What is the comparative health status and associated risk factors for the Métis? A population-based study in Manitoba, Canada

<p>Abstract</p> <p>Background</p> <p>Métis are descendants of early 17^thcentury relationships between North American Indians and Europeans. This study's objectives were: (1) to compare the health status of the Métis people to all other residents of Manitoba, Canada; and (2) to analyze factors in predicting the likelihood of diabetes and related lower limb amputation.</p> <p>Methods</p> <p>Using de-identified administrative databases plus the Métis Population Database housed at the Manitoba Centre for Health Policy, age/sex-adjusted rates of mortality and disease were calculated for Métis (n = 73,016) and all other Manitobans (n = 1,104,672). Diseases included: hypertension, arthritis, diabetes, ischemic heart disease (age 19+); osteoporosis (age 50+); acute myocardial infarction (AMI) and stroke (age 40+); total respiratory morbidity (TRM, all ages). Using logistic regression, predictors of diabetes (2004/05-2006/07) and diabetes-related lower-limb amputations (2002/03-2006/07) were analyzed.</p> <p>Results</p> <p>Disease rates were higher for Métis compared to all others: premature mortality before age 75 (4.0 vs. 3.3 per 1000, p < .001); total mortality (9.7 vs. 8.4 per 1000, p < .001); injury mortality (0.58 vs. 0.51 per 1000, p < .03); Potential Years of Life Lost (64.6 vs. 54.6 per 1000, p < .001); all-cause 5-year mortality for people with diabetes (20.8% vs. 18.6%, p < .02); hypertension (27.9% vs. 24.8%, p < .001); arthritis (24.2% vs. 19.9%, p < .001), TRM (13.6% vs. 10.6%, p < .001); diabetes (11.8% vs. 8.8%, p < .001); diabetes-related lower limb amputation (24.1 vs. 16.2 per 1000, p < .001); ischemic heart disease (12.2% vs. 8.7%, p < .001); osteoporosis (12.2% vs. 12.3%, NS), dialysis initiation (0.46% vs. 0.34%, p < .001); AMI (5.4 vs. 4.3 per 1000, p < .001); stroke (3.6 vs. 2.9 per 1000, p < .001). Controlling for geography, age, sex, income, continuity of care and comorbidities, Métis were more likely to have diabetes (aOR = 1.29, 95% CI 1.25-1.34), but not diabetes-related lower limb amputation (aOR = 1.13, 95% CI 0.90-1.40, NS). Continuity of care was associated with decreased risk of amputation both provincially (aOR = 0.71, 95% CI 0.62-0.81) and for Métis alone (aOR = 0.62, 95% CI 0.40-0.96).</p> <p>Conclusion</p> <p>Despite universal healthcare, Métis' illness and mortality rates are mostly higher. Although elevated diabetes risk persists for the Métis even after adjusting for sociodemographic, healthcare and comorbidity variables, the risk of amputation for Métis appears more related to healthcare access rather than ethnicity.</p

Experiences of Red River Métis Accessing COVID Vaccines: A partnership-based, whole-population linked administrative data study.

Objectives Red River Métis are Indigenous people hailing from the Canadian Prairies who have historically experienced poor health outcomes due to colonial practices. Researchers from the Manitoba Métis Federation (MMF) partnered with health services researchers to test whether MMF-led COVID initiatives were associated with access to COVID-19 testing and vaccines. Approach We linked the Métis Population Data-Base from the MMF (to identify Red River Métis) with whole-population COVID testing and vaccination data and health and social services administrative data (for information on sociodemographics and confounders) to complete this retrospective cohort study. We used restricted mean survival time models to test whether COVID-19 vaccination differed between Métis and all other Manitobans (AOM); models adjusted for demographics, comorbidities, and other characteristics (age, socioeconomic status, urbanicity, and mental health status). Data were stratified by sex and subsequent effect modification analyses tested whether associations differed by sex and physical health comorbidities. Results COVID testing rates were lower during the first year of the pandemic among Métis than among AOM. During the second year of the pandemic, this finding was reversed - Métis accessed tests at higher rates. There was no difference between Métis and AOM in accessing first vaccine doses before implementation of MMF-led initiatives. After initiatives were put in place, Métis received their second COVID vaccine, on average, 1.3 (95% CI 1.9-0.6) days sooner than AOM, after adjusting for confounders. Effect modification analyses showed this relationship was concentrated among females – female Métis received their second vaccine 1.7 (2.6-0.8) days sooner than female AOM; differences were non-significant for males. Métis with 2+ comorbidities received their vaccine second 2.9 (5.3-0.5) days sooner than AOM with 2+ comorbidities. Conclusion Public health initiatives prioritizing Métis for vaccines improved uptake. Initiatives led by Métis to improve COVID outcomes were critical to supporting Métis during the course of the pandemic. Public health response efforts need to operate from a standpoint that honours Indigenous sovereignty in their design and implementation

Living well: understanding the experience of diabetes and cardiovascular disease in First Nations peoples

