the health of first nations living off-reserve, inuit, and métis adults in canada:the impact of...

8/9/2019 The Health of First Nations Living Off-Reserve, Inuit, and Mtis Adults in Canada:The Impact of Socio-economic Stat

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Health Research Working Paper Series

The Health of First Nations Living

Off-Reserve, Inuit, and Mtis Adults inCanada:The Impact of Socio-economicStatus on Inequalities in Healthby Rochelle Garner, Gisle Carrire, Claudia Sanmartin and the

Longitudinal Health and Administrative Data Research Team

Health Information and Research Division

24-M, R.H. Coats Building, 100 Tunney's Pasture Driveway, Ottawa, K1A 0T6

Telephone: 1-800-263-1136

Catalogue no. 82-622-X No. 004

ISSN: 1915-5190

ISBN: 978-1-100-15673-6

Working Paper


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DRAFT

82-622-X No. 004ISSN: 1915-5190

ISBN: 978-1-100-15673-6

Statistics CanadaHealth Analysis Division

24-M, R.H. Coats Building, 100 Tunneys Pasture Driveway, Ottawa K1A 0T6Telephone number: 613-951-3977Facsimile number: 613-951-3959

Email: [email protected]

The product is available in electronic ormat: www.statcan.gc.ca

June 2010

Published by authority o the Minister responsible or Statistics Canada

Minister o Industry, 2010

La version ranaise de cette publication est disponible (no 82-622-X au catalogue, no 004).

Note o appreciation:Canada owes the success o its statistical system to a long-standing partnership between Statistics Canada, the citizens o Canada, itsbusinesses, governments and other institutions. Accurate and timely statistical inormation could not be produced without their continuedcooperation and goodwill.

Standards o service to the publicStatistics Canada is committed to serving its clients in a prompt, reliable and courteous manner. To this end, the Agency has developedstandards o service which its employees observe in serving its clients. To obtain a copy o these service standards, please contact StatisticsCanada toll ree at 1-800-263-1136. The service standards are also published on www.statcan.ca under About us > Providing services toCanadians.

The Health o First Nations Living Of-Reserve,Inuit, and Mtis Adults in Canada:

The Impact o Socio-economic Status onInequalities in Health

by Rochelle Garner, Gisle Carrire, Claudia Sanmartin and

the Longitudinal Health and Administrative Data Research Team

All rights reserved. The content of this electronic publication may be reproduced, in whole or in part, and by anymeans, without further permission from Statistics Canada, subject to the following conditions: that it be done solelyfor the purposes of private study, research, criticism, review or newspaper summary, and/or for non-commercial purposes;and that Statistics Canada be fully acknowledged as follows: Source (or "Adapted from," if appropriate): StatisticsCanada, year of publication, name of product, catalogue number, volume and issue numbers, reference period andpage(s). Otherwise, no part of this publication may be reproduced, stored in a retrieval system or transmitted in anyform, by any meanselectronic, mechanical or photocopyor for any purposes without prior written permission ofLicensing Services, Client Services Division, Statistics Canada, Ottawa, Ontario, Canada K1A 0T6.


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About Statistics Canada

Statistics Canada is authorized under the Statistics Actto collect, compile, analyze, abstract and publish statistics related to thehealth and well-being o Canadians. We conduct surveys o Canadians and collect administrative data to understand the statuso the nations health, characteristics and behaviours that promote health or place us at risk o ill health, interactions o Canadians

with the health system, direct measures o health, dynamics o health over time and health outcomes.We inorm Canadians through the analysis and dissemination o our data holdings. Statistics Canada publishes Health Reports

monthly, a peer-reviewed and indexed journal o population health and health services research.

For more inormation, visit our website at www.statcan.gc.ca

About the Longitudinal Health and Administrative Data Initiative

The Longitudinal Health and Administrative Data (LHAD) Initiative is a partnership among provincial and territorial ministries ohealth and Statistics Canada, as well as the Canadian Institute or Health Inormation, the Canadian Council o Cancer Registriesand the Vital Statistics Council or Canada. The objective o the Initiative is to address important inormation gaps by ensuringthat key administrative data, such as those routinely collected through the health system, can be used to undertake pan-Canadian research to improve the understanding o relationships among risk actors, socio-economic characteristics, healthstatus measures and health care utilization. The research involves the linking o provincial and territorial health administrativedata within themselves, and with Statistics Canada population health survey data, the births and deaths databases, and theCanadian Cancer Registry. In addition to complementing the important record linkage research already being done withinindividual provinces, LHAD studies create invaluable opportunities to learn rom comparisons among jurisdictions, as well asacilitate larger studies or less common types o events and conditions. In short, the LHAD Initiative is intended to establish theoundation or a Canadian record linkage program to help urther the advancement o knowledge about health determinants,outcomes and their relationships.

Statistics Canada is the operational arm o the LHAD partnership. Two divisions within Statistics Canada - the Health StatisticsDivision (HSD) and the Health Analysis Division (HAD) collaborate in supporting the Initiative.

HSD is responsible or ongoing administrative support including organizing Steering Committee meetings and providingsecretariat services to the Initiative. It is also responsible or building and maintaining the LHAD data processing environment,securely storing and processing LHAD datasets, and producing linkedanalysis fles or all approved studies.

HAD provides research support to the LHAD program via the LHAD Research Team. HAD is the primary source o healthresearch within Statistics Canada. Its mandate is to provide high quality, relevant and comprehensive inormation on the healthstatus o the population and on the health care system. This project represents one o our research studies undertaken by theLHAD Research team rom the research agenda developed by the LHAD Steering Committee in 2008.


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Acknowledgements

Statistics Canada acknowledges and thanks the many individuals who have contributed to the development o this report.Particularly, we would like to express our appreciation to the members o the LHAD Committee who identifed the priority areasor research and provided critical eedback:

Adalsteinn Brown (Co-chair, Ontario)

Michael Wolson (Co-chair, Statistics Canada, 2007-2009)

Anil Arora (Co-chair, Statistics Canada, 2009-present)

Joy Maddigan (Newoundland and Labrador)

Ann Vivian-Beresord (Newoundland and Labrador)

Pat Charlton (Prince Edward Island)

John Boyne (New Brunswick)

David Elliott (Nova Scotia)

Sten Ardal (Ontario)Vasanthi Srinivasan (Ontario)

Louis Barre (Manitoba and CIHI)

Deborah Malazdrewicz (Manitoba)

Jacqueline Messer-Lepage (Saskatchewan)

Bev Walkner (Alberta)

Ian Rongve (British Columbia)

Jean-Marie Berthelot (CIHI)

Julie McAuley (Statistics Canada)

Jillian Oderkirik (Statistics Canada)

The analyses and conclusions in this report do not necessarily reect those o the individual provincial representatives or theirrespective ministries o health.

Members o LHAD Research Team who provided scientifc leadership on the project include Gisle Carrire, Rochelle Garner,Helen Johansen, Saeeda Khan, Kim McGrail, Lindsay Porter, Michelle Rotermann, and Claudia Sanmartin.

We also thank Bob Kingsley and Richard Trudeau or their leadership and commitment to realizing the data goals o the LHADproject.

Thank you to ric Guimond o the Strategic Research and Analysis Directorate o Indian and Northern Aairs Canada, JennierPennock o the First Nations and Inuit Health Branch o Health Canada, and Heather Tait o the Social and Aboriginal StatisticsDivision o Statistics Canada or their insightul comments on drat versions o this report.

Finally, we thank the editorial and production team in Health Analysis Division or their input and expertise including JaniceFelman, Robert Pellarin, and Rasha Bradic.


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Executive summary

Aboriginal people First Nations, Mtis and Inuit comprise agrowing proportion o the Canadian population. Despite theyounger average age o these populations, First Nations, Mtis

and Inuit people tend to suer a greater burden o morbidityand mortality than non-Aboriginal Canadians. This may bedue, in part, to higher rates o socio-economic disadvantagein Aboriginal populations.

The objectives o the current study were:

To describe the health and well-being o Inuit, Mtis andFirst Nations adults living o-reserve, and to comparethese characteristics to those o non-Aboriginal adults;

To examine the contribution o socio-economic andliestyle actors to the health inequalities between Inuit,Mtis and First Nations adults living o-reserve and non-Aboriginal adults; and

To examine the health-related impact o socio-economicand liestyle actors or each o non-Aboriginal, FirstNations people living o-reserve, Mtis and Inuit adults.

To achieve these objectives, analyses were conductedusing data rom the 2006 Aboriginal Peoples Survey andthe 2007 Canadian Community Health Survey (Cycle 4.1).Examinations were limited to adults aged 20 and older romboth surveys.

Findings showed that First Nations, Mtis and Inuit adultswere less likely to report excellent or very good health thannon-Aboriginal adults, and were more likely to suer rom

an activity-limiting condition. Furthermore, First Nationsand Mtis adults were more likely to be diagnosed withone o several chronic conditions than were non-Aboriginal

adults, whereas Inuit adults were equally or less likely to bediagnosed with such conditions. Taking into account actorssuch as income and education minimized, but did not alwayseliminate, health disparities between Aboriginal and non-Aboriginal adults. Adjusting or other actors such as smokingstatus, body mass index, contact with a health proessional,or living in an urban centre did little to urther lessen healthdisparities. As well, the impact o many o these actors onhealth was dierent or the various Aboriginal groups thanthey were among non-Aboriginal adults.

