Modelling prevalent cardiovascular disease in an urban Indigenous population
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Published:2022-08-09
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Volume:
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ISSN:0008-4263
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Container-title:Canadian Journal of Public Health
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language:en
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Short-container-title:Can J Public Health
Author:
Avery LisaORCID, Maddox RaglanORCID, Abtan Robert, Wong Octavia, Rotondi Nooshin Khobzi, McConkey StephanieORCID, Bourgeois Cheryllee, McKnight Constance, Wolfe Sara, Flicker SarahORCID, Macpherson Alison, Smylie Janet, Rotondi MichaelORCID
Abstract
Abstract
Objective
Studies have highlighted the inequities between the Indigenous and non-Indigenous populations with respect to the burden of cardiovascular disease and prevalence of predisposing risks resulting from historical and ongoing impacts of colonization. The objective of this study was to investigate factors associated with cardiovascular disease (CVD) within and specific to the Indigenous peoples living in Toronto, Ontario, and to evaluate the reliability and validity of the resulting model in a similar population.
Methods
The Our Health Counts Toronto study measured the baseline health of Indigenous community members living in Toronto, Canada, using respondent-driven sampling. An iterative approach, valuing information from the literature, clinical insight and Indigenous lived experiences, as well as statistical measures was used to evaluate candidate predictors of CVD (self-reported experience of discrimination, ethnic identity, health conditions, income, education, age, gender and body size) prior to multivariable modelling. The resulting model was then validated using a distinct, geographically similar sample of Indigenous people living in Hamilton, Ontario, Canada.
Results
The multivariable model of risk factors associated with prevalent CVD included age, diabetes, hypertension, body mass index and exposure to discrimination. The combined presence of diabetes and hypertension was associated with a greater risk of CVD relative to those with either condition and was the strongest predictor of CVD. Those who reported previous experiences of discrimination were also more likely to have CVD. Further study is needed to determine the effect of body size on risk of CVD in the urban Indigenous population. The final model had good discriminative ability and adequate calibration when applied to the Hamilton sample.
Conclusion
Our modelling identified hypertension, diabetes and exposure to discrimination as factors associated with cardiovascular disease. Discrimination is a modifiable exposure that must be addressed to improve cardiovascular health among Indigenous populations.
Funder
Canadian Institutes for Health Research
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,General Medicine
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