Potential years of life lost at ages 25 to 74 among Métis and non-Status Indians, 1991 to 2001.

BACKGROUND: Aboriginal peoples experience a disproportionate burden of disease, compared with other Canadians. However, relatively little information is available about mortality among Métis and non-Status Indians. METHODS: This study calculates potential years of life lost before age 75 (PYLL) for people aged 25 to 74 by all-cause and cause-specific mortality, and examines the effect of socio-economic factors on premature mortality. Age-specific and age-standardized PYLL rates were calculated for 11,600 Métis, 5,400 non-Status Indians, and 2,475,700 non-Aboriginal adults based on the number of person-years at risk up to age 75. RESULTS: Métis and non-Status Indian adults had about twice the risk of dying before age 75, compared with non-Aboriginal adults. While the largest percentage of PYLL was due to non-communicable diseases such as cardiovascular disease and cancer, relative and absolute inequalities were greatest for injuries. Socioeconomic indicators such as income, education and employment explained a large share of the disparities in premature mortality. INTERPRETATION: The results highlight the losses of potential years of life due to chronic diseases, as well as the possible importance of injury prevention programs for Métis and non-Status Indians.

The relationship between socio-economic and geographic factors and asthma among Canada's Aboriginal populations.

OBJECTIVES: To examine the prevalence, exacerbations and management of asthma among Canada's Aboriginal populations, and its relationship to socio-economic and geographic factors. STUDY DESIGN: Secondary analysis of a national cross-sectional questionnaire survey. METHODS: Data were collected in 2000 and 2001 through a survey of Aboriginal children and adults residing on- and off-reserve as part of the 2001 Aboriginal People's Survey (APS). The asthma related outcome variables - physician-diagnosed asthma, attack in past year and regular use of inhalants - were examined in relation to socio-economic and geographic factors such as income, education, housing and location of residence. Statistical analyses were based on weighted univariate and multivariate logistic regressions. RESULTS: The results show variations in asthma diagnosis, attacks and inhalant use across geographic location, socio-economic and demographic characteristics. Geographic location was found to be significantly associated with asthma for both adults and children, with those living in the northern territories, on-reserve or rural locations being the least likely to be diagnosed. Geographic location and Aboriginal identity were also found to be significantly associated with asthma medication use. CONCLUSIONS: While these findings may suggest a "healthier" population in more remote locations, they alternatively point to a general pattern of under-diagnosis, potentially due to poor health care access, as is typical in more remote locations.

Birth outcomes in the Inuit-inhabited areas of Canada.

BACKGROUND: Information on health disparities between Aboriginal and non-Aboriginal populations is essential for developing public health programs aimed at reducing such disparities. The lack of data on disparities in birth outcomes between Inuit and non-Inuit populations in Canada prompted us to compare birth outcomes in Inuit-inhabited areas with those in the rest of the country and in other rural and northern areas of Canada. METHODS: We conducted a cohort study of all births in Canada during 1990-2000 using linked vital data. We identified 13,642 births to residents of Inuit-inhabited areas and 4,054,489 births to residents of all other areas. The primary outcome measures were preterm birth, stillbirth and infant death. RESULTS: Compared with the rest of Canada, Inuit-inhabited areas had substantially higher rates of preterm birth (risk ratio [RR] 1.45, 95% confidence interval [CI] 1.38-1.52), stillbirth (RR 1.68, 95% CI 1.38-2.04) and infant death (RR 3.61, 95% CI 3.17-4.12). The risk ratios and absolute differences in risk for these outcomes changed little over time. Excess mortality was observed for all major causes of infant death, including congenital anomalies (RR 1.64), immaturity-related conditions (RR 2.96), asphyxia (RR 2.43), sudden infant death syndrome (RR 7.15), infection (RR 8.32) and external causes (RR 7.30). Maternal characteristics accounted for only a small part of the risk disparities. Substantial risk ratios for preterm birth, stillbirth and infant death remained when the comparisons were restricted to other rural or northern areas of Canada. INTERPRETATION: The Inuit-inhabited areas had much higher rates of preterm birth, stillbirth and infant death compared with the rest of Canada and with other rural and northern areas. There is an urgent need for more effective interventions to improve maternal and infant health in Inuit-inhabited areas.

Mortality of Métis and registered Indian adults in Canada: an 11-year follow-up study.

BACKGROUND: Little information has been published about the mortality of the Métis people of Canada. This study describes mortality patterns among Métis and Registered Indian adults, compared with the non-Aboriginal population. DATA SOURCE AND METHODS: The 1991 to 2001 Canadian census mortality followup study tracked mortality among a 15% sample of respondents aged 25 or older, including 11,800 Métis, 56,700 Registered Indians and 2,624,300 non-Aboriginal adults, all of whom were enumerated by the 1991 census long-form questionnaire. Age-specific and age-standardized mortality rates and period life tables based on the number of person-years at risk were calculated across the various groups. Métis were defined by ethnic origin (ancestry). RESULTS: Compared with non-Aboriginal members of the cohort, life expectancy at age 25 was 3.3 and 5.5 years shorter for Métis men and women, respectively, and 4.4 and 6.3 years shorter for Registered Indians. For both Aboriginal groups, mortality rate ratios were highest at younger ages. Mortality rate differences among Métis men were particularly elevated for external causes and circulatory, respiratory and digestive system diseases; among Métis women, for circulatory system diseases, cancers, and digestive and respiratory system diseases. Generally, rate differences for Registered Indian men and women were further elevated. CONCLUSIONS: Métis adults had higher mortality rates compared with non-Aboriginal members of the cohort, but lower rates than did Registered Indians.

Life expectancy in the Inuit-inhabited areas of Canada, 1989 to 2003.

OBJECTIVES: Because of a lack of Aboriginal identifiers on death registrations, standard data sources and methods cannot be used to estimate basic health indicators for Inuit in Canada. Instead, a geographic-based approach was used to estimate life expectancy for the entire population of Inuit-inhabited areas. DATA SOURCES: The data are from the Canadian Mortality Database and the Census of Canada. ANALYTICAL TECHNIQUES: Areas where at least 33% of residents were Inuit were identified, based on census results. Vital statistics death records for 1989 through 2003 and census population counts for 1991, 1996 and 2001 were used to compute abridged life tables for the Inuit-inhabited areas in each of the three 5-year periods centered around those census years. MAIN RESULTS: In 1991, life expectancy at birth in the Inuit-inhabited areas was about 68 years, which was 10 years lower than for Canada overall. From 1991 to 2001, life expectancy in the Inuit-inhabited areas did not increase, although it rose by about two years for Canada as a whole. As a result, the gap widened to more than 12 years. Life expectancy in the Inuit-inhabited areas was generally highest in the Inuvialuit region (Northwest Territories) and Nunavut (Territory), followed by Nunatsiavut (Labrador) and Nunavik (Quebec). While these results are not specific to the Inuit population, such geographic-based methods can be used with any administrative datasets that include postal codes or municipal-level locality codes.