incidence also increased with age, with rates highest for First Nations females aged 50-74.Diabetes Case Definition.Diabetes Case Definition. To identify individuals with DM using Alberta Health and Wellnessadministrative database, ADSS applied the NDSS* algorithm:A. One hospitalization with an ICD-9 code of 250 (diabetes mellitus), selected from allavailable diagnostic codes on the Hospital Discharge Abstract for years 1995-2001, orequivalent ICD-10 codes (E10-14, diabetes) for years after 2001/2002; OR,B. Two physician claims with an ICD-9 code of 250 (diabetes mellitus) within two years.Key Messages:Key Messages:• The incidence and prevalence of diabetes is more than twiceas high among First Nations people, for both males andfemales, compared to non-First Nations people.• The increased incidence and prevalence of diabetes for FirstNations compared to non-First Nations has remained constantfrom 1995 to 2005.• Among First Nations people, the incidence and prevalence ofdiabetes are higher among females compared to males.AgeAge--Specific Diabetes Prevalence by Health Region, 2005Specific Diabetes Prevalence by Health Region, 2005Population of Alberta: 3,275,376(source: Population Registry File,March 31/06)* NDSS = National Diabetes Surveillance SystemAgeAge-- and Sexand Sex-- Adjusted Prevalence of Diabetes,Adjusted Prevalence of Diabetes,First Nations and NonFirst Nations and Non--First Nations, 1995 to 2005First Nations, 1995 to 2005““First NationsFirst Nations”” Definition:Definition:• Any individual residing in Alberta – whether on- or off-reserve – registered under the federalIndian Act and entitled to Treaty status, with a “First Nations” or “Inuit” identifier.• Aboriginal people not “registered” – i.e. First Nations without Treaty status and Métis – wereincluded in the non-First Nations comparison group.AgeAge-- and Sexand Sex-- Adjusted Incidence of Diabetes,Adjusted Incidence of Diabetes,First Nations and NonFirst Nations and Non--First Nations, 1995 to 2005First Nations, 1995 to 2005DiscussionDiscussionThe more than two-fold higher incidence and prevalence rates of DM for First Nationscompared to non-First Nations people is consistent with national survey data and studiesbased on primary data collection in Canada.(1-5) The rates are also consistent with thosereported in Ontario, where the NDSS definition was applied using administrative data.(6)Our findings of higher prevalence rates among First Nations women compared to menare also consistent with prior reports. This may be partly due to higher rates of undiagnoseddiabetes amongst men, who may be less likely to seek medical care. Of concern, youngchildbearing aged women show prevalence rates of DM twice as high as non-First Nations.It is likely that some First Nations women captured here had gestational diabetes, whichreinforces the notion of “diabetes begetting diabetes”.(7)While the epidemic of DM among First Nations requires interventions that target all agegroups, our findings suggest that younger age groups (women in particular), should be thefocus of treatment and prevention efforts.Prevalence increased with older age for First Nations males and females. Prevalence wasalso higher among First Nations females compared to males, though the rate of increase inthe prevalence over the 10-year period was more marked for the male population. Similarresults are evident with respect to the incidence among the First Nations. Incidence alsoincreased with older age, with rates highest for First Nations females aged 50-74.[Limitation: Age-specific prevalence and incidence rates for First Nations should be interpreted with caution,especially in the oldest age categories, due to unreliable reporting of deaths and small number of cases.AgeAge--Specific Diabetes Prevalence Rates of FemaleSpecific Diabetes Prevalence Rates of FemaleFirst Nations and NonFirst Nations and Non--First Nations, 1995 to 2005First Nations, 1995 to 2005AgeAge--Specific Diabetes Incidence Rates of FemaleSpecific Diabetes Incidence Rates of FemaleFirst Nations and NonFirst Nations and Non--First Nations, 1995 to 2005First Nations, 1995 to 2005AgeAge--Specific Diabetes Prevalence Rates of MaleSpecific Diabetes Prevalence Rates of MaleFirst Nations and NonFirst Nations and Non--First Nations, 1995 to 2005First Nations, 1995 to 2005AgeAge--Specific Diabetes Incidence Rates of MaleSpecific Diabetes Incidence Rates of MaleFirst Nations and NonFirst Nations and Non--First Nations, 1995 to 2005First Nations, 1995 to 20051. Dean HJ, Mundy RL, Moffatt M: Non-insulin-dependent diabetes mellitus in Indian children in Manitoba. Canadian Medical Association Journal 147:52-57, 1992.2. Dannenbaum D, Verronneau M, Torrie J: Comprehensive computerized diabetes registry - Serving the Cree of Eeyou Istchee (eastern James Bay). Canadian Family Physician 45:364-370, 1999.3. Hux, J., Booth, G., and Laupacis, A. The ICES Practice Atlas: Diabetes in Ontario. 2002. Institute for Clinical Evaluative Sciences (ICES), and the Canadian Diabetes Association. Available from:www.ices.on.ca/webpage.cfm?site_id=1&org_id=67&morg_id=0&gsec_id=0&item_id=1312&type=atlas4. Pollex RL, Khan HM, Connelly PW, Young TK, Hegele RA: The metabolic syndrome in Inuit. Diabetes Care 27:1517-1518, 2004.5. Young TK: Contributions to chronic disease prevention and control: studies among the Kivalliq Inuit since 1990. International Journal of Circumpolar Health 62:323-330, 2003.6. Mohamed N, Dooley J: Gestational diabetes and subsequent development of NIDDM in aboriginal women of northwestern Ontario. International Journal of Circumpolar Health 57 Suppl 1:355-358, 1998.7. Godfrey KM, Barker DJ: Fetal programming and adult health. Public Health Nutrition 4:611-624, 2001024681012141995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005YearRateper100age20+Non-First Nations First Nations024681012141995 1996 1997 1998 1999 2000 2001 2002 2003 2004YearRateper1000age20+Non-First Nations First Nations05101520253035404520-34 35-49 50-64 65-74 75+Age GroupRateper100First Nations - 1995Non-First Nations - 1995First Nations - 2005Non-First Nations - 200505101520253020-34 35-49 50-64 65-74 75+Age GroupRateper1000Non-First Nations - 1995First Nations - 1995Non-First Nations - 2004First Nations - 200405101520253035404520-34 35-49 50-64 65-74 75+Age GroupRateper100First Nations - 1995Non-First Nations - 1995First Nations - 2005Non-First Nations - 2005Funding provided by:

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