Summary of Other BRAID Research Projects Dr. Richard Oster MDSi - - PowerPoint PPT Presentation

Summary of Other BRAID Research Projects

• Dr. Richard Oster

MDSi Final Community Gathering November 19, 2014 Edmonton

Outline

• Recent projects
• Current projects
• Future

Recent projects

Provincial adult FIRST NATIONS diabetes trends

Oster RT et al. CMAJ. 2011;183(12):E803-8 ►Recent projects

* Prevalence increasing significantly in both groups, but faster in non-First Nations over time * Female First Nations have significantly higher rates of diabetes than males, but males appear to be ‘catching up’

* Statistically significant (p<0.05) from female 2006 prevalence. ** Statistically significant (p<0.01) from total 1998 prevalence.

Age-adjusted prevalence of diabetes in Alberta Métis Settlements, 1998 and 2006, by gender, from self-report census

►Recent projects Ralph-Campbell K et al. Int J Circumpolar Health. 2009;68(5):433-42

Provincial youth FIRST NATIONS diabetes prevalence trends

►Recent projects

0.05 0.1 0.15 0.2 0.25 0.3 0.35 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Status Aboriginal General population

* Prevalence increasing significantly faster in First Nations over time (in particular for male youth)

Oster RT et al. Int J Circumpolar Health. 2012;71:18501

Provincial youth FIRST NATIONS diabetes incidence trends

Oster RT et al. Int J Circumpolar Health. 2012;71:18501 ►Recent projects

0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Status Aboriginal General population

* Incidence increasing significantly faster in First Nations over time (in particular for male youth)

Diabetes in pregnancy

Provincial data to understand the extent of the problem of diabetes in pregnancy in Alberta Qualitative approach to understand the experience

• f diabetes in pregnancy and what factors could

contribute to achieving a healthy pregnancy in First Nations women

►Recent projects

Pregnancy and diabetes

Pre-existing diabetes OR gestational diabetes both can have (epigenetic) consequences The baby gets the increased glucose (and other good or bad nutrition) from the mother This affects the baby’s pancreas: with lifelong consequences

Diabetes in pregnancy

Women without diabetes Women with diabetes First Nations Non-First Nations First Nations Non-First Nations

Age (years) 24.7 (5.8) 28.7 (5.5)† 28.9 (6.2) 31.6 (5.3)‡ Weight ≥ 91 kg 10.8% (10.5-11.2) 8.0% (7.9-8.1)† 31.7% (29.3-34.1) 18.4% (17.9-19.0)‡ Parity 1.7 (1.9) 0.9 (1.1)† 2.2 (2.1) 1.1 (1.4)‡ Anemia 2.3% (2.1-2.5) 0.6% (0.5-0.6)† 1.3% (0.8-2.0) 0.5% (0.4-0.7)‡ Smoker 54.7% (54.1-55.3) 17.0% (16.9-17.2)† 49.4% (46.8-51.9) 14.3% (13.8-14.8)‡ Alcohol ≥ 1 drink/day 0.9% (0.8-1.1) 0.1% (0.0-0.1)† 0.6% (0.3-1.2) 0.1% (0.0-0.1)‡ Alcohol ≥ 3 drinks ever 9.5% (9.2-9.9) 1.6% (1.5-1.6)† 7.2% (5.9-8.6) 0.9% (0.8-1.04)‡ Drug dependent 6.6% (6.3-6.9) 0.9% (0.8-0.9)† 3.5% (2.6-4.6) 0.4% (0.3-0.5)‡ Antepartum risk ≥ 7 10.4% (10.1-10.8) 5.1% (5.1-5.2)† 30.7% (28.4-33.1) 19.8% (19.2-2.4)‡ HBW 16.7% (16.3-17.2) 11.1% (10.9-11.1)† 29.3% (27.0-31.6) 12.9% (12.4-13.4)‡ Breastfeeding 71.2% (70.5-72.8) 88.3% (88.2-88.6)† 74.7% (69.3-79.6) 86.3% (85.4-87.1)‡ Preterm 9.2% (8.9-9.6) 8.8% (8.7-8.9)† 17.3% (15.4-19.3) 14.7% (14.2-15.3)‡ Stillbirth 1.2% (1.1-1.3) 0.7% (0.6-0.7)† 2.1% (1.5-2.9) 0.6% (0.5-0.8)‡

 Significant difference (p < 0.05) between First Nations without diabetes and First Nations with diabetes † Significant difference (p < 0.05) between First Nations and non-First Nations without diabetes ‡ Significant difference (p < 0.05) between First Nations and non-First Nations with diabetes

