Avoidable mortality among First Nations adults in Canada: A cohort analysis.

BACKGROUND: Avoidable mortality is a measure of deaths that potentially could have been averted through effective prevention practices, public health policies, and/or provision of timely and adequate health care. This longitudinal analysis compares avoidable mortality among First Nations and non-Aboriginal adults. DATA AND METHODS: Data are from the 1991-to-2006 Canadian Census Mortality and Cancer Follow-up Study. A 15% sample of 1991 Census respondents aged 25 or older was linked to 16 years of mortality data. This study examines avoidable mortality among 61,220 First Nations and 2,510,285 non-Aboriginal people aged 25 to 74. RESULTS: During the 1991-to-2006 period, First Nations adults had more than twice the risk of dying from avoidable causes compared with non-Aboriginal adults. The age-standardized avoidable mortality rate (ASMR) per 100,000 person-years at risk for First Nations men was 679.2 versus 337.6 for non-Aboriginal men (rate ratio = 2.01). For women, ASMRs were lower, but the gap was wider. The ASMR for First Nations women was 453.2, compared with 183.5 for non-Aboriginal women (rate ratio = 2.47). Disparities were greater at younger ages. Diabetes, alcohol and drug use disorders, and unintentional injuries were the main contributors to excess avoidable deaths among First Nations adults. Education and income accounted for a substantial share of the disparities. INTERPRETATION: The results highlight the gap in avoidable mortality between First Nations and non-Aboriginal adults due to specific causes of death and the association with socioeconomic factors.

Cancer patterns in Inuit Nunangat: 1998-2007.

OBJECTIVES: To compare cancer incidence patterns between residents of Inuit Nunangat and the rest of Canada. STUDY DESIGN: Cancer cases were geographically linked to either Inuit Nunangat or the rest of Canada using postal codes or other geographic information. Population estimates were derived from the 2001 and 2006 censuses. METHODS: Cancer cases were combined from 1998 to 2007 for Inuit Nunangat and the rest of Canada. Age-standardised incidence rates were calculated for all site cancers and sub-sites by sex. Standardised rate ratios between these 2 areas were calculated for all site cancers and sub-sites. RESULTS: The age-standardised incidence rate for all cancer sites (1998-2007) was 14% lower for the Inuit Nunangat male population and 29% higher for the female population by comparison to the rest of Canada. Cancers of the nasopharynx, lung and bronchus, colorectal, stomach (males), and kidney and renal pelvis (females), were elevated in the Inuit Nunangat population compared to the rest of Canada, whereas prostate and female breast cancers were lower in the Inuit Nunangat population. CONCLUSIONS: Cancers with potentially modifiable risk factors, such as buccal cavity and pharynx, nasopharynx, lung and bronchus, and colorectal cancer were elevated in the Inuit Nunangat population compared to the rest of Canada. Besides greater smoking prevalence within Inuit Nunangat by comparison to the rest of Canada, distinct socioeconomic characteristics between respective area populations including housing, and income may have contributed to incidence differentials. This study demonstrated that a geographic approach can be used in cancer surveillance when populations of interest are spatially distinguishable, and reside across distinct jurisdictions whose combined cancer registries will not completely provide information to identify the population of interest.

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

BACKGROUND: Compared with other Canadians, First Nations peoples experience a disproportionate burden of illness and disease. Potential years of life lost (PYLL) before age 75 highlights the impact of youthful or early deaths. DATA AND METHODS: The 1991 to 2001 Canadian census mortality follow-up study tracked a 15% sample of adults aged 25 or older over more than a decade. This study examined mortality among people aged 25 to 74-55,600 Status Indians (39,200 on reserve and 16,500 off reserve) and 2,475,700 non-Aboriginal adults-all of whom were enumerated by the 1991 census long-form questionnaire. Age-standardized PYLL rates were calculated, based on the number of person-years at risk before age 75. RESULTS: Status Indian adults had 2.5 times the risk of dying before age 75, compared with non-Aboriginal adults. Results did not differ greatly by residence on or off reserve. Relative and absolute inequalities were greatest for unintentional and intentional injuries. Socio-economic factors such as income, education, housing and employment explained a substantial share of the disparities in premature death. INTERPRETATION: Status Indian adults had higher rates of premature mortality. Socio-economic factors played an important role in those disparities. Injuries were important contributors to both relative and absolute inequalities.

Enhanced surveillance for acute and likely acute hepatitis B in Canada: 1999 to 2002.

OBJECTIVE: To assess the incidence of clinically identified hepatitis B cases, as well as the demographic and risk behaviour profiles of these cases in a defined Canadian population. METHODS: An enhanced hepatitis surveillance system was established in October 1998 to identify acute hepatitis B and C cases in Canada. Acute and likely acute cases, as determined by laboratory testing, collectively defined incident clinical hepatitis B cases. Data from 1999 to 2002 on incidence, demographic characteristics and risk behaviour characteristics were collected and analyzed. RESULTS: During the 1999 to 2002 surveillance period, 379 cases were identified in a target population ranging from 3,128,179 to 8,576,071 individuals. The observed hepatitis B incidence rate was 1.93/100,000 person-years in the surveillance area. The incidence rate was 2.74 times higher in men. The observed incidence rates decreased for all age groups over the surveillance period but remained high in the 20- to 29-year-old and 30- to 39-year-old age groups, as well as in men. Of the incident cases, 55.9% self-identified as being born in Canada and 18.5% as being born in Asia, while 18.7% did not identify a birth area. Of the Canadian-born cases, 61.3% identified themselves as Caucasian, 11.3% as Aboriginal and 23.6% as no ethnic category. Injection drug use was the most reported risk behaviour (19.1%), followed closely by sex-associated risk behaviours. A large proportion, 24%, indicated none of the known risk behaviours. CONCLUSIONS: The hepatitis B incidence rate has shown some decrease in the surveillance population from 1999 to 2002 and this may be due, in part, to past intervention programs (eg, vaccination programs and health promotion campaigns). The authors' results identify some high-risk groups that would benefit from additional prevention and control programs, and further targeted research and intervention.