Peripheral arterial disease in Ontario First Nations people with diabetes: a longitudinal population-based cohort study

Shah, Baiju R.; Frymire, Eliot; Jacklin, Kristen; Jones, Carmen; Khan, Shahriar; Slater, Morgan; Walker, Jennifer; Green, Michael E.

doi:10.9778/cmajo.20190162

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…Notwithstanding the difference in the overall LA rates between the two populations (RI and GP), individuals aged 50+ years in both populations had higher rates of LA than those aged 0-49 years. These findings are consistent with those reported in Alberta with LA cases increasing with age, and 47% of LA cases in both RI and GP populations occurred in those aged 65-84 years [35]. Within the age groups, RI were more likely to have LA than GP with RI individuals 0-49 years of age 2.04 times more likely as GP to have LA and RI individuals 50+ years of age 5.33 times more likely as GP to have LA.…”

Section: Discussionsupporting

confidence: 91%

“…Our finding that the rate of LA among Saskatchewan RI is 1.7 times higher than GP are supported by observations of LA in RI populations related to diabetes in other Canadian provinces [35][36][37]. Shah et al (2019) examined Ontarians with diabetes and found a 3-5 times higher risk of lower extremity amputation (LEA) in RI than GP populations [35]. Similarly, a study in Alberta found a 3 times higher average age-adjusted rate of LEA in First Nations than Non-First Nations populations with diabetes [36].…”

Section: Discussionsupporting

confidence: 86%

“…Our finding that the rate of LA among Saskatchewan RI is 1.7 times higher than GP are supported by observations of LA in RI populations related to diabetes in other Canadian provinces [ 35 – 37 ]. Shah et al (2019) examined Ontarians with diabetes and found a 3–5 times higher risk of lower extremity amputation (LEA) in RI than GP populations [ 35 ].…”

Section: Discussionsupporting

confidence: 85%

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Incidence and trends of limb amputation in first nations and general population in Saskatchewan, 2006–2019

Essien

Linassi

Larocque³

et al. 2021

PLoS ONE

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Background There is conflicting evidence whether limb amputation (LA) disproportionately affects indigenous populations. To better understand this disparity, we compared the LA incidence rate between First Nations persons registered under the Indian Act of Canada (RI) and the general population (GP) in Saskatchewan. Methods We used Saskatchewan’s retrospective administrative data containing hospital discharge LA cases, demographic characteristics (age and sex), and residents population reported in the database stratified by RI and GP from 2006–2019. The LA cases for each stratified group were first disaggregated into three broad categories: overall LA (all reported LA), primary LA (first reported LA), and subsequent LA (revision or contralateral LA), with each category further split into the level of amputation defined as major amputation (through/above the ankle/wrist joint) and minor amputation (below the ankle/wrist joint). LA rates were calculated using LA cases as the numerator and resident population as the denominator. Joinpoint and negative binomial regressions were performed to explore the trends further. Results Overall, there were 1347 RI and 4520 GP LA cases reported in Saskatchewan from 2006–2019. Primary LA made up approximately 64.5% (869) of RI and 74.5% (3369) of GP cases, while subsequent LA constituted 35.5% (478) of RI and 25.5% (1151) of GP cases. The average age-adjusted LA rate was 153.9 ± 17.3 per 100,000 in the RI cohort and 31.1 ± 2.3 per 100,000 in the GP cohort. Overall and primary LA rates for the GP Group declined 0.7% and 1.0%, while subsequent LA increased 0.1%. An increased LA rate for all categories (overall 4.9%, primary 5.1%, and subsequent 4.6%) was identified in the RI group. Overall, minor and major LA increased by 6.2% and 3.3%, respectively, in the RI group compared to a 0.8% rise in minor LA and a 6.3% decline in major LA in the GP group. RI females and males were 1.98–1.66 times higher risk of LA than their GP counterparts likewise, RI aged 0–49 years and 50+ years were 2.04–5.33 times higher risk of LA than their GP cohort. Diabetes mellitus (DM) was the most prevalent amputation predisposing factor in both groups with 81.5% of RI and 54.1% of GP diagnosed with DM. Also, the highest proportion of LA was found in the lowest income quintile for both groups (68.7% for RI and 45.3% for GP). Conclusion Saskatchewan’s indigenous individuals, specifically First Nations persons registered under the Indian Act of Canada, experience LA at a higher rate than the general population. This disparity exists for all variables examined, including overall, primary, and subsequent LA rates, level of amputation, sex, and age. Amplification of the disparities will continue if the rates of change maintain their current trajectories. These results underscore the need for a better understanding of underlying causes to develop a targeted intervention in these groups.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

“…Our finding that the rate of LA among Saskatchewan RI is 1.7 times higher than GP are supported by observations of LA in RI populations related to diabetes in other Canadian provinces [ 35 – 37 ]. Shah et al (2019) examined Ontarians with diabetes and found a 3–5 times higher risk of lower extremity amputation (LEA) in RI than GP populations [ 35 ].…”

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Incidence and trends of limb amputation in first nations and general population in Saskatchewan, 2006–2019