Results o this study showed that, while income andeducational levels partially explained dierences in health

between Aboriginal and non-Aboriginal Canadians, disparitiesoten persisted. Such fndings point to the existence o otheractors contributing to the greater burden o morbidity amongFirst Nations, Mtis and Inuit people. Furthermore, the actorsoten associated with health in the general population do notact in the same way among specifc Aboriginal populations.Future research may wish to examine broader, more culturally-relevant predictors o health among Aboriginal people.


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Table of contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Study objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Aboriginal people more likely to report poorer health outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

The case o diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Accessing health proessionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Socio-economic and demographic profles dier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Smoking and body mass index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Income and education explain some but not all dierences in health status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Sequential models or general health status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Sequential models or likelihood o being diagnosed with at least one chronic condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Sequential models or diabetes, asthma and arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Factors associated with health outcomes dierent or Aboriginal and non-Aboriginal adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Discussion and conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Reerences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Technical notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Calculating and comparing descriptive (proportion, means) statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Comparing estimates rom a single logistic regression model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Comparing estimates rom separate logistic regression models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19


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1

Health Analysis Division Working Paper SeriesStatistics Canada, catalogue no. 82-622-X, no. 004, June 2010

The Health o First Nations Living Of-Reserve, Inuit, and Mtis Adults in Canada: The Impact o Socio-economic Status on Inequalities in Healthh

HealthAnal sisDivision Wor kin Pa er Ser iestatistics Canada catalo ueno.82-622-X no. 004 June2010

Introduction

Over the past number o years, the proportion o Aboriginalpeople (First Nations, Mtis and Inuit) in the Canadianpopulation has been growing. According to the 2006 Census,

Aboriginal people comprised 3.7% o the population, up rom2.8% only ten years prior.1 This increase has been shown tobe driven, not so much by increased ertility rates, but ratherby ethnic mobility, which reers to changes over time inthe ethnic identity that individuals report.2 In other words,a greater proportion o Canadians are sel-identiying asAboriginal persons than did in the past.

On average, the Aboriginal population is considerablyyounger than the non-Aboriginal population. Nearly hal(47%) o the Aboriginal population is under the age o 25,compared to less than one-third (30%) o the non-Aboriginalpopulation (Figure 1).

Despite being a younger population, the health and well-being o Aboriginal people in Canada is generally poorerthan that o non-Aboriginal Canadians. For example, in 2001the lie expectancy o those living in Inuit-inhabited regionso the country was more than 12 years lower than that orthe Canadian population as a whole,3 and those reportingRegistered Indian status had signifcantly higher mortalityrates than those who did not.4 First Nations and Mtis adultstend to report poorer general health, are more likely to reportchronic conditions such as diabetes,arthritis or high blood pressure, and aremore likely to suer an activity-limitingcondition than non-Aboriginal adults.5-8

In addition to various healthinequalities, there are also signifcantinequalities in terms o socio-economicresources and conditions betweenAboriginal and non-Aboriginal people inCanada. According to the 2006 Census,non-Aboriginal Canadians reportedhigher personal incomes on average thandid people who sel-identifed as Mtis,Inuit or First Nations.9 There are alsosignifcant gaps in educational attainment,whereby Aboriginal people are less

likely to complete high school or achieve postsecondaryeducation than non-Aboriginal people.7,10-12

There is a large literature linking poorer socio-economicconditions with poorer health outcomes.13-21 Given thisassociation, it is possible that the health inequalitiesexperienced by First Nations, Mtis and Inuit adults arethe result o poverty and socio-economic disadvantage.Conversely, health disparities may persist even in the absenceo socio-economic dierences between Aboriginal and non-Aboriginal people.

Study objectives

To address such issues, the present study had three objectives:

1. To describe the health and well-being o Inuit, Mtis andFirst Nations adults living o-reserve, and to comparethese characteristics to those o non-Aboriginal adults;

2. To examine the contribution o socio-economic andliestyle actors to the health inequalities between Inuit,Mtis and First Nations adults living o-reserve and non-Aboriginal adults; and

3. To examine the health-related impact o socio-economicand liestyle actors or each o non-Aboriginal, FirstNations people living o-reserve, Mtis and Inuit adults.

Figure 1Age distribution o Aboriginal identity and non-Aboriginal identity populations, Canada, 2006

Source: 2006 Census.

5%

12%

13%

13%

15%

16%

12%

7%

6%

9%

20%

18%

14%

14%

12%

7%

3%

2%

Younger than 5

5 to 14

15 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

Aboriginal identity population

Age group

Non-Aboriginal identity population


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2 The Health o First Nations Living Of-Reserve, Inuit, and Mtis Adults in Canada: The Impact o Socio-economic Status on Inequalities in Health

Health Analysis Division Working Paper Series Statistics Canada, catalogue no. 82-622-X, no. 004, June 2010

h

HealthAnal sisDivision Workin Pa er Ser ies tatistics Canada catalo ueno.82-622-X no. 004 June2010

Data sources

This study used two data sources. The irst, which provided health inormation or Aboriginal people, was the 2006 AboriginalPeoples Survey (APS). The second data source, which provided health inormation or non-Aboriginal people, was the 2007Canadian Community Health Survey (CCHS), Cycle 4.1. Both surveys contained similar health and socio-demographic questions

which were used to compare health and socio-economic conditions between First Nations, Mtis, Inuit and non-Aboriginal adults(ages 20 and up).

The Aboriginal Peoples Survey (APS) provides data on the social and economic conditions o First Nations people living o-reserve, Mtis and Inuit, aged 6 years and older. As a post-censal survey, the 2006 APS used responses to the 2006 Census as abasis or sampling. Further details on the APS can be ound elsewhere.22 The APS sample used in this study was limited to thoseaged 20 and older (n=25,236).

In the Census, and included in the APS, individuals reported whether they sel-identiied as an Aboriginal person. Morespeciically, individuals indicated whether they sel-identiied as First Nations (North American Indian), Mtis or Inuit. Individualswho responded airmatively to a single Aboriginal identity category were retained in the sample o Aboriginal respondents(n=20,086). Individuals who did not sel-identiy as Aboriginal (n=4,231), who responded to multiple categories in the Aboriginalidentity question (n=472) or who indicated that they were part o some other Aboriginal identity population (n=447) wereexcluded rom the sample. The inal sample o Aboriginal adults included 4040 Inuit, 7279 Mtis and 8767 First Nations adultsliving o-reserve.

As noted, the 2006 APS was only conducted o-reserve. Thereore, throughout this document, whenever the term First Nationsis used, it reers only to First Nations people living o-reserve, and should not be interpreted as relating to First Nations peopleliving on-reserve.

The CCHS is a cross-sectional survey that collects inormation related to health status, health care utilization and healthdeterminants or the Canadian population aged 12 and older living in private dwellings in the 10 provinces and 3 territories. TheCCHS excludes individuals living on Indian reserve communities, institutions, ull-time members o the Canadian Armed Forces,and residents o remote regions o the country. Further details on the design and sampling rame or the CCHS can be oundelsewhere.23 The CCHS sample used in this study was limited to those aged 20 and older (n=58,957).

As part o the CCHS, respondents were asked, Are you an Aboriginal person, that is, North American Indian, Mtis or Inuit?Those who answered in the airmative were excluded rom the CCHS sample in the present study (n=2,671). Remainingrespondents comprised the non-Aboriginal sample in analyses. The inal sample included 56,286 non-Aboriginal adults.


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3




Findings

Aboriginal people more likely to report poorer

health outcomes

In general, Aboriginal people were less likely to report beingin optimal health than non-Aboriginal people. First Nations,Mtis and Inuit adults were all signifcantly less likely than non-Aboriginal adults to rate their health as excellent or very goodor to report having no activity-limiting conditions (Table 1).First Nations and Mtis adults were also more likely than non-Aboriginal adults to report that they had been diagnosedwith a chronic condition. Conversely, this proportion wassignifcantly lower among Inuit adults (Table 1).

Looking at specifc chronic conditions, in almost all casesFirst Nations and Mtis adults were signifcantly more likelythan non-Aboriginal adults to report having been diagnosed

by a doctor with the condition (Figure 2). Conversely, Inuitadults were generally less or similarly likely to be diagnosedwith a particular condition as compared to non-Aboriginaladults. The exceptions were experiencing the eects o astroke and stomach or intestinal ulcers, where the prevalenceo these conditions was signifcantly higher or Inuit adults.(See Appendix Table A or crude and age-sex adjustedprevalence rates o sel-reported chronic conditions).

It should be noted that the questionsregarding the presence o chronic conditionsas asked in both the CCHS and the APSspeciy that the individual be diagnosed with

a particular condition by a doctor or healthproessional. As such, these fndings do notnecessarily indicate that these individualsdid not have these conditions; rather, theyhave not received a specifc diagnosis roma doctor or health proessional.

The case o diabetes

Although not the most commonly reportedchronic condition, diabetes was signifcantlymore prevalent among First Nations (9.3%)and Mtis (7.5%) adults than amongnon-Aboriginal adults (6.5%) (Table 2).