Oster RT et al. BMC Pregnancy Childbirth. 2014 Apr 10;14:136 ►Recent projects

Diabetes in pregnancy

First Nations Non-First Nations Rate ratio*

Gestational diabetes 6.1% (6.0-6.1) 3.8% (3.7-3.9) 1.6† Pre-existing diabetes 1.5% (1.4-1.5) 0.6% (0.6-0.6) 2.5†

* First Nations-to-non-First Nations † p < 0.01 for rate ratio Oster RT et al. BMC Pregnancy Childbirth. 2014 Apr 10;14:136 ►Recent projects

Diabetes in pregnancy

Gestational diabetes Pre-existing diabetes

5 10 15 20 25 30 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Rate per 1000

First Nations Non First Nations

1 2 3 4 5 6 7 8 9 10 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Rate, %

First Nations Non First Nations

* Only significant increase over time: Gestational diabetes in non-First Nations

Oster RT et al. BMC Pregnancy Childbirth. 2014 Apr 10;14:136 ►Recent projects

Diabetes in pregnancy

• Efforts must be made to improve pregnancy care: Patient-centered care
• Healthcare providers should work to strengthen women’s support systems:
• healthcare system
• Spouses, family, peers, cultural and/or community supports
• Recognize women’s internal drive to protect their baby; avoid inducing fear
• Strategies are needed to enhance the awareness and knowledge of diabetes in pregnancy

Support Awareness and Resources Control Challenges Positives

Oster RT et al. Qualitative Health Research. 2014 Nov;24(11):1469-80. ►Recent projects

Secondary analyses - Stillbirths

• Stillbirth rates have remained stable in Alberta over 10 years, but are

higher in First Nations pregnancies compared to non-First Nations

– Pre-existing diabetes was a strong risk factor for stillbirth

0.5 1 1.5 2 2.5 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year Prevalence First Nations Non-First Nations

►Recent projects Oster RT & Toth EL. Journal of Obstetrics and Gynecology Canada. Accepted 2014

Secondary analyses – Birth weights

• Low Birth Weight prevalences remained stable over time in

First Nations, yet Low Birth Weight is more common in First Nations infants

►Recent projects

0.5 1 1.5 2 2.5 3 3.5 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 First Nations Non First Nations

Age-adjusted Very LBW (≤ 1500g) prevalence over time by ethnicity

2 4 6 8 10 12 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 First Nations Non First Nations

Age-adjusted LBW (≤ 2500g) prevalence over time by ethnicity Oster RT & Toth EL. In preparation

Secondary analyses – Birth Weights

• Although High Birth Weight is more common in First Nations infants

compared to non-First Nations, High Birth Weight prevalence is decreasing

5 10 15 20 25 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 First Nations Non First Nations

Age-adjusted HBW (≥ 4000g) prevalence over time by ethnicity Age-adjusted Very HBW (≥ 4000g) prevalence over time by ethnicity

0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 First Nations Non First Nations

Oster RT & Toth EL. In preparation ►Recent projects

Cultural continuity and diabetes

• We explored the association between cultural

continuity and/or self-determination, and diabetes prevalence in Aboriginal communities in Alberta – We used a mixed method design which started with and emphasized a qualitative description, building to a second smaller quantitative piece

►Recent projects

Cultural continuity and diabetes

• Communities are fighting to rehabilitate their culture and consequent self-

determination, with improved health and well-being in mind

Cultural Continuity “livelihood” “being who we are” “sacred” “everything” “respect” “way of life” “who we are is determined through our language” Healthy Nations “Every Nation in this country has been gifted with that ability to (heal themselves)” “Diabetes is a cultural thing” “The success is how solid they are as a community in their culture” Self-Determination “Self-determination means self-sustaining” “Not depend on anybody” “Self sustaining is tied right back to our culture, our source

• f life”

Western Society Intergenerational trauma Government Policies

►Recent projects Oster RT et al. Qualitative Health Research. 2014 Nov;24(11):1469-80.

Cultural continuity and diabetes

• Generalizing obscures differences in diabetes prevalence

5 10 15 20 First Nations (names removed)

Oster RT et al. Qualitative Health Research. 2014 Nov;24(11):1469-80. ►Recent projects

Cultural continuity and diabetes

• Cultural continuity protects against diabetes

R-squared = 0.338 P-value = 0.005 Adjusted R2 = 0.218 F (4, 22) = 2.81 5 10 15 20 20 40 60 80 100 Indigenous language knowledge (%)

Oster RT et al. Qualitative Health Research. 2014 Nov;24(11):1469-80. ►Recent projects

Cultural continuity and diabetes

• Interventions aimed at reducing

type 2 diabetes rates should work to break down the barriers to cultural continuity