Essien

Linassi

Larocque³

et al. 2021

PLoS ONE

View full text Add to dashboard Cite

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“…Because the OLIS data were acquired at ICES during the present study, we were unable to perform any longitudinal analysis of the links between the levels of glycemic control we observed and the high rates of complications reported in our other papers. [8][9][10][11][12] However, it is highly likely that HbA 1c level sare an important driver of the observed differences in outcomes, given the well-known strong association between glycemic control and complications of diabetes. Leiter and colleagues 47 highlighted the difficulties in achieving glycemic control in their recent report combining results from the Diabetes Mellitus Assessment of Clinical Management in Ontario (DM-ACTION) and Diabetes Mellitus Improving Patient Care in Our Communities (DM-IMPACT) studies.…”

Section: Discussionmentioning

confidence: 99%

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Green¹,

Shah²,

Slater³

et al. 2020

CMAJ

Self Cite

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D iabetes and its related complications are major contributors to morbidity and mortality worldwide. 1-3 Indigenous populations in Canada and around the world are disproportionately affected by diabetes owing to the complex relations among colonization, social disadvantage, stress, trauma and metabolic health. 4-7 In addition to our own work showing persistently higher rates of peripheral vascular disease, stroke, cardiac disease, renal dysfunction and ophthalmologic complications in Ontario First Nations, 8-12 other Canadian and international studies also showed higher complication rates in diverse Indigenous populations. 6,7,13-15 Glycemic control is fundamental to the management of diabetes and the prevention of complications. 16 Glycated hemoglobin (A 1c) is a reliable way to estimate the average level of glucose in the blood. 17 Since A 1c levels higher than 7.0% have been associated with an increased risk of microvascular complications, 18-20 treatment guidelines suggest A 1c should be measured every 3-6 months to ensure that glycemic goals are being met or maintained. 21 Since people with diabetes also have an elevated risk for cardiovascular disease, 22-24 management and control of cardiovascular risk factors, particularly lipids such as low-density lipoprotein (LDL) cholesterol, are also important. 25-27 Guidelines further recommend that a full lipid profile be measured every 1-3 years, depending on cardiovascular risk, and suggest that LDL be consistently less than 2.0 mmol/L. 28 Control of A 1c and lipids has been shown to be associated with reduced morbidity and mortality in patients with diabetes. 18,29-32 One possible reason for the high burden of complications among Indigenous people with diabetes may be failure to achieve control of these 2 key clinical parameters. We examined differences between Status First Nations people with diabetes in Ontario and all other Ontario residents with diabetes in rates of monitoring of A 1c and lipids, achievement of targets for A 1c and LDL outlined in clinical guidelines, and patterns of medication use to help attain these targets.

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“…6 A high incidence of lower extremity amputations among Canada's First Nations populations motivated this study. 4,[7][8][9] We sought to identify health care access barriers among First Nations patients at risk of amputation or who had undergone amputa tion for diabetic foot ulcers in Southern Saskatchewan, explore experiences of patients who had undergone amputa tions for diabetic foot ulcers and those who sought care for diabetic foot ulcers and identify potential solutions to reduce health care barriers.…”

mentioning

confidence: 99%

Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study

Wees,

Pandey,

Nicolay

et al. 2023

cmajo

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Background: First Nations people in Canada are overrepresented among those who have undergone nontraumatic lower extremity amputation, and are more likely to be younger, have diabetic foot infections and have no previous revascularization procedures than non–First Nations populations who have undergone lower extremity amputations. We sought to identify access barriers for high-risk First Nations patients, explore patients’ experiences with health care systems and identify solutions. Methods: Employing a community participatory research design, we engaged representatives from 2 communities. They assisted with research design and data analysis, and approved the final manuscript. Using a hermeneutic phenomenological approach and purposeful sampling, we conducted 5 semistructured focus groups between August and December 2021 with community health care teams and patients at risk for, or who had previously undergone, a nontraumatic lower extremity amputation. Results: Patients’ ( n = 10) and community health care providers’ ( n = 18) perspectives indicated that barriers to health care access led to delayed care and increased complications and risk for lower extremity amputations, leading to aggressive procedures upon receiving care. Barriers to care led to negative experiences at urban centres and aggressive procedures created further distrust, leading to care disengagement and poor outcomes. Patients and providers both suggested building stronger partnerships between urban and rural health care providers, improving education for patients and health care providers and identifying innovative strategies to improve patients’ overall health. Interpretation: Systemic changes, health promotional program and reliable on-reserve primary care are needed to create equitable access for First Nation patients at risk for lower extremity amputations. The study results imply that health care delivery for First Nations patients at risk for lower extremity amputations can be improved through stronger partnership and communication between urban and community providers, and continued education and cultural competency training for urban health care providers.

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Peripheral arterial disease in Ontario First Nations people with diabetes: a longitudinal population-based cohort study

Cited by 8 publications

References 16 publications

Incidence and trends of limb amputation in first nations and general population in Saskatchewan, 2006–2019

Incidence and trends of limb amputation in first nations and general population in Saskatchewan, 2006–2019

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study

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