Conversely, diabetes was signifcantly lessprevalent among Inuit adults (4.9%).Diabetes is a risk actor or reductions inunctional health, while it also increasesthe risk o premature death. Complicationsdue to diabetes may also result in blindness,amputation, ischemic heart disease, strokeand kidney ailure.24

Diabetes is oten broken down into types.Type 1 diabetes, sometimes reerred toas insulin-dependent diabetes or juvenilediabetes, is a condition when the body

produces little to no insulin and is usuallydiagnosed in children or young adults. Type2 diabetes, sometimes reerred to as non-insulin-dependent diabetes or adult-onsetdiabetes, is the most common orm o thecondition and occurs when the body cannotproperly use the insulin it produces or cannotproduce su cient insulin. Type 2 diabetes isusually diagnosed in adulthood, although itcan occur during childhood, and is generallytreated through diet and exercise.24

Table 1Sel-reported health characteristics, by Aboriginal identity group, of-reserve populationaged 20 or older, Canada, 2006/2007

Health characteristicsNon-Aboriginal

(n=56,286)First Nations

(n=8,767)Mtis

(n=7,279)Inuit

(n=4,040)

percentage

Excellent or very good health 58.7 51.3* 56.7* 49.2*

No activity limitations 74.0 58.3* 59.1* 64.2*

Any diagnosed chronic conditions 46.0 50.5* 50.4* 38.7*

* signiicantly dierent rom estimate or non-Aboriginal (p


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h


Table 2Characteristics o individuals diagnosed with diabetes, by Aboriginal identity group, of-reserve population aged 20 and older, Canada, 2006/2007

Health characteristics Non-Aboriginal First Nations Mtis Inuit

Diagnosed with diabetes, percentage (n) 6.5 (4,443) 9.3* (862) 7.5* (522) 4.9* (169)

Age at diagnosis, mean (standard error) 50.8 (0.4) 44.0 *(0.8) 43.9* (0.8) 46.4* (1.8)Type o diabetes, percentageType 1 4.2 13.4* 13.5* 18.2*Type 2 87.7 64.7* 69.3* 35.8*Gestational only 0.5 4.8* 2.2* 4.0*Pre-diabetic/ Borderline .. 6.5 5.0 6.3Dont know /Cant determine 7.6 10.6* 10.0* 35.7*

Treatment, percentageCurrently use insulin 20.9 24.6 27.8* 17.8Use other drugs 72.4 81.9* 82.1* 79.8Special diet .. 24.3 22.1 17.6Exercise or physiotherapy .. 11.7 13.1 8.3Traditional remedies .. 2.6 0.9 XOther .. 8.6 10.0 5.6



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5




doctor in the past year, but were signifcantly more likely tohave seen or talked to a nurse, than were non-Aboriginalpeople (Table 3). The dierence was particularly marked orInuit, where 55% o Inuit saw or talked to a doctor and 64%

saw or talked to a nurse in the past year, compared to 77%and 11% o non-Aboriginal respondents, respectively (Table3). What cannot be discerned rom these data is whether ornot the meeting with a health proessional occurred ace-to-ace or over the telephone.

When specifc health care services are unavailable in acommunity, it may be necessary or a person to be movedto another location in order to have access to the necessaryservices. In the APS, respondents wereasked i they had been away rom home ora period o a month or more and, i so, thereason or such an absence. Three percent o

First Nations adults, 2% o Mtis adults, andmore than 5% o Inuit adults indicated thatthey had been absent rom their home or amonth or more in the past 12 months due toillness (Table 3).

Socio-economic and demographic

proles difer

While there are large health disparities orFirst Nations, Mtis and Inuit adults, thereare other important dierences betweenthese groups and non-Aboriginal adults inCanada. In general, Aboriginal people wereyounger, more likely to have less than a highschool education, and more likely to havelower personal incomes than non-Aboriginalpeople (Table 4). While more than 2 out o5 non-Aboriginal adults reported a personalincome o $40,000 or more per year, a similarproportion o Mtis, and more than halo First Nations and Inuit adults reportedpersonal incomes less than $20,000 a year(Table 4). Furthermore, while nearly 60%

o non-Aboriginal adults reportedhaving a postsecondary degree, thisproportion was signifcantly lower orFirst Nations (39.5%), Mtis (44.3%) andInuit (27.8%) adults.

There was also a dierential patterno residence across the country. FirstNations adults living o-reserve weremore likely to live in the Westernprovinces than were non-Aboriginaladults (46.8% vs. 29.3%). Mtis weremore likely to live in the Prairie provinces(47.6%), while Inuit were more likely toinhabit the Territories (53.3%) and the

northern parts o Qubec and Newoundland and Labrador,which comprise the Inuit land claims regions. Furthermore,while the majority o non-Aboriginal respondents lived inurban areas (82.1%), the proportion o Aboriginal adults

living in urban areas was signifcantly lower (Table 4). Thiswas particularly true among Inuit, where the majority oindividuals (78.5%) lived in rural or Arctic communities.

These geographic dierences may be importantdeterminants o health in that health care delivery canvary greatly by region. For example, none o the 52 Inuitcommunities in the North have year-round road access,and only a ew have hospitals.12 In addition, many northern

Table 3Accessing health care proessionals and absence rom home due to illness, by Aboriginal identitygroup, of-reserve population aged 20 or older, Canada, 2006/2007

Access to health care proessional / Absencerom home

Non-Aboriginal(n=56,286)

First Nations(n=8,767)

Mtis(n=7,279)

Inuit(n=4,040)

percentage

Saw doctor or nurse in past year 78.8 77.6* 75.4* 77.5*

Saw amily doctor 77.4 73.9* 73.1* 55.3*

Saw nurse 11.2 30.5* 26.2* 63.2*

Away rom community or more than 1 monthbecause o illness

.. 2.9 2.0 5.2



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h


Methods

Descriptive statistics (proportions, means) were compared using Z- and t-tests or independent samples. Because o dierencesin methodologies or constructing bootstrap weights between the two surveys, regression models that included both Aboriginaland non-Aboriginal respondents were sample weighted but not bootstrapped. This may result in variance estimates that areartiicially small; thereore a more conservative p-value (0.01) was used in such analyses when determining statistical signiicance

o estimates. However, proportions, means and regression models that were run separately or each Aboriginal identity groupwere bootstrapped using appropriate methodologies.

Sequential regression models: Interpreting odds ratios and the order of variable selection

The sequential model analysis examined the cumulative impact o various socio-economic, liestyle and health care access actorson the health o First Nations, Mtis and Inuit adults relative to that o non-Aboriginal adults. This impact is seen through the useo odds ratios, which compare the odds o a particular outcome or First Nations, Mtis or Inuit adults relative to non-Aboriginaladults ater taking other actors into account. Because non-Aboriginal adults orm the reerence group, their deault value is1.0, which is depicted by a horizontal line in Figures 4 through 8. In these igures, odds ratios (bars) and their associated 99%conidence intervals that do not include the value o 1.0 or overlap the horizontal line indicate that the odds o the health-related outcomes are signiicantly dierent rom non-Aboriginal adults or First Nations, Mtis or Inuit adults.

Although variables could have been added to the models in a number o ways, the rationale or the sequence o variables is asollows. Step 1 variables included age and sex, as age is known to vary between non-Aboriginal and Aboriginal populationsand age and sex are known to be closely associated with health. Step 2 variables included income and education, as one o theobjectives o this study was to determine whether health disparities between Aboriginal and non-Aboriginal adults were due tosocio-economic dierences. The three remaining steps in the model-building moved rom individual (i.e. smoking status andBMI category) to contextual (i.e. urban place o residence) actors to take into account the broader determinants o health. Theorder chosen could impact the estimates rom intermediary (steps 1 though 4) models, but estimates rom step 5 would be thesame regardless o the order o variable inclusion.

Determining diabetes type in the CCHS

In the 2007 CCHS cycle 4.1, respondents who indicated that they had been diagnosed with diabetes were not asked with whattype o diabetes they had been diagnosed. However, using other inormation available in the survey, it is possible to use the Ng-Dasgupta-Johnson algorithm27 to impute diabetes type.

This seven-step algorithm determines diabetes type using the ollowing inormation: whether diabetic women had been

diagnosed with diabetes other than when pregnant; whether pills were used in the past month or the treatment o diabetes;whether the respondent was currently taking insulin; the individuals age at diagnosis o diabetes; the time between diagnosisand initiation o insulin treatment; and the respondents age at the time o interview.

In the inal step o the Ng-Dasgupta-Johnson algorithm, diabetics that had not been classiied to a diabetes type category in theprevious steps were classiied as Type 2. To maintain comparability with the inormation provided in the APS, where diabeticsare allowed to indicate that they do not know their type o diabetes, CCHS diabetics that had not been otherwise classiied bythe seventh step were assigned a diabetes typology o cant determine. Thereore, the rate o Type 2 diabetes presented in thisreport may dier rom that reported by others using the same data source.

For urther details on methods used in this study, see Technical notes.

or isolated communities fnd it di cult to recruit and retainhealth care proessionals.26 Furthermore, areas with a greaterpopulation density oten have greater access to health careproviders and medical resources. As such, many northernand isolated communities lack adequate health care access.

