Linking First Nations data to administrative health data within Manitoba

Introduction First Nation peoples (FNs) were unable to track their own health care trends due to limitations in datasets. The key linked file enables FNs to identify themselves within administrative datasets and work with Crown governments to bring equity in all services and departments to support FNs understanding of wellness. Objectives and Approach First Nations Health and Social Secretariat of Manitoba (FNHSSM) was established by 2013 resolution of Assembly of Manitoba Chiefs (AMC) and incorporated in 2014. FNHSSM leads and supports research according to FNs criteria approved by the Chiefs in Assembly. Information Sharing Agreements (ISA) have been developed with federal and provincial governments to mandate the processes for data linkage. The ISA allows Indian Status Register (ISR) data of Department of Indigenous Services Canada (DISC) to be transferred to FNHSSM to provide oversight, and link to Provincial Personal Health Information Numbers (PHINs) to create the de-identified, scrambled, and encrypted Key Linked file. Results Previous linkages were done in early 2000s with FNs approval and oversight. The 2018 linkage is the first time that ISAs have been formally developed. ISA-1 is between FNHSSM and Manitoba Health Seniors and Active Living (MHSAL) to create Key Linked file. ISA-2 is between FNHSSM, MHSAL and Manitoba Centre for Health Policy (MCHP) at University of Manitoba, to create the FNs Research File. This research file can only be accessed with application to and approval by the MFNs Health Information Research Governance Committee. This key linked file allows FNHSSM to prepare community health profiles specifically and only for each FN, to respect FNs Data Governance under Chief and Council. A regional report on Manitoba FNs will be created for all MFNs, FNHSSM and MHSAL. Conclusion/Implications Linking datasets helps to strengthen FNs data governance in re-building nations, recognizing FNs inherent right to self-determination. Linking files help to provide meaningful data to advocate for FNs rights and access to the resources and social determinants of health needed to achieve equity in Manitoba

Our Children, Our Future: The Health and Well-being of First Nations Children in Manitoba, Canada.

Objectives Given the impact of colonization and responding to Canada’s Truth and Reconciliation Commission, we aimed to provide baseline measures of First Nations children’s health and social outcomes in Manitoba, Canada. We also aimed to create a research process where Indigenous and non-Indigenous researchers work collaboratively and in culturally safe ways. Approach We formed a team consisting of members of First Nation organizations and academic researchers.  Knowledge Keepers from Anishinaabe, Cree, Anishininew, Dakota and Dene Nations guided the study, interpreted results and ensured meaningful knowledge translation.  This retrospective cohort study utilized population-based health, social services, education and justice administrative data that allowed de-identified individual-level linkages across all databases through a scrambled health number.  Adjusted rates and rate ratios were calculated using a generalized liner modeling approach to compare First Nations children (n=61,726) and all other Manitoba children (n=279,087) and comparing First Nations children living on and off-reserve. Results Large disparities between First Nations and other Manitoba children were found in birth outcomes, physical and mental health, health services, education, social services, justice system involvement and mortality. First Nations infants had higher rates of preterm births, large-for-gestational-age births, newborn readmissions to hospital and lower rates of breastfeeding initiation compared with other Manitoba infants. Suicide rates among First Nations adolescents were ten times higher than among other adolescents in Manitoba, yet we found few differences in diagnosis of mood and anxiety disorders between the groups. First Nations children were also seven times more likely to apprehended by child protection services and youth were ten times more likely to be criminally accused.  Knowledge Keepers offered their perspectives on these findings. Conclusion These findings demonstrate that an enormous amount of work is required in virtually every area – health, social, education and justice – to improve First Nations children’s lives. There is an urgent need for equitable access to services, and these services should be self-determined, planned and implemented by First Nations people

Documenting First Nations Access to COVID Vaccines: A whole-population linked administrative data study.

Objectives First Nations (FN) organizations worked with public health and governments to improve FN access to COVID-19 vaccines by prioritizing FN communities in vaccination initiatives. FN researchers and data scientists partnered to test whether these efforts were associated with increased access to COVID-19 vaccines among FN compared with all other Manitobans. Approach This retrospective cohort study linked whole-population administrative data from (i) the First Nations research file, (ii) COVID testing and vaccination data, and (iii) health and social services for sociodemographic data and information on potential confounders. Several public health policies were created to improve access to COVID vaccines among FN; we tested whether FN received their 1st and 2nd vaccines sooner than all other Manitobans (AOM) using restricted mean survival time models. We adjusted for sociodemographic characteristics, comorbidities, and whether FN lived on- or off-reserve. We conducted sex-specific and effect modification analyses to test whether associations differed by sex. Results Prioritizing FN to receive vaccines was associated with increased vaccine uptake compared with AOM. After adjusting for various confounders, FN received their first dose 15.5 (95% CI 14.9 – 16.0) days sooner than AOM and their second dose 13.9 (13.3 – 14.5) days sooner than AOM. Sex-stratified and subsequent effect modification analyses using interaction terms, found that differences were greater for males than for females: FN males received their first dose 18.1 (17.3 – 18.8) days sooner than AOM males and FN females received their first dose 12.9 (12.2 – 13.7) days sooner than AOM females. This pattern held for second doses as well. FN with comorbidities also received vaccines sooner than AOM with similar comorbidity levels 20.9 days (23.1 – 18.8) among those with 3+ comorbidities. Conclusion Partnerships between public health entities and FN organizations that respect FN community sovereignty were instrumental in supporting FN health and well-being during COVID-19. Policies and programs that prioritized FN people for vaccines improved uptake saving lives. This partnership-based COVID-19 response can provide a framework for future public health efforts

Prevalence and risk factors of caregiver reported Severe Early Childhood Caries in Manitoba First Nations children: results from the RHS Phase 2 (2008–2010)