Bibliography: p. 234-252In the past fifty years, rates of Type 2 diabetes and cardiovascular disease (CVD) have escalated in the First Nations population until they have become the most prevalent chronic diseases in that population (Young et al., 1999). The biophysiologic processes of Type 2 diabetes and CVD are well documented. However, the experiences of First Nations Peoples living with these diseases have not been well investigated. Understanding how the First Nations Peoples 'live well' with these diseases may provide some direction to health care providers in assisting prevention efforts. This ethnographic study focused on First Nations People from the Opaskwayak Cree Nation in northern Manitoba. Fifteen participants (eight men, seven women) engaged in semi-structured interviews which were audio recorded, transcribed, and analyzed using an inductive and reflexive process. Analysis focused on culturally embedded attitudes and practices that allowed First Nations participants to 'live well' with Type 2 diabetes and CVD. 'Living well' was defined by the participants as being more than physical adaptation; it encompassed balancing and maintaining the emotional, spiritual, and environmental aspects of their lives. The investigation provided an opportunity for the participants' voices to be heard. By listening to these voices, I was able to identify the factors which enabled the Opaskwayak Cree Nation People to 'live well' with Type 2 diabetes and CVD. Considering these factors led to the development of a holistic model which can be used to guide practice and further research. For the participants in this study, culturally based spiritual beliefs, supportive families, and mutually respectful relationships with health care providers enabled them to 'live well' with Type 2 diabetes and CVD. This information can assist health care providers and policy makers to develop services that support the First Nations People's ability to 'live well' when faced with chronic illness

Men and women managing coronary artery disease risk: Urban-rural contrasts

People's beliefs about health and making lifestyle changes associated with risk reduction and disease prevention can vary based on their gender and ethnocultural affiliation. Our objective was to describe and explain how gender and ethnocultural affiliation influence the process that people undergo when faced with making lifestyle changes related to their coronary artery disease (CAD) risk. A series of grounded theory studies were undertaken in Alberta, Canada, with men and women from five ethnocultural groups diagnosed with CAD. Here, we describe the cultural aspects associated with urban- and rural-living in 42 Euro-Celtic men and women. Data were collected through semi-structured, audio-recorded interviews and analysed using constant comparative methods. The core variable that emerged through the process was 'meeting the challenge'. There were three phases to the process of managing CAD risk: pre-diagnosis/event, liminal self, and living with CAD. Intra-personal, inter-personal, extra-personal, and socio-demographic factors influenced the participants' capacity to meet the challenge of managing their CAD risk. The influence of these factors was either direct or indirect through the intertwined elements of the participants' knowledge about CAD and perceived extent of necessary change. Each element of this process was influenced by the participants' gender and culture (urban- versus rural-living). When healthcare providers understand and work with the gender- and ethnoculturally based components that influence people's appraisal of their cardiac health and their decision-making, appropriate secondary prevention interventions and positive health outcomes are more likely to follow.Urban-rural living Gender Coronary artery disease Secondary prevention Grounded theory Canada

We’re here too: child health information-seeking experiences and preferences of Red River Métis families – a qualitative study

Abstract Background Red River Métis families need access to meaningful and appropriate resources when their children are sick. At the invitation of the Manitoba Métis Federation (MMF) to partner in this research, our aim was to understand Red River Métis parents’ experiences and preferences for seeking child health information when their child is acutely ill, to inform the adaptation of existing parent resources. Methods A qualitative descriptive approach underpinned by a participatory paradigm guided this study. Semi-structured interviews were conducted with 19 Red River Métis parents and Elders via Zoom or telephone. An inductive thematic analysis approach was used to explore patterns and themes across the data. Results Analysis generated four themes: (1) We’re here too; (2) We are not all the same; (3) Finding trustworthy information; and (4) Information needs to be widely available. Red River Métis pride was prominent in the results. Parents provided tangible ways to modify existing parent resources, including adding information on how to access Elders, healers and/or traditional medicines and showing different family structures, transport, living situations, Métis names, and incorporating Métis languages. While most parents reported looking for child health information online, they also stressed the need to provide multiple options, including information sheets, recognizing that parents seek information in different contexts. Parents also emphasized the importance of accessible, safe spaces to find child health information, including local schools, community centres, healthcare organizations and the MMF. Conclusion There is a lack of child health information created specifically for Red River Métis families. The development of this information can support their information needs and preferences and the ongoing efforts to revitalize Red River Métis culture and language. Study findings will inform the adaptation and dissemination of existing child health resources to ensure they reflect Red River Métis parents’ information needs and preferences. This research is a critical step in addressing an identified need for Red River Métis families to have culturally relevant and meaningful child health resources, and in the pursuit of equitable care for all children in Canada. Trial Registration N/A

Food Behaviours and Health Indicators in Manitoba Adolescents and Relation to the Healthy Eating Index