Conversely, certain provinces (Newoundland and Labrador,Qubec) provide more physicians and medical acilities percapita than others.26 Thereore, geography can be viewedas an important determinant o health in terms o access toservices.

Other aspects o a persons living environment can alsosignifcantly impact their health. Among Aboriginal people,14% o First Nations adults living o-reserve elt that theirwater at home was not sae to drink. By comparison, nearly12% o Mtis adults and 15% o Inuit adults elt the same

(Table 5). Furthermore, almost 1 in 5 First Nations adults livingo-reserve (18.9%) and Mtis adults (17.9%) said that theirdrinking water was contaminated during certain times o theyear. This fgure rose to more than one-third (35.9%) o Inuitadults.


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Smoking and body mass index

Other known health risk actors include smoking and obesity.Smoking is known to increase the likelihood o developingnumerous chronic health conditions as well as reduce anindividuals lie expectancy.28,29 In the present study, daily

smoking was signifcantly more prevalent among Aboriginaladults than among non-Aboriginal adults (Table 6). This wasparticularly true among Inuit, where 60% o adults reportedsmoking on a daily basis.

Excess body weight has also been associated with poorerhealth and reduced lie expectancy.30-34 The body mass index(BMI) is oten used as an indicator o excess weight and isclassifed into our categories: (i) underweight (BMI


14/34



h


with a chronic condition between Inuitand non-Aboriginal adults statisticallynon-signifcant. Further adjustments orsmoking and body mass index (Figure 5,step 3), having seen or spoken to a doctor

or nurse in the past year (Figure 5, step 4)or living in an urban location (Figure 5, step5) resulted in small changes towards paritywith non-Aboriginal adults or First Nationso-reserve and Mtis adults, althoughtheir odds o being diagnosed with achronic conditions remained signifcantlyhigher than that o non-Aboriginal adults.For Inuit adults, adjusting or theseactors resulted in signifcantly lowerodds o being diagnosed with a chroniccondition compared to non-Aboriginaladults. As previously noted, the wording

o the questions involved in this analysisrequired that the individual be diagnosedby a doctor. As such, this analysis does notindicate that these individuals did not havethese conditions, but rather that they hadnot been diagnosed as such. Coe cientsrom the sequential step-wise models canbe ound in Appendix Table E.

Sequential models for diabetes,

asthma and arthritis

Rather than examine the odds o havingone o several chronic conditions, we alsoexamined the odds o being diagnosedwith three specifc chronic conditions:diabetes (Figure 6), asthma (Figure 7), andarthritis (Figure 8). Unadjusted prevalencerates o these conditions indicated thatFirst Nations and Mtis adults weresignifcantly more likely than non-Aboriginal adults to have been diagnosedwith each o diabetes, asthma and arthritis.Conversely, Inuit adults were signifcantlyless likely to have been diagnosed withdiabetes or arthritis, but were equally as

likely to have been diagnosed with asthma, as non-Aboriginaladults. Ater adjusting or the dierent age distributionsbetween these populations (step 1), the likelihood o beingdiagnosed with diabetes or the Inuit population was similarto that in the non-Aboriginal population (Figure 6), whereasthe likelihood o being diagnosed with arthritis exceededthat or non-Aboriginal adults (Figure 8). In the case o eachcondition, while adjusting or socio-economic (income andeducation), liestyle (smoking and body mass index), accessto health proessionals (having seen a doctor or nurse inthe past year) and place o residence (urban) eliminated

Figure 5Odds ratios showing unadjusted and cumulative efects o socio-economic, liestyle and healthcare access actors on being diagnosed with at least one chronic condition, by Aboriginal identitygroup, of-reserve population aged 20 or older, Canada, 2006/2007

Note: Reerence group is non-Aboriginal adults denoted by horizontal line.Source: 2006 Aboriginal Peoples Survey; 2007 Canadian Community Health Survey, cycle 4.1.

Odds ratio of being

diagnosed with at least

one chronic condition

First Nations Mtis Inuit

Non-Aboriginal

0.00

0.25

0.50

0.75

1.00

1.25

1.501.75

2.00

2.25

Unadjusted Step 1: Age and

sex

Step 2: Add

income and

education

Step 3: Add

smoking and

body mass index

Step 4: Add

doctor/nurse

contact

Step 5: Add

urban residence

=99% confidence interval

Figure 4Odds ratios showing unadjusted and cumulative efects o socio-economic, liestyle and healthcare access actors on being in excellent or very good health, by Aboriginal identity group,of-reserve population aged 20 or older, Canada, 2006/2007


Odds ratio of

excellent or very goodself-reported health

0.00

0.20

0.40

0.60

0.80

1.00

1.20


sex

Step 2: Add

income and

education

Step 3: Add

smoking and

body mass index

Step 4: Add

doctor/nurse

contact

Step 5: Add

urban residence

First Nations

Non-Aboriginal=99% confidence interval

Mtis Inuit

between First Nations adults living o-reserve, Mtis adultsand non-Aboriginal adults, this adjustment clarifes that, orInuit and non-Aboriginal adults o the same age, Inuit adultsare signifcantly more likely to have been diagnosed with atleast one chronic condition (Figure 5, step 1). This was notclear rom simple descriptive statistics that did not take intoaccount the dierent age structures o these populations(Table 1). Further adjusting or income and educationalattainment in step 2 brought all groups closer to parity withthe non-Aboriginal population. In act, this adjustmentrendered any dierences in the likelihood o being diagnosed


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9




any dierences between Inuit and non-Aboriginal adults inthe likelihood o being diagnosed with the condition, FirstNations and Mtis adults remained signifcantly more likelyto be diagnosed with these conditions. Coe cients rom thesequential step-wise models are ound in Appendix Tables G, Iand K or diabetes, asthma, and arthritis, respectively.

Factors associated with health

outcomes diferent or Aboriginal

and non-Aboriginal adults

From the previous sequential step-wisemodels, it was shown that certain health

disparities between Aboriginal and non-Aboriginal people could be diminished,but not necessarily eliminated, bycontrolling or the eect o various socio-economic and demographic actors.However, the impact o these actorsmay not be the same across Aboriginalidentity groups. Initial analyses oundseveral signifcant interactions o theseactors with Aboriginal identity in themodels. Thereore, separate modelsor each identity group were run andestimates across models were compared

(or technical description o analysismethodology, see Technical notes).

Logistic models were conductedseparately or each Aboriginal identitygroup (non-Aboriginal, First Nationso-reserve, Mtis and Inuit) to estimatethe likelihood o reporting each o thepreviously examined health outcomes:excellent or very good general health(Table 7), diagnosed by a healthproessional with one o several chronicconditions (Table 8), diagnosed with

diabetes by a health proessional (Table9), diagnosed with asthma by a healthproessional (Table 10), and diagnosedwith arthritis by a health proessional(Table 11).

The majority o actors seemed to havesimilar eects across models or each othe health outcomes. However, a ewactors stood out as having dierenteects according to Aboriginal identitygroup. One such actor was gender.Among non-Aboriginal adults, men

were signifcantly less likely than women(OR=0.9) to report being in excellent orvery good health (Table 7). Conversely, or First Nations, Mtisand Inuit adults, men and women were similarly likely toreport being in excellent or very good health. The estimatesor First Nations and Inuit adults diered signifcantly romthe model or non-Aboriginal adults (Table 7). Furthermore,whereas non-Aboriginal men and women were equally aslikely to have been diagnosed by a doctor with at least onechronic condition (OR=1.0), men were signifcantly less likelyto be diagnosed with a chronic condition than women among

Figure 6Odds ratios showing unadjusted and cumulative efects o socio-economic, liestyle and healthcare access actors on being diagnosed with diabetes, by Aboriginal identity group, of-reservepopulation aged 20 or older, Canada, 2006/2007


0.00

0.50

1.00

1.50

2.00

2.50

Odds ratio of being

diagnosed withdiabetes


Non-Aboriginal


sex

Step 2: Add

income and

education

Step 3: Add

smoking and

body mass index

Step 4: Add

doctor/nurse

contact

Step 5: Add

urban residence

=99% confidence interval

Figure 7Odds ratios showing unadjusted and cumulative efects o socio-economic, liestyle and healthcare access actors on being diagnosed with asthma, by Aboriginal identity group, of-reservepopulation aged 20 or older, Canada, 2006/2007


Odds ratio of being

diagnosed with

asthma


Non-Aboriginal


sex

Step 2: Add

income and

education

Step 3: Add

smoking and

body mass index

Step 4: Add

doctor/nurse

contact

Step 5: Add

urban residence

0.00

0.50

1.00

1.50

2.00

2.50 =99% confidence interval


16/34


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11




adults, particularly the latter. Such fndings may indicate thatthe BMI cut-points used in the general population may not beappropriate or First Nations or Inuit people, an argument thathas been made by others.35

In the same way, other characteristics had dierent healthimpacts across Aboriginal and non-Aboriginal populations, aswell as across First Nations, Mtis and Inuit populations.

Table 7Adjusted odds ratios relating selected socio-demographic and health-related actors to reporting excellent or very good health, by Aboriginalidentity group, of-reserve population aged 20 or older, Canada, 2006/2007

A: Non-Aboriginal(n=56,054)

B: First Nations(n=8,692)

C: Mtis(n=7,225)

D: Inuit(n=3,950)

Adjustedodds ratio

95%

conidenceinterval

Adjustedodds ratio

95%

conidenceinterval

Adjustedodds ratio

95%

conidenceinterval

Adjustedodds ratio

95%

conidenceinterval

rom to rom to rom to rom to

Male 0.86*BD 0.81 0.92 1.15AC 1.00 1.32 0.92B 0.80 1.05 1.10A 0.90 1.34

Personal incomeLess than $10,000 0.55*B 0.48 0.61 0.41*AC 0.33 0.52 0.63*B 0.50 0.79 0.59* 0.43 0.82

$10,000 to $19,999 0.61*B 0.55 0.68 0.47*A 0.37 0.60 0.59* 0.47 0.75 0.68* 0.48 0.97

$20,000 to $29,999 0.81* 0.73 0.90 0.77 0.60 1.00 0.88 0.69 1.12 0.91 0.64 1.29

$30,000 to $39,999 1.00 1.00 1.00 1.00

$40,000 to $59,999 1.07 0.96 1.19 0.98 0.75 1.27 1.32*D 1.04 1.67 0.81C 0.55 1.21

$60,000 or more 1.46*D 1.31 1.62 1.12 0.83 1.51 1.55*D 1.19 2.02 0.92AC 0.63 1.34

EducationLess than secondary graduation 0.67* 0.60 0.73 0.66* 0.53 0.83 0.56* 0.45 0.70 0.80 0.59 1.10

Secondary graduation 1.00 1.00 1.00 1.00

Some postsecondary 1.00 0.88 1.12 0.98 0.77 1.24 1.02 0.81 1.29 1.30 0.85 2.00Postsecondary graduation 1.07B 0.99 1.16 1.38*AC 1.13 1.70 1.04B 0.86 1.26 1.11 0.78 1.57

Daily smoker 0.55*B 0.50 0.59 0.67*AC 0.58 0.77 0.54*B 0.47 0.62 0.60* 0.49 0.74

Body mass indexUnder-/Acceptable weight 1.00 1.00 1.00 1.00

Overweight 0.72*BD 0.66 0.77 0.88A 0.74 1.03 0.71*D 0.61 0.84 1.03AC 0.81 1.30

Obese 0.41*BD 0.38 0.45 0.51*AC 0.43 0.61 0.37*BD 0.31 0.44 0.67*AC 0.51 0.89

Saw doctor or nurse in past year 0.63* 0.58 0.69 0.55* 0.46 0.65 0.59* 0.50 0.70 0.66* 0.53 0.82

Urban residence 0.85* 0.80 0.91 0.86* 0.76 0.97 0.88 0.77 1.00 1.17 0.85 1.62

* estimate signiicantly dierent rom zero (p


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Table 8Adjusted odds ratios relating selected socio-demographic and health-related actors to likelihood o being diagnosed with at least one chroniccondition, by Aboriginal identity group, of-reserve population aged 20 or older, Canada, 2006/2007



C: Mtis(n=7,182)

D: Inuit(n=3,886)

Adjustedodds ratio

95%conidence

intervalAdjusted

odds ratio

95%conidence

intervalAdjusted

odds ratio

95%conidence

intervalAdjusted

odds ratio

95%conidence

interval


Male 1.03BCD 0.96 1.11 0.81*A 0.69 0.94 0.83*A 0.71 0.96 0.69*A 0.55 0.87

Personal incomeLess than $10,000 1.48* 1.28 1.70 1.37* 1.09 1.73 1.42* 1.12 1.80 1. 29 0.94 1.77

$10,000 to $19,999 1.41* 1.24 1.61 1.44* 1.12 1.84 1.33* 1.05 1.67 1.22 0.84 1.79

$20,000 to $29,999 1.05 0.92 1.19 1.14 0.87 1.51 1.09 0.84 1.40 1.22 0.84 1.76

$30,000 to $39,999 1.00 1.00 1.00 1.00

$40,000 to $59,999 0.88* 0.78 0.99 0.98 0.75 1.27 0.78D 0.61 1.00 1.25C 0.83 1.88

$60,000 or more 0.78*D 0.69 0.88 0.82D 0.60 1.10 0.74*D 0.57 0.97 1.38ABC 0.86 2.20

EducationLess than secondary graduation 1.25*D 1.12 1.39 1.33*D 1.05 1.69 1.23 0.99 1.53 0.83AB 0.53 1.27


Some postsecondary 1.20* 1.05 1.39 1.35* 1.04 1.75 1.07 0.85 1.35 0.86 0.49 1.51Postsecondary graduation 0.93 0.85 1.01 1.05 0.83 1.33 1.06 0.87 1.28 0.81 0.48 1.34

Daily smoker 1.26*D 1.16 1.36 1.29*D 1.11 1.50 1.35*D 1.16 1.57 0.97ABC 0.76 1.25


Overweight 1.64*BD 1.52 1.76 1.14A 0.96 1.36 1.41*D 1.20 1.65 0.82AC 0.59 1.15

Obese 2.87*BD 2.63 3.13 2.12*A 1.76 2.55 2.50*D 2.09 3.00 1.59*AC 1.16 2.19

Saw doctor or nurse in past year 2.67* 2.43 2.92 2.87* 2.40 3.44 2.66* 2.26 3.14 2.18* 1.63 2.93

Urban residence 1.00B 0.94 1.08 1.24*A 1.09 1.40 1.07 0.93 1.23 1.38 0.94 2.03



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Table 9Adjusted odds ratios relating selected socio-demographic and health-related actors to likelihood o being diagnosed with diabetes, by Aboriginalidentity group, of-reserve population aged 20 or older, Canada, 2006/2007



C: Mtis(n=7,225)

D: Inuit(n=3,951)

Adjustedodds ratio

95%conidence

intervalAdjusted

odds ratio

95%conidence

intervalAdjusted

odds ratio

95%conidence

intervalAdjusted

odds ratio

95%conidence

interval


Male 1.66*BCD 1.49 1.84 0.96A 0.76 1.21 1.16A 0.91 1.49 0.93A 0.60 1.43

Personal income

Less than $10,000 1.11 0.87 1.42 1.42 0.98 2.05 1.50 0.98 2.29 1.51 0.67 3.40

$10,000 to $19,999 1.18 0.95 1.48 1.31 0.90 1.91 1.41 0.95 2.09 0.85 0.39 1.83

$20,000 to $29,999 0.83 0.68 1.03 0.92 0.59 1.42 0.90 0.59 1.38 0.74 0.34 1.63

$30,000 to $39,999 1.00 1.00 1.00 1.00

$40,000 to $59,999 0.68* 0.54 0.86 0.90 0.61 1.33 0.69 0.44 1.08 0.50 0.19 1.33

$60,000 or more 0.50*B 0.40 0.63 1.08AC 0.65 1.78 0.48*B 0.30 0.78 0.86 0.37 2.00

Education

Less than secondary graduation 1.27* 1.06 1.52 1.41 0.96 2.03 0.91 0.64 1.30 0.57 0.23 1.42


Some postsecondary 0.97C

0.75 1.26 0.91 0.59 1.39 0.55*A

0.35 0.85 0.85 0.30 2.42Postsecondary graduation 0.94D 0.80 1.11 0.75 0.51 1.10 0.67* 0.48 0.93 0.31*A 0.13 0.76

Daily smoker 0.96 0.83 1.12 1.13 0.88 1.45 1.03 0.79 1.34 0.83 0.53 1.27

Body mass index

Under-/Acceptable weight 1.00 1.00 1.00 1.00

Overweight 1.97* 1.71 2.27 1.92* 1.33 2.77 1.83* 1.23 2.74 1.16 0.51 2.61

Obese 4.64* 4.02 5.35 4.90* 3.58 6.70 5.24* 3.59 7.65 5.14* 2.38 11.13

Saw doctor or nurse in past year 2.31*C 1.80 2.97 2.50* 1.85 3.38 3.69*A 2.42 5.63 3.88* 1.78 8.44

Urban residence 1.27* 1.14 1.42 1.08 0.88 1.32 1.07 0.84 1.35 2.19* 1.11 4.33



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Table 10Adjusted odds ratios relating selected socio-demographic and health-related actors to likelihood o being diagnosed with asthma, by Aboriginalidentity group, of-reserve population aged 20 or older, Canada, 2006/2007



C: Mtis(n=7,230)

D: Inuit(n=3,957)

Adjustedodds ratio

95%

conidenceinterval

Adjustedodds ratio

95%

conidenceinterval

Adjustedodds ratio

95%

conidenceinterval

Adjustedodds ratio

95%

conidenceinterval


Male 0.69* 0.62 0.77 0.64* 0.53 0.79 0.69* 0.56 0.83 0.52* 0.35 0.78

Personal incomeLess than $10,000 1.18D 0.97 1.44 1.47* 1.08 1.99 1.16D 0.87 1.55 3.07*AC 1.78 5.30

$10,000 to $19,999 1.23*D 1.01 1.50 1.68* 1.23 2.31 1.25 0.92 1.70 2.83*A 1.60 5.00

$20,000 to $29,999 1.17D 0.96 1.42 1.23D 0.84 1.80 1.14D 0.83 1.57 3.22*ABC 1.57 6.62

