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Demographic Risk Factors for Fracture in First Nations People

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Abstract

Background

Recently, First Nations people were shown to be at high fracture risk compared with the general population. However, factors contributing to this risk have not been examined. This analysis focusses on geographic area of residence, income level, and diabetes mellitus as possible explanatory variables since they have been implicated in the fracture rates observed in other populations.

Methods

A retrospective, population-based matched cohort study of fracture rates was performed using the Manitoba administrative health data (1987-1999). The First Nations cohort included all Registered First Nations adults (20 years or older) as indicated in either federal and/or provincial files (n=32,692). Controls (up to three for each First Nations subject) were matched by year of birth, sex and geographic area of residence. After exclusion of unmatched subjects, analysis was based upon 31,557 First Nations subjects and 79,720 controls.

Results

Overall and site-specific fracture rates were significantly higher in the First Nations cohort. Income quintile, geographic area of residence, and diabetes were fracture determinants but the excess fracture risk of First Nations ethnicity persisted even after adjustment for these factors.

Conclusion

First Nations people are at high risk for fracture but the causal factors contributing to this are unclear. Further research is needed to evaluate the importance of other potential explanatory variables.

Résumé

Contexte

On a récemment démontré que le risque de fracture était plus élevé chez les membres des Premières nations que dans la population générale. Cependant, les facteurs pouvant contribuer à ce risque n’ont pas été examinés. La présente étude porte sur la région de résidence, le niveau de revenu et le diabète sucré, qui pourraient être des variables explicatives, car elles jouent un rôle dans les taux de fracture observés dans d’autres populations.

Méthode

À l’aide des données administratives sur la santé du Manitoba (1987-1999), nous avons mené une étude de cohortes représentative et rétrospective portant sur les taux de fracture. La cohorte des Premières nations comprenait tous les membres des Premières nations d’âge adulte (20 ans et plus) désignés comme étant „ inscrits ” dans les bases de données fédérales et/ou provinciales (n = 32 692). Les témoins (jusqu’à trois pour chaque sujet des Premières nations) ont été assortis aux cas selon l’année de naissance, le sexe et la région de résidence. Après avoir exclu les cas non assortis, notre analyse s’est fondée sur 31 557 sujets des Premières nations et 79 720 témoins.

Résultats

Les taux de fracture globaux et par site étaient sensiblement plus élevés dans la cohorte des Premières nations. Le quintile de revenu, la région de résidence et le diabète étaient des déterminants du taux de fracture, mais il subsiste un risque de fracture plus élevé chez les membres des Premières nations, même après ajustement selon ces trois facteurs.

Conclusion

Les membres des Premières nations présentent un risque de fracture élevé, mais les facteurs causals de cette situation ne sont pas clairs. Il faudrait pousser la recherche pour évaluer l’importance d’autres variables explicatives possibles.

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Author information

Authors and Affiliations

  1. Department of Medicine, University of Manitoba, 409 Taché Avenue, Winnipeg, MB, R2H 2A6, Canada

    William D. Leslie MD, MSc & Elizabeth A. Salamon MD

  2. Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

    Shelley A. Derksen MSc, Colleen Metge PhD, Lisa M. Lix PhD & Leslie L. Roos PhD

  3. Assembly of Manitoba Chiefs’ Health Information and Research Committee, Canada

    Pauline Wood Steiman BA

Authors
  1. William D. Leslie MD, MSc
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  2. Shelley A. Derksen MSc
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  3. Colleen Metge PhD
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  4. Lisa M. Lix PhD
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  5. Elizabeth A. Salamon MD
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  6. Pauline Wood Steiman BA
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  7. Leslie L. Roos PhD
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Corresponding author

Correspondence to William D. Leslie MD, MSc.

Additional information

Acknowledgements of Sources of Support: Supported by a grant from the Health Sciences Centre Foundation. The authors are indebted to Health Information Services and Manitoba Health for providing the data used in this study, to the First Nations and Inuit Health Branch and Indian and Northern Affairs Canada for permission to use the Status Verification System, and to the Health Information Research Committee of the Assembly of Manitoba Chiefs for actively supporting this work. The results and conclusions are those of the authors, and no official endorsement by Manitoba Health is intended or should be inferred. Special thanks to Ms. Doreen Sanderson, Dr. John O’Neil and Dr. Patricia Martens for their assistance in this project.

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Leslie, W.D., Derksen, S.A., Metge, C. et al. Demographic Risk Factors for Fracture in First Nations People. Can J Public Health 96 (Suppl 1), S45–S50 (2005). https://doi.org/10.1007/BF03405316

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