Adolescence is a vital period of growth and development, both of which are dependent on adequate nutrition; however, concerns persist about poor nutrition and inappropriate food behaviours. In addition to nutrition assessment, the context of food and health behaviour is necessary to understand how dietary choices are shaped and related to diet quality. This study describes food-related behaviours and health indicators associated with dietary quality among adolescents in Manitoba, Canada. A stratified two-stage sampling method was used to collect data on the diet, food behaviours and health indicators of 1587 grade nine students. Diet quality was analysed using the Healthy Eating Index-Canada. Several food behaviours and health indicators varied by gender and school region (urban, rural, northern). The Independent Samples t-test and one-way ANOVA (analysis of variance) assessed differences between groups on the Healthy Eating Index-Canada. Higher Healthy Eating Index-Canada scores were found for those eating family dinners more frequently; consuming breakfast and lunch more frequently; consuming breakfast at home; eating lunch and morning snacks at school; purchasing fewer meals and snacks from cafeterias and vending machines; believing that food and nutrition education is important; not attempting to lose weight; being classified as &lsquo;healthy weight&rsquo;; and getting more sleep. Many Manitoba youth are exhibiting food and health behaviours that increase their risk of having a poor diet

First Nations and Metis peoples’ access and equity challenges with early childhood oral health: a qualitative study

Abstract Background Inequities in early childhood oral health are evident amongst Indigenous peoples and communities in Manitoba, Canada. Early childhood caries (ECC) is decay in primary dentition in children under 6 years of age. A severe form of the disease occurs at a higher rate in Indigenous populations compared to the general population. ECC has been strongly associated with social determinants of health. Methods Focus groups and sharing circles were conducted with four First Nations and Metis communities in urban and rural communities in Manitoba. There were eight groups in total of purposively sampled participants (n = 59). A grounded theory approach guided thematic analysis of audio recorded and transcribed data. Results Indigenous participants experienced challenges similar to those found in the general population, such as encouraging and motivating parents and caregivers to establish regular oral hygiene routines for their children. However other challenges reported, disproportionately affect Indigenous communities. These include poor access to dental care, specifically no dental offices within 1 h driving radius and not having transportation to get there. Not having evidence-based oral health information to support good oral hygiene practices, preventing parents from making the best choices of oral hygiene products and oral health behaviours for their children. Poverty and food insecurity resulting in poor nutritional choices and leading to ECC. For example, feeding children sugary foods and beverages because those are more readily avialble than healthy options. Confusing or difficult encounters with dental professionals, highlighted as a factor that can erode trust, reduce compliance and impact continued attendance at dental offices. Conclusion Closing existing early childhood oral health gaps for First Nations and Metis peoples and communities requires equity-oriented healthcare approaches to address specific problems and challenges faced by these populations. Family, community and systemic level interventions that directly implement community recommendations are needed

Does Participation in Full-Time Kindergarten Improve Metis Students’ School Outcomes? A Longitudinal Population-Based Study from Manitoba, Canada

As a result of the colonization of Canada, Metis have faced many political and socioeconomic challenges, one of which is the lower educational achievement of Metis students vs other Canadian students. In this study, we examined whether full-time kindergarten (FTK) vs half-time kindergarten (HTK) was associated with improved educational outcomes for Metis students in Manitoba using linked, population-based administrative data from 1998/99-2012/13. The cohort included 271 FTK and 405 HTK Metis students. We used generalized linear models with binomial distribution to calculate predicted probabilities and risk ratios for the outcomes (assessments of numeracy and literacy in Grades 3, 7 and 8; student engagement in Grade 7; high school graduation). However, we observed no significant differences in outcomes between FTK and HTK students, suggesting that FTK is not sufficient to overcome the structural barriers to academic success Metis students may face

Does Participation in Full-Time Kindergarten Improve Metis Students’ School Outcomes? A Longitudinal Population-Based Study from Manitoba, Canada

This study, a partnership between &lt;Organization 1&gt; and &lt;Organization 2&gt;, investigated whether attending full-time kindergarten (FTK) was associated with better educational outcomes for Metis students in Manitoba, who may face unique barriers to academic success. We utilized linked administrative data from the Manitoba Population Research Data Repository. For each measured education outcome, there were no significant differences in how Metis students who attended FTK vs Metis students who attended half-time kindergarten (HTK) performed. FTK does not provide sufficient support to Metis students to overcome the structural barriers to academic success they may face. It is likely that an upstream approach to addressing the structural barriers is needed to support improved outcomes in this population

Understanding Manitoba Inuit’s Social Programs Utilization and Needs: Methodological Innovations

Manitoba is home to approximately 1,500 Inuit, and sees 16,000 consults yearly from the Kivalliq region of Nunavut to access services. The purpose of our study was to develop detailed profiles of Inuit accessing services in Manitoba, by using administrative data routinely collected by Manitoban agencies, to support the development of Inuit-centric services. This study was conducted in partnership with the Manitoba Inuit Association, and Inuit Elders from Nunavut and Manitoba. Findings shows that the Inuit community living in Manitoba is fairly stable, with only approximately 5 percent of Inuit moving in and out of Manitoba on any given year. Inuit settle primarily in Winnipeg, and a significant proportion depend on social programs such as Income Assistance and housing support. A significant number of Inuit children have contact with the Child Welfare System. Our results support the need for more Inuit-centric programming, including family support and language programs