$30,000 to $39,999 1.00 1.00 1.00 1.00

$40,000 to $59,999 0.99D 0.82 1.21 0.96D 0.65 1.41 0.81D 0.56 1.16 2.29*ABC 1.20 4.34

$60,000 or more 1.01D 0.83 1.24 0.78D 0.50 1.18 0.71D 0.47 1.07 2.35*ABC 1.18 4.69

EducationLess than secondary graduation 1.47* 1.23 1.74 1.12 0.82 1.52 1.20 0.89 1.61 0.90 0.50 1.64


Some postsecondary 1.15 0.93 1.42 1.15 0.82 1.62 1.09 0.79 1.50 0.96 0.42 2.23Postsecondary graduation 1.20* 1.04 1.38 1.10 0.81 1.50 1.15 0.87 1.51 0.97 0.52 1.80

Daily smoker 1.19*B 1.05 1.35 0.89A 0.72 1.09 1.11 0.92 1.35 0.83 0.58 1.19


Overweight 1.29* 1.15 1.45 1.07 0.83 1.39 1.05 0.82 1.34 1.10 0.67 1.80

Obese 1.68* 1.48 1.92 1.58* 1.23 2.02 1.73* 1.36 2.21 1.21 0.77 1.91

Saw doctor or nurse in past year 1.86* 1.59 2.17 1.72* 1.33 2.22 1.76* 1.37 2.24 1.64 0.95 2.82

Urban residence 1.11* 1.00 1.23 1.09 0.91 1.30 1.23* 1.02 1.48 1.47* 1.06 2.03



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Table 11Adjusted odds ratios relating selected socio-demographic and health-related actors to likelihood o being diagnosed with arthritis, by Aboriginalidentity group, of-reserve population aged 20 or older, Canada, 2006/2007



C: Mtis(n=7,230)

D: Inuit(n=3,957)

Adjustedodds ratio

95%

conidenceinterval

Adjustedodds ratio

95%

conidenceinterval

Adjustedodds ratio

95%

conidenceinterval

Adjustedodds ratio

95%

conidenceinterval


Male 0.64* 0.59 0.69 0.65* 0.55 0.77 0.71* 0.60 0.84 0.54* 0.38 0.76

Personal incomeLess than $10,000 1.24* 1.06 1.44 1.54* 1.16 2.05 1.55* 1.18 2.05 1.48 0.93 2.36

$10,000 to $19,999 1.27* 1.11 1.46 1.57* 1.14 2.17 1.37* 1.04 1.81 1.50 0.91 2.46

$20,000 to $29,999 1.01C 0.89 1.16 1.05 0.75 1.47 1.40*A 1.06 1.85 1.03 0.61 1.75

$30,000 to $39,999 1.00 1.00 1.00 1.00

$40,000 to $59,999 0.86* 0.75 0.99 0.98 0.71 1.34 0.76 0.56 1.03 1.31 0.76 2.24

$60,000 or more 0.84*D 0.72 0.96 0.70*D 0.49 1.00 0.81 0.59 1.12 1.39AB 0.63 3.06

EducationLess than secondary graduation 1.17* 1.05 1.31 1.22 0.94 1.59 1.15 0.89 1.49 0.71 0.36 1.41


Some postsecondary 0.99 0.83 1.19 1.18 0.86 1.62 1.00 0.76 1.32 0.66 0.28 1.55

Postsecondary graduation 0.94 0.85 1.04 1.13 0.87 1.46 1.04 0.83 1.31 0.77 0.34 1.76

Daily smoker 1.50* 0.37 1.64 1.46* 1.23 1.73 1.43* 1.20 1.70 1.20 0.84 1.72


Overweight 1.36*D 1.26 1.47 1.18D 0.97 1.44 1.32*D 1.08 1.61 0.68ABC 0.43 1.07

Obese 1.98*D 1.81 2.18 1.58* 1.28 1.96 1.79*D 1.47 2.17 1.10AC 0.72 1.69

Saw doctor or nurse in past year 1.99*BD 1.78 2.22 2.79*ACD 2.18 3.56 2.10*BD 1.71 2.60 1.17ABC 0.75 1.80

Urban residence 0.86*BD 0.80 0.93 1.12A 0.96 1.30 0.98D 0.84 1.15 1.44AC 0.87 2.40



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Discussion and conclusions

In general, the health o Aboriginal adults is poorer than thato non-Aboriginal adults. Inuit, Mtis and First Nations adultsliving o-reserve were less likely to report being in excellent

or very good health and were more likely to report at leastone activity limitation than were non-Aboriginal adults. Therewere also dierences in the likelihood o being diagnosed withseveral or specifc chronic health conditions. These healthgaps were urther exacerbated ater taking into account theyounger average age structure o the Aboriginal population.

This health gap is narrowed in certain cases ater takinginto account socio-economic characteristics such as incomeand educational attainment. However, in most cases, Inuit,Mtis and First Nations adults living o-reserve remained inpoorer health than non-Aboriginal adults even ater socio-economic, health care access and liestyle risk actors were

taken into account.The act that health inequalities remain or Aboriginal

people relative to non-Aboriginal Canadians indicates thatother actors are at play. Some have argued that proximalactors actors that have a direct impact on health suchas behaviour and socio-economic characteristics are limitedin their ability to explain health disparities. Rather, actorsthat have an indirect eect on health, such as the health caresystem and, more specifc to Aboriginal people in Canada,actors o racism and social exclusion may play an importantrole in generating and maintaining health inequalities.36,37

Such actors are, however, di cult to conceptualize andmeasure and were, thereore, not addressed in the presentstudy.

The act that income and education levels could not ullyexplain the dierences in health status between Aboriginaland non-Aboriginal adults is not an indication that these

actors are unimportant. Low income and education havebeen shown, in this study and in others,19-21,38 to be associatedwith poorer health outcomes. At a very basic level income

is reective o ones ability to access resources, and thosewith higher incomes generally have access to higher qualityresources. Such resources may include high-quality housing,transportation, adequate nutrition, and access to clean water,all o which can impact health. Achieving higher educationmay increase ones knowledge o healthy liestyles and o thehealth care system and how to navigate it.

This study also demonstrated that actors typicallyassociated with health in the general population do notact in the same way or First Nations, Mtis and Inuit adults.For example, male gender was signifcantly associated withhigher rates o diabetes in the non-Aboriginal population.

However, there was no dierence in the likelihood o beingdiagnosed with diabetes among men and women or FirstNations, Mtis and Inuit adults. There were also dierencesamong First Nations, Mtis and Inuit groups in relation tovarious measures o health. Such fndings indicate severalthings. First, the actors associated with health amongnon-Aboriginal adults are not necessarily the same actorsthat aect the health o Aboriginal people, nor do theseactors have the same eect on health. Second, there arealso important dierences between First Nations, Mtis andInuit adults in terms o the actors that impact health, whichhighlights the importance o examining these identity groupsseparately and not using a pan-Aboriginal approach when

examining health.

References

1. Statistics Canada.Aboriginal Peoples in Canada in 2006: Inuit, Mtis and

First Nations, 2006 Census (Catalogue 97-558-XIE) Ottawa: StatisticsCanada, 2008

2. Guimond E. Ethnic mobility and the demographic growth o CanadasAboriginal populations rom 1986 to 1996. In: Blanger A, ed. Reporton the Demographic Situation in Canada, 1998-1999 (Statistics CanadaCatalogue 91-209-XIE) Ottawa: Statistics Canada, 2006.

3. Wilkins R, Uppal S, Fins P, Sencal S, Guimond , Dion R. Lie expectancyin Inuit-inhabited regions o Canada, 1989 to 2003. Health Reports(Statistics Canada, Catalogue 82-003) 2009; 19(1): 1-13.

4. Wilkins R, Tjepkema M, Mustard C, Choinire R. The Canadian censusmortality ollow-up study, 1991 through 2001. Health Reports (StatisticsCanada, Catalogue 82-003) 2009; 19(3): 25-43.

5. Health Canada.A Statistical Profile on the Health of First Nations in Canada

2000 (Health Canada, Catalogue H35-4/30-2000) Ottawa, Minister oHealth Canada, 2005.

6. Janz T, Seto J, Turner A.Aboriginal Peoples Survey, 2006: An Overviewof the Health of the Mtis Population (Catalogue 89-637-X No. 004)Ottawa: Statistics Canada, 2009.

7. RHS National Team.First Nations Regional Longitudinal Health Survey (RHS)2002/03. Ottawa: Assembly o First Nations/First Nations InormationGovernance Committee, 2007

8. Tjepkema M. The health o the o-reserve Aboriginal population.HealthReports (Statistics Canada, Catalogue 82-003) 2002; 13(Suppl. 1): 1-16.


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9. Statistics Canada. 2006 Census o Population -- Income Statistics(4) in Constant (2005) Dollars, Age Groups (5A), Aboriginal Identity,Registered Indian Status and Aboriginal Ancestry (21), Highest Certiicate,Diploma or Degree (5) and Sex (3) or the Population 15 Years andOver With Income o Canada, Provinces, Territories, 2000 and 2005 -20% Sample Data (Statistics Canada catalogue 97-563-XCB2006008).Available at: http://www12.statcan.gc.ca/census-recensement/2006/

dp-pd/tbt/Rp-eng.cm?LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0&GID=614135&GK=0&GRP=1&PID=96254&PRID=0&PTYPE=88971,97154&S=0&SHOWALL=0&SUB=0&Temporal=2006&THEME=81&VID=0&VNAMEE=&VNAMEF=.

10. Richards J.Closing the Aboriginal/non-Aboriginal Education Gaps. Toronto:C.D. Howe Institute, 2008.

11. Richards J, Hove J, Aolabi K.Understanding the Aboriginal/Non-AboriginalGap in Student Performance: Lessons from British Columbia. Toronto: C.D.Howe Institute, 2008.

12. Tait H.Aboriginal Peoples Survey, 2006: Inuit Health and Social Conditions(Statistics Canada, Catalogue 89-637-X No. 001) Ottawa: StatisticsCanada, 2008.

13. Avlund K, Holstein BE, Osler M, et al. Social position and health in oldage: the relevance o dierent indicators o social position.Scandinavian

Journal of Public Health 2003; 31(2): 126-36.14. Backlund E, Sorlie PD, Johnson NJ. The shape o the relationship between

income and mortality in the United States - Evidence rom the nationallongitudinal mortality study.Annals of Epidemiology1996; 6(1): 12-20.

15. Duncan GJ. Income dynamics and health. International Journal of HealthServices 1996; 26(3): 419-44.

16. Hart CL, Smith GD, Blane D. Inequalities in mortality by social classmeasured at 3 stages o the liecourse.American Journal of Public Health1998; 88(3): 471-4.

17. Kawachi I. Income inequality and health. In: Berkman LF, Kawachi I,editors. Social Epidemiology. New York: Oxord University Press, Inc.,2000: 76-94.

18. Lahelma E, Martikainen P, Laaksonen M, et al. Pathways betweensocioeconomic determinants o health. Journal of Epidemiology andCommunity Health 2004; 58(4): 327-32.

19. Lynch JW, Kaplan GA, Shema SJ. Cumulative impact o sustainedeconomic hardship on physical, cognitive, psychological, and socialunctioning.New England Journal of Medicine 1997; 337(26): 1889-95.

20. Davey Smith G, Hart C, Blane D, et al. Lietime socioeconomic positionand mortality: Prospective observational study. British Medical Journal1997; 314(7080): 547-52.

21. Davey Smith G, Hart C, Blane D, et al. Adverse socioeconomic conditionsin childhood and cause speciic adult mortality: prospective observationalstudy. British Medical Journal1998; 316(7145): 1631-35.

22. Calcutt D.Aboriginal Peoples Survey, 2006: Concepts and Methods Guide(Statistics Canada, Catalogue 89-637-X No. 003) Ottawa: Statistics Canada,2009.

23. Statistics Canada. Canadian Community Health Survey (CCHS) 2007Microdata files -- User Guide. Ottawa: Statistics Canada, 2008. Available at:

http://www.statcan.gc.ca/cgi-bin/a-dr.cgi?l=eng&loc=http://www.statcan.gc.ca/imdb-bmdi/document/3226_D7_T9_V4-eng.pd&teng=User%20Guide&tra=Guide%20de%20lutilisateur.

24. Murphy K, Connor Gorber S, ODwyer A. Health State Descriptions forCanadians: Diabetes (Statistics Canada, Catalogue 82-619-MIE - No. 002)Ottawa: Statistics Canada, 2005.

25. Kelly C, Booth G. Diabetes in Canadian women. BMC Womens Health2004; 4(Suppl 1): S16-S24.

26. Romanow RJ. Building on Values: The Future of Health Care in Canada ,

Ottawa: National Library o Canada, 2002.27. Ng E, Dasgupta K, Johnson JA. An algorithm to dierentiate diabetic

respondents in the Canadian Community Health Survey. Health Reports(Statistics Canada, Catalogue 82-003) 2008; 19(1): 1-9.

28. Das SK. Harmul eects o cigarette smoking. Molecular and CellularBiochemistry2003; 253(1-2): 159-65.

29. Fagerstrom K. The epidemiology o smoking: Health consequencesand beneits o cessation. Drugs 2002; 62(Suppl 2.): 1-9.

30. Charbonneau-Roberts G, Saudny-Unterberger H, Kuhnlein HV et al.Body mass index may overestimate the prevalence o overweight andobesity among the Inuit. International Journal of Circumpolar Health2005; 64(2): 163-9.

31. McCargar L, Should the 1988 Canadian Guidelines for Healthy Weightsbe Updated? Ottawa: Health Canada, 2003

32. Young TK, Bjerregaard P, Dewailly E et al. Prevalence o obesity andits metabolic correlates among the circumpolar Inuit in 3 countries.

American Journal of Public Health 2007; 97(4): 691-5.

33. Bertakis KD, Azari R. Obesity and the use o health care services.ObesityResearch 2005; 13(2): 372-9.

34. Field AE, Coakley EH, Must A et al. Impact o overweight on the risk odeveloping common chronic diseases during a 10-year period.Archivesof Internal Medicine 2001; 161(9): 1581-6.

35. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumerenceand health risk: Evidence in support o current National Institutes oHealth guidelines.Archives of Internal Medicine 2002; 162(11): 2074-9.

36. King M, Smith A, Gracey M. Indigenous health part 2: The underlyingcauses o the health gap. Lancet2009; 374: 76-85.

37. Loppie Reading C, Wien F. Health Inequalities and Social Determinants

of Aboriginal Peoples Health. British Columbia: National CollaboratingCentre or Aboriginal Health, 2009.

38. Krieger N, Williams DR, Moss NE. Measuring social class in US publichealth research: concepts, methodologies, and guidelines.Annual Reviewof Public Health 1997; 18: 341-78.

39. Allison PA. Comparing logit and probit coeicients across groups.Sociological Methods & Research 1999; 28(2): 186-208.

40. Hoetker G. Confounded coefficients: Accurately comparing logit and probit coefficients across groups. Illinois: University o Illinois atUrbana-Champaign, 2004.


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Technical notes

Both the CCHS and the APS include sample weights thatallow the analyst to calculate estimates that are generalizableto the larger population. Each survey also employs the use

o bootstrap weights to adjust variance estimates or thecomplexities o each surveys design. However, the numberand nature o replicates dier between the two surveys.The CCHS employs 500 replicate weights, whereas the 2006APS employs 1000 replicate weights. Furthermore, varianceestimation using the 2006 APS bootstrap weights must beadjusted using Fays actor, whereas this is not the case whenusing CCHS data. Given that these inter-survey dierencescould not be addressed in a single model or test, othermethods were used in analyses that required comparisonsbetween Aboriginal and non-Aboriginal respondents (e.g.comparing proportions or means), or analyses that werebased on a single model that included both the Aboriginaland non-Aboriginal samples.

Calculating and comparing descriptive statistics

Descriptive statistics (proportions, means) were calculatedseparately or Aboriginal and non-Aboriginal respondents,using the appropriate sample and bootstrap weights or theparticular survey. To compare proportion estimates betweenAboriginal and non-Aboriginal respondents, the ollowingequations were used:

wherep1

andp2

are the proportions rom each sample and sep1

and sep2

are the standard errors o the proportions.

To compare mean estimates between Aboriginal and non-Aboriginal respondents, the ollowing equations were used:

where 1x and 2x are the mean estimates rom the two

independent samples, and are the standard error

estimates o the two means.

Comparing estimates rom a single logistic

regression model

For certain analyses, CCHS and APS data were included ina single model in order to compare the relative impact oAboriginal identity on a particular outcome. In such analyseswhere the model included both Aboriginal and non-Aboriginalrespondents, models were weighted using a normalizedsampling weight. In lieu o bootstrapping the model, which

would normally adjust variance estimates to account or thecomplex survey design but could not be undertaken due tothe aorementioned dierences in the number and nature o

bootstrap weights or the two surveys, a more conservativealpha value (p


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Table AUnadjusted and age-sex-standardized prevalence o diagnosed chronic conditions, by Aboriginal identity group, of-reserve population aged 20 or

older, Canada, 2006/2007

Chronic conditionsNon-

Aboriginal

Unadjusted Age-sex-standardized

First Nations Mtis Inuit First Nations Mtis Inuit

percentage

Arthritis 16.9 24.3* 23.6* 15.2 27.7* 27.6* 20.7*

Asthma 7.4 13.7* 13.5* 8.1 13.3* 13.3* 9.5*

Cancer 1.7 3.2* 3.7* 2.3 4.0* 4.4* 3.3*

Diabetes 6.5 9.3* 7.5* 4.9* 11.4* 9.5* 7.6

Emphysema 0.8 1.1* 1.3* 0.7 1.4* 1.7* 1.2

Heart problems 5.3 7.5* 7.8* 5.9 9.5* 9.8* 8.6*

Hypertension 18.2 17.9 17.9 14.5* 21.8* 21.7* 20.0

Eects o stroke 1.3 2.5* 2.2* 2.0* 3.5* 2.9* 3.3*

Stomach/Intestinal ulcers 3.1 13.7* 12.9* 8.7* 14.6* 13.8* 9.9*



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Table CAdjusted odds ratios rom sequential step-wise logistic regression models or reporting excellent or very good health, of-reserve population aged 20or older, Canada, 2006/2007