• Traditional Indigenous

languages require urgent protection and revival

• Researchers, health care

providers, and policy makers need to collaborate with, understand, and engage individual Aboriginal communities rather than generalizing policies and approaches

►Recent projects Chandler MJ & Lalonde CE. Horizons. 2003;10 (1):68-72

Provincial adult FIRST NATIONS mortality trends

Oster RT et al. CMAJ. 2011;183(12):E803-8 ►Recent projects

* Mortality in those with diabetes is decreasing significantly over time in both groups * Mortality in those without diabetes is decreasing significantly over time in non-First Nations only

LIFE EXPECTANCY – Gap not getting better Alberta First Nations vs. NON First Nations

Alberta Health, division of surveillance

50.00 55.00 60.00 65.00 70.00 75.00 80.00 85.00 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

First Nations Non First Nations

INFANT MORTALITY – Gap not getting better Alberta First Nations vs. NON First Nations

Alberta Health, division of surveillance

0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 First Nations Non First Nations

Current projects

‘Lawson’ Project

• A culturally competent RN and certified

diabetes educator of First Nations descent was hired to work specifically with women that have diabetes in pregnancy in a large Aboriginal community

– Build relationships – Enhance awareness – Co-ordinate care and communication – Provide consistent care – Increase rates of identification, and ultimately improve perinatal care

►Current projects

ENRICH First Nations

• Community-based and collaborative project to

gain an in-depth understanding of how to better support pregnant Aboriginal women, with the ultimate goal of improving pregnancy-related health

– Community engagement / relationship building – Community advisory committee – Elders mentoring program

►Current projects

CVCD (Cardiovascular Alliance, the “MRI” study)

• Nationwide study aimed at understanding

early risk factors for cancer, heart disease, diabetes, stroke, and dementia

– Environmental factors – Contextual factors (including culture, social structures, exercise, eating habits, smoking, health care access, etc.) – MRI scan

►Current projects

Forge Ahead

• Nationwide project aimed at developing and

evaluating community-driven, culturally relevant, primary healthcare models that enhance chronic disease management and appropriate access to available services in Aboriginal communities in Canada

– Assess current state of care – Enhance patient access and implement quality improvement initiatives – Develop sustainable strategies

►Current projects

Future work

Applying for grants

• “ABC study”: an Aboriginal birth cohort?
• Retrospectively study the relationship

between A1c levels and future health

• utcomes in non-diabetic Aboriginal

individuals

• Investigation of the perception and experience
• f menopausal symptoms in Aboriginal

women

►Future projects

Questions?

Dr Richard Oster: 780-492-3859 roster@ualberta.ca

http://braidresearch.ca

References

• Oster RT and Toth EL. Stillbirth epidemiology and risk factors among First Nations and non-First Nations

pregnancies in Alberta, Canada from 2000 to 2009. Accepted in Journal of Obstetrics and Gynecology Canada

• Oster RT, Grier A, Lightning P, Mayan MJ, and Toth EL. Cultural continuity, self-determination, and

diabetes in Alberta First Nations. International Journal of Equity in Health 2014 Oct 19;13(1):92

• Oster RT, King K, Morrish DW, Mayan MJ and Toth EL. Diabetes in pregnancy among First Nations women

in Alberta, Canada: a retrospective analysis. BMC Pregnancy and Childbirth 2014;14(1):136

• Oster RT, Mayan MJ and Toth EL. Diabetes in Pregnancy Among First Nations Women. Accepted in

Qualitative Health Research

• Oster RT, Johnson JA, Balko SU, Svenson L and Toth EL. Increasing rates of diabetes amongst Status

Aboriginal youth in Alberta, Canada. International Journal of Circumpolar Health 2012;71(0):1-7

• Oster RT, Johnson JA, Hemmelgarn B, King M, Balko SU, Svenson L, Crowshoe L, and Toth EL. Recent

epidemiologic trends of diabetes mellitus among status Aboriginal adults. Canadian Medical Association Journal 2011;183(12):E803-8

• Ralph-Campbell K, Oster RT, Connor T, Pick M, Pohar S, Thompson F, Thompson P, Daniels M,

Deschambeau L, Werner-Leonard A, Cardinal S and Toth EL. Increasing rates of diabetes and cardiovascular risk in Métis Settlements in northern Alberta. International Journal of Circumpolar Health 2009;68(5):433-442

• Chandler MJ, Lalonde C: Cultural continuity as a protective factor against suicide in First Nations youth.

Horizons -- A Special Issue on Aboriginal Youth, Hope or Heartbreak: Aboriginal Youth and Canada’s Future 2003, 10(1):68-72