Diabetes in our Communities:

Transcription

1 Diabetes in our Communities: National Results from the First Nations Regional Health Survey (RHS) 2015/16 April 18, 2018 National Indigenous Diabetes Conference

2 Overview Introduction to the Regional Health Survey Burden of Diabetes Social determinants of health and modifiable risk factors Diabetes screening Treatment Health impacts Health care access

3 Vision: First Nations Information Governance Centre FNIGC envisions that every First Nation will achieve data sovereignty in alignment with their distinct worldview. Mission: We partner to strengthen First Nations data sovereignty and the development of governance and information management systems at the community level. We adhere to free, prior and informed consent, respect nation-to-nation relationships, and recognize the distinct customs of nations, to achieve transformative change.

4 Partnerships & Coordination National Regional First Nations Information Governance Centre Assembly of First Nations (Ex-Officio) Union of Nova Scotia Mi kmaq Union of New Brunswick Indians First Nation of Quebec and Labrador Health and Social Services Commission Chiefs of Ontario Nanaandawewigamig First Nations Health and Social Secretariat of Manitoba Federation of Sovereign Indigenous Nations (Saskatchewan) Albert First Nations Information Governance Centre Dene Nation Council of Yukon First Nations British Columbia First Nations Health Authority

5 First Nations Regional Health Survey (RHS) Represent all First Nations living on-reserve and northern communities Designed to collect information on health and well-being Provide First Nations with key information for program planning, policy & advocacy at subregional, regional and national levels

6 More than just another survey The RHS is a national survey under complete First- Nations control. Implemented in keeping with the First Nations principles of OCAP. Rooted in self-determination, nationhood, selfgovernance and nation re-building.

7 RHS Cultural Framework Sexual Health Practices Exercise & Nutrition Food Security Gambling Alcohol & Drugs Smoking Demographics Income, Employment & Education Health Care Access Housing Migration Social Economic REASON Health Behaviours/Lifestyle ACTION First Nations Health & Wellness RELATIONSHIPS Personal & Community Wellness and Culture VISION Physical Health Health Care Utilization Injuries Dental Care Activity Limitations Health Conditions Chronic Diseases Immunization Community Wellness Personal Wellness Language & Culture Residential Schools

8 Limitations of presentation Distinct cultures of our First Nations presented in aggregated statistics Represents only First Nations living on reserve and northern communities Self-reported diabetes Have you been told by a health care professional that you have diabetes? We are interested in "long-term conditions" which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional. Limitations of a cross-sectional survey can examine associations only and not the order of causation Lots of numbers Try to focus more on the story

9 % of FN adults living on reserves or northern communities 25% 20% 20.6% 20.6% Age-adjusted Diabetes Prevalence (18+ years) RHS 1 (2002/03) RHS 2 (2008/10) RHS 3 (2015/16) 19.2% 19.5% 18.5% 18.2% 21.7% 22.5% 20.1% 15% 10% 5% 0% Both Male Female Diabetes type 2 accounts for more than 90% of the diabetes diagnoses in 2015/2016. Age-standardized to the Canadian Population, using 5 year age groups and excluding missing categories

10 % of adults Age-adjusted Diabetes Prevalence (18+ years) 25% 20% 19.9% 18.0% 21.6% Age-standardized to the Canadian Population, using 5-year age groups and including gestational diabetes 15% 10% 12.9% 13.0% 13.0% 6.8% 7.8% 6.0% Both Male Female 5% 0% First Nations living on reserves and northern communities(1) First Nations off-reserve(2) Non-indigenous(2) (1) Source: First Nations Regional Health Survey (2008/10), FNIGC (missing categories are included in denominator for comparison purposes) (2) Pan - Canadian Health Inequalities Data Tool, 2017 Edition. A joint initiative of the Public Health Agency of Canada, the Pan - Canadian Public Health Network, Statistics Canada, and the Canadian Institute of Health Information. Source: Canadian Community Health Survey - Annual Component ( )

11 Average age at onset among First Nations adults: 37.8 years Gender Male: 38.0 Female: 37.7 Community Size* Large: 37.8 Medium: 37.3 Small: 40.9 (higher than medium) Highest education Under HS: 36.8 HS only: 37.5 PSE: 38.6 University and up: 37.4 Remoteness* Urban 38.9 Rural 36.2 (lower than urban and remote/special access) Remote/Special access: 40.1 Residential school* No: 36.3 Yes: 42.2 *Statistical significance, p<0.05

12 Labour force participation Education Crowded housing Food security Household Income (before tax) Remoteness Community size Sense of belonging Residential school attendance Cultural activities participation Language used most often in daily life Social determinants of health *Red text signifies an association exists with a diabetes diagnosis, but does not imply causation

13 Distribution of risk factors in the population (regardless of diabetes diagnosis) BMI: Underweight/normal (24.7%) Overweight or more (75.3%) Physical activity: Active (27.1%) vs. Moderately active (16.3%) vs. Inactive (56.6%) Currently smoking: No (46.5%) vs. Yes (53.5%) Frequency of nutritious balanced meals: Always/almost always (41.1%) vs. Sometimes/rarely/never (58.9%) *Red text signifies an association with a diabetes diagnosis

14 % of FN adults 90% 80% 70% 60% 50% 40% 30% 20% 10% 27% Have you had a blood sugar test? 43% 49% 61% 72% Screening 77% 73% 0% Age Group With increasing age group, the proportion of the population screened increases. However the question, asks whether the individual has ever had a blood sugar test and not necessarily the frequency or the last one performed

15 Diabetes and Pregnancy 16.9 % of women with diabetes were pregnant when first diagnosed Among women who were first diagnosed at pregnancy, 83.1% were told they had diabetes other than during pregnancy. Among children 0-11 years, almost 1 child out every 10 had a mother diagnosed with gestational diabetes during pregnancy of the child

16 % of pregnant women Screening pregnant women 90.0% 80.0% 81.4% 79.3% 85.6% 70.0% 60.0% 50.0% 40.0% 38.7% 35.7% 1st trimester 2nd trimester 30.0% 3rd trimester 20.0% 14.6 E 10.0% 0.0% Never had a blood sugar test in lifetime Visited doctor or nurse in past 12 months * *May not necessarily have visited health care professional during the pregnancy

17 Treatment or measure to manage diabetes 17 out of 20 people stated that their diabetes has prompted them to adopt a healthier lifestyle, which includes a good diet and/or exercise (85.3%)

18 Monitoring Diabetes- Frequency of checking blood sugar More than once a day 22.6% 24.9% Once a day times in the past two weeks 15.8% 5.9% 4.9% 25.9% 6-9 times in the past two weeks 2-5 times in the past two weeks Not at all in the past two weeks

19 Time between diagnosis and starting insulin 12.7% Less than 1 month 54.6% 4.2 E % 2.8% 3.1 E % 22.6% 1 month to less than 2 months 2 months to less than 6 months 6 months to less than 1 year 1 year or more Never

20 % of FN adults with diabetes Impact of Diabetes 35% 32.8% 30% 25% 20% 28.6% 26.3% 21.2% E High sampling variability, interpret with caution 15% 13.1% 11.4% 10% 5% 2.4 E % 0% Affect feeling in hands/feet (e.g. neuropathy) Affect vision (e.g retinopathy) Affect circulation (e.g. blood vessels/heart) Affect lower limbs Resulted in infections Affect kidney function Resulted in amputation Overall, 53% of First Nations adults with diabetes have experienced at least one of these complications.

21 Diabetes Education and Barriers More than half of First Nations adults with diabetes attend a diabetes clinic or see someone for diabetes education (59.2%) Among those who do not attend stated the following barriers: no longer required (have all information needed)- 53% chose not to attend % E diabetes clinic is not available in the area - 8.0% E does not fit my schedule 7.9% E insufficient information of where to go - 7.6% E diabetes health specialist is not available in the area - 5.7% E transportation costs 5.0% E Felt health service would be inadequate 2.1% E E High sampling variability, interpret with caution

22 Overall health care services* 14% of First Nations adults with diabetes do not have a primary health care provider 16% have a health care provider that has changed twice or more within the last 12 months Almost 9 in 10 visited a doctor or community health nurse in the past 12 months *may include health care services for conditions other than diabetes

23 Barriers to receiving health care* Waiting list too long Not covered by NIHB Did not know if it was covered by NIHB Felt health care provided was inadequate Could not afford direct cost of care/services Doctor or nurse is not available in my area Prior approval of NIHB was denied Service not available in my area Could not afford transpotation Difficulty in getting traditional care Unable to arrange transportation Health facility not available in my area Felt service was not culturally appropriate Chose not to see health care professional Cannot affort child care costs 5.1% 25.9% 23.7% 23.4% 22.9% 21.2% 20.9% 20.0% 19.3% 16.0% 14.4% 13.6% 12.7% 10.0% 30.3% 0% 5% 10% 15% 20% 25% 30% 35% % FN adults with diabetes that required care in the past 12 months *may include health care services for conditions other than diabetes

24 Difficulties accessing health services through NIHB program No difficulty 52.1% Not applicable (didn't need service or try to access) Medication Dental care Vision care Other medical supplies Tansportation servces or cost (air or road) Chiropractor Escort travel Hearing aid Ambulance service 13.2% 19.0% 17.8% 13.6% 8.3% E 8.1% 7.8% E 4.7% 2.3% E 1.5% E 0% 10% 20% 30% 40% 50% 60% % FN adults with diabetes *may include health care services for conditions other than diabetes E High sampling variability, interpret with caution

25 Traditional medicine 1 in 4 First Nations adults with diabetes have consulted a traditional healer in the past 12 months (27.2%) 56.4% have never consulted a traditional healer; 2 out of 5 First Nations adults with diabetes have used traditional medicine in the past 12 months (42.2%) *Traditional medicine can include herbal remedies, spiritual therapies, assistance from healers, or other practices indigenous to the First Nations culture. Consultation or medicine may not necessarily have been used specifically to treat diabetes.

26 Difficulties with accessing traditional medicine* % of FN adults with diabetes 0% 10% 20% 30% 40% 50% No difficulties accessing Not interested in using Do not know enough about it Do not know where to get it Not available in health care setting Too far to travel Not covered by NIHB Cannot afford it Restrictions/regulations Concerned about effects Child care 10.9% 8.0% 5.7% 5.4% E 4.7% 2.6% 1.3% E 1.2% E 0.8% E 28.8% 46.1% *may include traditional medicine for conditions other than diabetes E High sampling variability, interpret with caution

27 Home care services for people with diabetes % needing services 0% 5% 10% 15% 20% 25% % receiving (among those that needed services) 0% 20% 40% 60% 80% Home maintenance 23.2% Home maintenance 43.9% Light housekeeping 19.0% Light housekeeping 55.0% Running errands 11.9% Running errands 48.4% Care from a nurse 9.3% Care from a nurse 72.3% Meals prepared 8.7% Meals prepared 55.8% Paying bills 8.7% Paying bills 45.2% Personal care 7.3% E Personal care 41.7% E Long term care Palliative care 4.7% 1.2% E Long term care Palliative care F 39.9% E Almost 3 in 10 First Nations with diabetes have activity limitations due to a physical condition E High sampling variability, interpret with caution F Suppressed due to small cell size or extreme sampling variability

28 Wela lin! Maria Santos Program Manager, First Nations Data Centre