Step 1 Step 2 Step 3 Step 4 Step 5

Adjustedoddsratio

99%conidence

interval Adjustedoddsratio

99%conidence


99%conidence


99%conidence


99%conidence

interval

rom to rom to rom to rom to rom to

Aboriginal identity groupNon-Aboriginal 1.00 1.00 1.00 1.00 1.00

First Nations 0.63* 0.59 0.67 0.78* 0.73 0.83 0.91* 0.85 0.97 0.91* 0.85 0.97 0.90* 0.85 0.97

Mtis 0.79* 0.74 0.85 0.91* 0.85 0.98 1.06 0.99 1.14 1.05 0.98 1.13 1.04 0.97 1.12

Inuit 0.54* 0.50 0.59 0.75* 0.69 0.83 1.00 0.91 1.10 1.01 0.92 1.11 0.94 0.85 1.04

Male 1.05* 1.01 1.09 0.95* 0.91 0.99 1.01 0.97 1.05 0.95* 0.91 0.99 0.95* 0.91 0.99

Age (centred at 20)Linear 0.99* 0.98 0.99 0.97* 0.97 0.98 0.98* 0.98 0.98 0.98* 0.98 0.99 0.98* 0.98 0.99

Quadratic 0.9998* 0.9997 0.9998 1.0001* 1.0000 1.0001 0.9999* 0.9998 1.0000 0.9999* 0.9998 1.0000 0.9999* 0.9998 1.0000

Personal incomeLess than $10,000 0.51* 0.45 0.57 0.49* 0.43 0.55 0.48* 0.43 0.54 0.48* 0.43 0.54

$10,000 to $19,999 0.52* 0.49 0.56 0.53* 0.50 0.57 0.53* 0.49 0.57 0.53* 0.49 0.57

$20,000 to $29,999 0.56* 0.53 0.60 0.57* 0.53 0.60 0.57* 0.53 0.60 0.57* 0.53 0.60$30,000 to $39,999 1.00 1.00 1.00 1.00

$40,000 to $59,999 0.91* 0.86 0.98 0.92* 0.86 0.99 0.92* 0.86 0.99 0.92* 0.86 0.99

$60,000 or more 0.93* 0.87 1.00 0.93* 0.86 1.00 0.93* 0.86 1.00 0.92* 0.86 0.99

EducationLess than secondary graduation 0.63* 0.59 0.68 0.66* 0.61 0.70 0.65* 0.61 0.70 0.65* 0.60 0.69


Some postsecondary 1.02 0.94 1.10 0.98 0.91 1.07 1.01 0.93 1.09 1.01 0.93 1.10

Postsecondary graduation 1.20* 1.13 1.27 1.11* 1.05 1.18 1.13* 1.07 1.20 1.14* 1.07 1.21

Daily smoker 0.57* 0.54 0.59 0.55* 0.53 0.58 0.55* 0.52 0.58

Body mass indexUnder-/Acceptable weight 1.00 1.00 1.00

Overweight 0.75* 0.72 0.79 0.76* 0.72 0.79 0.75* 0.72 0.79

Obese 0.43* 0.41 0.45 0.44* 0.41 0.46 0.43* 0.41 0.46

Saw doctor or nurse in past year 0.62* 0.59 0.65 0.62* 0.59 0.65

Urban residence

0.88* 0.84 0.93* signiicant ly dierent rom zero (p


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Table DUnadjusted and adjusted odds ratios relating Aboriginal identity and selected characteristics tobeing diagnosed with at least one chronic condition (relative to non-Aboriginal identity), of-reserve population aged 20 or older, Canada, 2006/2007


Oddsratio

99%conidence

intervalOddsratio

99%conidence

intervalOddsratio

99%conidence

interval

rom to rom to rom to

Unadjusted 1.20* 1.13 1.27 1.20* 1.12 1.28 0.74* 0.68 0.81

Adjusted or:Age and sex 1.84* 1.72 1.96 1.82* 1.70 1.96 1.20* 1.09 1.32

plus income 1.65* 1.54 1.77 1.70* 1.58 1.83 1.07 0.98 1.18

plus education 1.70* 1.59 1.82 1.73* 1.61 1.86 1.05 0.95 1.16

plus daily smoker 1.79* 1.67 1.91 1.78* 1.66 1.91 1.12* 1.02 1.23

plus body mass index 1.67* 1.57 1.79 1.66* 1.55 1.79 1.10 1.00 1.21

plus saw doctor/nurse in past year 1.88* 1.76 2.00 1.90* 1.77 2.04 1.20* 1.09 1.32

plus urban residence 1.84* 1.72 1.96 1.83* 1.70 1.96 1.20* 1.09 1.33



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Table EAdjusted odds ratios rom sequential step-wise logistic regression models or being diagnosed with at least one chronic condition, of-reservepopulation aged 20 or older, Canada, 2006/2007

Step 1 Step 2 Step 3 Step 4 Step 5

Adjustedoddsratio

99%

conidenceinterval Adjustedoddsratio

99%


99%


99%


99%

conidenceinterval

rom to rom to rom to rom to rom to

Aboriginal identity groupNon-Aboriginal 1.00 1.00 1.00 1.00 1.00

First Nations 1.84* 1.72 1.96 1.57* 1.47 1.68 1.41* 1.32 1.51 1.42* 1.33 1.53 1.43* 1.33 1.53

Mtis 1.82* 1.70 1.96 1.64* 1.52 1.76 1.47* 1.37 1.58 1.52* 1.41 1.64 1.53* 1.42 1.65

Inuit 1.20* 1.09 1.32 0.98 0.89 1.08 0.86* 0.77 0.95 0.83* 0.75 0.92 0.86* 0.77 0.96

Male 0.84* 0.81 0.88 0.89* 0.85 0.93 0.82* 0.79 0.86 0.90* 0.86 0.95 0.91* 0.86 0.95

Age (centred at 20)

Linear 1.00 0.99 1.00 1.01 1.00 1.01 1.00 0.99 1.00 1.00 0.99 1.00 1.00 0.99 1.00

Quadratic 1.0009* 1.0008 1.0010 1.0008* 1.0007 1.0008 1.0009* 1.0008 1.0010 1.0009* 1.0008 1.0010 1.0009* 1.0008 1.0010

Personal incomeLess than $10,000 1.24* 1.09 1.41 1.28* 1.12 1.46 1.30* 1.14 1.48 1.30* 1.14 1.48

$10,000 to $19,999 1.50* 1.39 1.63 1.51* 1.39 1.63 1.51* 1.39 1.64 1.51* 1.40 1.64

$20,000 to $29,999 1.46* 1.36 1.56 1.47* 1.37 1.57 1.48* 1.38 1.59 1.49* 1.39 1.59$30,000 to $39,999 1.00 1.00 1.00 1.00

$40,000 to $59,999 1.11* 1.03 1.19 1.11* 1.03 1.19 1.12* 1.04 1.20 1.12* 1.04 1.20

$60,000 or more 1.05 0.97 1.13 1.04 0.96 1.13 1.05 0.97 1.14 1.05 0.97 1.14

Educational attainmentLess than secondary graduation 1.24* 1.15 1.34 1.22* 1.13 1.31 1.24* 1.15 1.34 1.25* 1.15 1.35


Some postsecondary 1.20* 1.10 1.31 1.22* 1.11 1.33 1.18* 1.07 1.29 1.17* 1.07 1.29

Postsecondary graduation 0.95 0.89 1.01 1.00 0.94 1.06 0.96 0.90 1.02 0.96 0.90 1.02

Daily smoker 1.22* 1.15 1.28 1.28* 1.21 1.35 1.28* 1.21 1.35

Body mass indexUnder-/Acceptable weight 1.00 1.00 1.00

Overweight 1.50* 1.42 1.58 1.49* 1.41 1.57 1.49* 1.42 1.57

Obese 2.70* 2.54 2.87 2.65* 2.49 2.82 2.66* 2.50 2.83

Saw doctor or nurse in past year 2.66* 2.50 2.82 2.65* 2.50 2.82

Urban residence

1.07* 1.01 1.13* signiicantly dierent rom zero (p


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Table FUnadjusted and adjusted odds ratios relating Aboriginal identity and selected characteristics tobeing diagnosed with diabetes (relative to non-Aboriginal identity), of-reserve population aged20 or older, Canada, 2006/2007


Oddsratio

99%conidenceinterval Odds

ratio

99%conidenceinterval Odds

ratio

99%conidenceinterval

rom to rom to rom to

Unadjusted 1.47* 1.33 1.64 1.16* 1.03 1.32 0.75* 0.62 0.91

Adjusted or:

Age and sex 2.14* 1.91 2.39 1.61* 1.42 1.83 1.22 1.00 1.49

plus income 1.94* 1.73 2.18 1.52* 1.33 1.73 1.10 0.89 1.34

plus education 1.99* 1.78 2.23 1.53* 1.34 1.74 1.03 0.84 1.26

plus daily smoker 2.17* 1.94 2.42 1.62* 1.43 1.85 1.25* 1.02 1.53

plus body mass index

the health of first nations living off-reserve, inuit, and métis adults in canada:the impact of...

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