Citation

Martens PJ, Bartlett JG, Prior HJ, Sanguins J, Burchill CA, Burland EM, Carter S. BMC Public Health 2011; 11(1): 814.

Copyright

(Copyright © 2011, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/1471-2458-11-814

PMID

22011510

PMCID

PMC3257314

Abstract

BACKGROUND: Metis are descendants of early 17th century relationships between North American Indians and Europeans. This study's objectives were: (1) to compare the health status of the Metis people to all other residents of Manitoba, Canada; and (2) to analyze factors in predicting the likelihood of diabetes and related lower limb amputation. METHODS: Using de-identified administrative databases plus the Metis Population Database housed at the Manitoba Centre for Health Policy, age/sex-adjusted rates of mortality and disease were calculated for Metis (n=73,016) and all other Manitobans (n=1,104,672). Diseases included: hypertension, arthritis, diabetes, ischemic heart disease (age 19+); osteoporosis (age 50+); acute myocardial infarction (AMI) and stroke (age 40+); total respiratory morbidity (TRM, all ages). Using logistic regression, predictors of diabetes (2004/05-2006/07) and diabetes-related lower-limb amputations (2002/03-2006/07) were analyzed. RESULTS: Disease rates were higher for Metis compared to all others: premature mortality before age 75 (4.0 vs. 3.3 per 1000, p<.001); total mortality (9.7 vs. 8.4 per 1000, p<.001); injury mortality (0.58 vs. 0.51 per 1000, p<.03); Potential Years of Life Lost (64.6 vs. 54.6 per 1000, p<.001); all-cause 5-year mortality for people with diabetes (20.8% vs. 18.6%, p<.02); hypertension (27.9% vs. 24.8%, p<.001); arthritis (24.2% vs. 19.9%, p<.001), TRM (13.6% vs. 10.6%, p<.001); diabetes (11.8% vs. 8.8%, p<.001); diabetes-related lower limb amputation (24.1 vs. 16.2 per 1000, p<.001); ischemic heart disease (12.2% vs. 8.7%, p<.001); osteoporosis (12.2% vs. 12.3%, NS), dialysis initiation (0.46% vs. 0.34%, p<.001); AMI (5.4 vs. 4.3 per 1000, p<.001); stroke (3.6 vs. 2.9 per 1000, p<.001). Controlling for geography, age, sex, income, continuity of care and comorbidities, Metis were more likely to have diabetes (aOR=1.29, 95% CI 1.25-1.34), but not diabetes-related lower limb amputation (aOR=1.13, 95% CI 0.90-1.40). Continuity of care was associated with decreased risk of amputation both provincially (aOR=0.71, 95% CI 0.62-0.81) and for Metis alone (aOR=0.62, 95% CI 0.40-0.96). CONCLUSION: Despite universal healthcare, Metis' illness and mortality rates are mostly higher. Although elevated diabetes risk persists for the Metis even after adjusting for sociodemographic, healthcare and comorbidity variables, the risk of amputation for Metis appears more related to healthcare access rather than ethnicity.

Language: en