Objectives. The high prevalence and severity of caries among Canadian First Nations children is a growing concern. Dental surgery in hospital is often necessary to treat the signs of decay but does not address the underlying factors contributing to its development. The purpose of this study was to determine the prevalence and risk factors of caregiver-reported Baby Bottle Tooth Decay (BBTD), or Severe Early Childhood Caries (S-ECC), among preschool children recruited in Phase 2 of the First Nations Regional Longitudinal Health Survey (RHS). Study Design. Cross-sectional study including interviews with caregivers. Methods. This study was limited to data from Manitoba First Nations participating in the RHS Phase 2 (2008–10). Data were restricted to caregiver interviews for their child <72 months of age. The main variable of interest was caregiver-reported BBTD, an antecedent term for S-ECC. Data analysis included descriptive statistics and bivariate analyses; p≤0.05 was significant. Results. Overall, caregivers of 431 preschool children responded. According to caregiver reports, 102/410 (24.9%) children had S-ECC. Further, 65.0% responded that their child had already undergone treatment for caries. Children with S-ECC were significantly older than those without. S-ECC was also associated with paternal education levels and employment status, and maternal smoking during pregnancy. Breastfed children were less likely to have S-ECC, while consuming drink crystal beverages in bottles, and daily intake of soft drinks, juice, sweets and fast food were associated with increased risk. Those who reported that healthcare services were not available and were not culturally appropriate were significantly more likely to have children with S-ECC. Conclusions. Caregiver reports suggest that nearly 1 in every 4 children has been affected by S-ECC. Identified risk factors for Manitoba First Nations children included age, education and employment, dietary practices, access to care, and disruption to family and culture. This local evidence can be used to help inform future caries prevention activities in these Manitoba communities

Children’s Oral Health Initiative: workers’ perspectives on its impact in First Nations communities

IntroductionSince 2004, the Children’s Oral Health Initiative (COHI) has been working in many First Nations and Inuit communities in Canada to address oral health disparities, specifically early childhood caries (ECC). The COHI community-based approach improves early childhood oral health (ECOH) by balancing prevention with minimally invasive dentistry. The goal is to reduce the burden of oral disease, mainly by minimizing the need for surgery. We investigated program success in First Nations communities in the province of Manitoba, from the perspective of COHI staff. MethodsFirst Nations community-based dental therapists and dental worker aides participated in three focus groups and an in-depth semistructured interview. The collected data were thematically analyzed. ResultsData from 22 participants yielded converging and practitioner-specific themes. Participants reported that dental therapists and dental worker aides provide access to basic oral care in their communities including oral health assessments, teeth cleaning, fluoride varnish applications and sealants. The participants agreed that education, information sharing and culturally appropriate parental engagement are crucial for continuous support and capacity building in the community programs. Low enrolment, difficulty accessing homes and getting consent, limited human resources as well as lack of educational opportunities for dental worker aides were identified challenges. ConclusionOverall, the participants reported that the COHI program positively contributes to ECOH in First Nations communities. However, increased community-based training for dental workers, community awareness about the program, and engagement of parents to facilitate culturally appropriate programming and consent processes are critical to improving program outcomes

Initiative en santé buccodentaire des enfants : le point de vue des intervenants quant à ses effets dans les communautés des Premières Nations

IntroductionDepuis 2004, l’équipe de l’Initiative en santé buccodentaire des enfants (ISBE) oeuvre dans de nombreuses communautés inuites et des Premières Nations du Canada à remédier aux disparités en matière de santé buccodentaire, en particulier en ce qui concerne la carie de la petite enfance. Alliant prévention et dentisterie peu invasive, l’approche communautaire de l’ISBE améliore la santé buccodentaire dans la petite enfance. Le programme a pour but de réduire le plus possible le fardeau de la maladie buccodentaire, en particulier d’éviter les opérations chirurgicales. Nous avons étudié les résultats du programme au sein des communautés des Premières Nations du Manitoba du point de vue du personnel de l’ISBE. MéthodologieDes thérapeutes dentaires et des aides dentaires oeuvrant dans des communautés des Premières Nations ont participé à trois groupes de discussion et à une entrevue semi-structurée approfondie. Les données rassemblées ont été analysées par thème. RésultatsDes thèmes convergents propres aux professionnels des soins dentaires sont ressortis des données obtenues auprès de 22 participants. Les participants ont indiqué que les thérapeutes dentaires et les aides dentaires offrent un accès à des soins buccodentaires de base dans les communautés : l’évaluation de la santé buccodentaire, le nettoyage des dents, l’application de vernis fluoré et la pose d’agents de scellement. Les participants étaient d’accord pour affirmer que l’éducation, l’information et des relations culturellement appropriées avec les parents sont cruciales pour la prestation d’un soutien continu et le renforcement des capacités au sein des programmes communautaires. Parmi les défis mentionnés, il y a le peu d’inscriptions au programme, les difficultés d’accès aux domiciles et d’obtention du consentement, le manque de ressources humaines et l’insuffisance des occasions d’apprentissage offertes aux aides dentaires. ConclusionDans l’ensemble, les participants ont indiqué que l’ISBE contribuait favorablement à la santé buccodentaire dans la petite enfance au sein des communautés des Premières Nations. Cependant, une offre accrue en matière de formation du personnel dentaire au sein des communautés, le fait que les membres des communautés soient au courant de l’existence du programme et la participation des parents en vue de processus de prestation et de consentement culturellement appropriés seraient essentiels à l’amélioration des résultats du programme

COVID-19 diagnostic testing and vaccinations among First Nations in Manitoba: A nations-based retrospective cohort study using linked administrative data, 2020-2021.

BackgroundDifferential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM).Methods and findingsIn this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms.ConclusionIn this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada