2012 (Feb 8-10) Integrated Chronic Disease Prevention: It Works! CDPAC Fourth Pan-Canadian Conference , presentation by Richard Oster (BRAID Research)

1. TRACKING RATES OF DIABETES
AMONGST STATUS ABORIGINAL
AND GENERAL POPULATION
YOUTH IN ALBERTA, CANADA
Richard Oster
PhD Candidate
University of Alberta
CDPAC, Ottawa
February 8th 2012

2. OUTLINE
 Background
 Methods
 Results
 Summary

3. BACKGROUND

4. Introduction
Background
Methods
Results CANADA’S ABORIGINAL PEOPLES
Summary
 First Nations and Canada Alberta
Inuit (‘status’ and
‘non‐status’), as well
First 696 310 97 130
as Métis Nations
 3.8% of total
Inuit 50 340 1 600
population
 The contemporary
Métis 388 465 85 240
Aboriginal
population is young,
growing and Total 1 135 115 183 970
urbanizing Adapted from Statistics Canada, 2006

5. Introduction
Background
Methods
Results DIABETES IN STATUS ABORIGINALS
Summary
 Rapid emergence of type 2 diabetes
 Prevalence 2‐5 times higher
 Females have higher prevalence, but gap
may be closing

6. Introduction
Background Prevalence and incidence of diabetes among
Methods
people aged 20 years or more in Alberta
Results
Summary
Oster et al, 2011

7. Introduction
Background
Methods
Results DIABETES IN STATUS ABORIGINALS
Summary
 Perhaps more alarming are reports of
increasing obesity and emerging type 2
diabetes in Aboriginal youth
 Those with early‐onset type 2 diabetes
experience a longer duration of disease and
thus have an increased risk of developing
complications

8. Introduction
Background Age‐specific diabetes incident case counts and
Methods incidence by period in Saskatchewan
Results
Summary
Dyck et al, 2010

9. Introduction
Background
Methods
Results Type 2 diabetes incidence from a tertiary care
Summary pediatric Diabetes Education Centre in
Manitoba
Dean et al, 2003

10. Introduction
Background
Methods
Results
Summary
Clinical, metabolic, behavioral, and sociodemographic
risk factors for chronic complications among Navajo
youth with type 2 diabetes
Variable Clinical type 2 diabetes
N 66
% with A1c > 9.5 43.3%
% with waist circumference > 90th 82.5%
percentile
% with hypertension 35.5%
% with hypertriglyceridemia 74.1%
% with low HDL 41.1%
% with microalbuminuria 31.5%
Adapted from Dabelea et al, 2009

11. Introduction
Background
Methods
Results IN ALBERTA?
Summary
 The epidemiology of diabetes
in Aboriginal youth has not
been explored in Alberta
 The Alberta Diabetes
Surveillance System (ADSS)
includes administrative data on
youth
 OBJECTIVE: To track and compare
trends in diabetes rates from 1995 to
2007 for Status Aboriginal and general
population youth

12. METHODS

13. Introduction
Background
Methods
Results DATA SOURCE
Summary
 Data from 1995‐2007 for youth (< 20 years)
was obtained: physician claims, vital
statistics, hospital discharge data
 Diabetes cases were identified using the
National Diabetes Surveillance System
algorithm
 Does not differentiate between type 1 and type
2 diabetes
 The Status Aboriginal identifier captures
First Nations and Inuit peoples both on‐ and
off‐reserve with Treaty status

14. Introduction
Background
Methods
Results DATA ANALYSES
Summary
 Crude annual diabetes prevalence and
incidence rates by ethnicity
 Odds ratios (OR) were calculated to
compare the likelihood of being a prevalent
case and incident case of diabetes for the
two populations in 2007
 Average Annual Percent Changes (AAPC) in
prevalence and incidence from 1995 to 2007
were determined and compared

15. RESULTS

16. Introduction
Background
Methods
Results CRUDE DIABETES RATES, 2007
Summary
Crude diabetes prevalence and incidence among Status Aboriginal and general
population youth, 2007
Odds ratio
Status Aboriginal General population (95% CI)
Prevalence rate (per
100)
Combined 0.27 0.31 0.90 (0.76, 1.07)
Females 0.31 0.30 1.02 (0.81, 1.29)
Males 0.25 0.31 0.79 (0.61, 1.01)
Incidence rate (per
1000)
Combined 0.59 0.49 1.21 (0.83, 1.75)
Female 0.56 0.49 1.15 (0.67, 1.98)
Males 0.61 0.49 1.26 (0.76, 2.10)

17. Introduction
Background
Methods
Results CRUDE PREVALENCE OVER TIME
Summary
0.35
Status Aboriginal
0.3 General population
0.25
Rate per 100
0.2
0.15
0.1
0.05
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year

18. Introduction
Background
Methods
Results CRUDE INCIDENCE OVER TIME
Summary
0.9
0.8 Status Aboriginal
General population
0.7
0.6
Rate per 1000
0.5
0.4
0.3
0.2
0.1
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year

19. Introduction
Background
Methods
Results ETHNICITY COMPARISONS OVER TIME
Summary
Ethnicity comparisons of AAPC (Average annual percent change) in diabetes
prevalence and incidence among Status Aboriginal and general population
youth, 1995- 2007
AAPC Status Aboriginal AAPC General population
Prevalence
Combined 6.98*† 3.93*
Female 5.70*†§ 3.70*§
Male 9.18*† 4.15*
Incidence
Combined 8.92* 4.01*
Female 6.18*§ 3.36*§
Male 11.65*† 4.62*
* p < 0.05 for AAPC
† p < 0.05 for AAPC ethnicity comparison
§ p < 0.05 for AAPC sex comparison

20. SUMMARY

21. Introduction
Background
Methods
Results TAKE HOME MESSAGES
Summary
 Diabetes prevalence and incidence has
increased among all Alberta youth
 Status Aboriginal youth, males in particular,
experienced a disproportionate growth in
diabetes
 If unabated, increasing diabetes in youth
will likely only further perpetuate the
diabetes epidemic in the Status Aboriginal
population

22. Introduction
Background
Methods
Results ACKNOWLEDGEMENTS
Summary
 Dr. Ellen Toth
 Sheri Pohar
 ADSS
 Dr. Jeff Johnson
 Stephanie Balko
 Greg Hugel
 Alberta Health and Wellness
 Larry Svenson

23. Introduction
Background
Methods
Results REFERENCES
Summary
 Dean HJ et al. Can J Diabetes. 2003;27(4):449‐54.
 Dabelea D et al. Diabetes Care. 2009;32(Suppl
2):S141‐7.
 Dyck R et al. CMAJ. 2010;182(3):249‐56.
 Oster RT et a l. CMAJ. 2011;183(12):E803‐8.
 Statistics Canada. 2006. Available online at:
http://www12.statcan.gc.ca/census‐
recensement/2006/as‐sa/97‐558/index‐eng.cfm

24. Introduction
Background
Methods
Results QUESTIONS
Summary
Richard Oster
roster@ualberta.ca
www.braiddm.ca