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

► Recent projects Provincial adult FIRST NATIONS diabetes trends * 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’ Oster RT et al. CMAJ. 2011;183(12):E803-8

► Recent projects Age-adjusted prevalence of diabetes in Alberta Métis Settlements, 1998 and 2006, by gender, from self-report census * Statistically significant (p<0.05) from female 2006 prevalence. ** Statistically significant (p<0.01) from total 1998 prevalence. Ralph-Campbell K et al. Int J Circumpolar Health. 2009;68(5):433-42

► Recent projects Provincial youth FIRST NATIONS diabetes prevalence trends 0.35 Status Aboriginal * Prevalence increasing significantly General population faster in First Nations over time (in 0.3 particular for male youth) 0.25 0.2 0.15 0.1 0.05 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Oster RT et al. Int J Circumpolar Health. 2012;71:18501

► Recent projects Provincial youth FIRST NATIONS diabetes incidence trends Status Aboriginal 0.9 General population * Incidence increasing significantly 0.8 faster in First Nations over time (in particular for male youth) 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Oster RT et al. Int J Circumpolar Health. 2012;71:18501

► Recent projects Diabetes in pregnancy Provincial data to understand the extent of the problem of diabetes in pregnancy in Alberta Qualitative approach to understand the experience of diabetes in pregnancy and what factors could contribute to achieving a healthy pregnancy in First Nations women

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

► Recent projects Diabetes in pregnancy Women without diabetes Women with diabetes First Nations Non-First Nations First Nations Non-First Nations 24.7 (5.8)  28.7 (5.5) † 31.6 (5.3) ‡ Age (years) 28.9 (6.2) 10.8% (10.5-11.2)  8.0% (7.9-8.1) † 18.4% (17.9-19.0) ‡ Weight ≥ 91 kg 31.7% (29.3-34.1) 1.7 (1.9)  0.9 (1.1) † 1.1 (1.4) ‡ Parity 2.2 (2.1) 2.3% (2.1-2.5)  0.6% (0.5-0.6) † 0.5% (0.4-0.7) ‡ Anemia 1.3% (0.8-2.0) 54.7% (54.1-55.3)  17.0% (16.9-17.2) † 14.3% (13.8-14.8) ‡ Smoker 49.4% (46.8-51.9) 0.1% (0.0-0.1) † 0.1% (0.0-0.1) ‡ Alcohol ≥ 1 drink/day 0.9% (0.8-1.1) 0.6% (0.3-1.2) 9.5% (9.2-9.9)  1.6% (1.5-1.6) † 0.9% (0.8-1.04) ‡ Alcohol ≥ 3 drinks ever 7.2% (5.9-8.6) 6.6% (6.3-6.9)  0.9% (0.8-0.9) † 0.4% (0.3-0.5) ‡ Drug dependent 3.5% (2.6-4.6) 10.4% (10.1-10.8)  5.1% (5.1-5.2) † 19.8% (19.2-2.4) ‡ Antepartum risk ≥ 7 30.7% (28.4-33.1) 16.7% (16.3-17.2)  11.1% (10.9-11.1) † 12.9% (12.4-13.4) ‡ HBW 29.3% (27.0-31.6) 88.3% (88.2-88.6) † 86.3% (85.4-87.1) ‡ Breastfeeding 71.2% (70.5-72.8) 74.7% (69.3-79.6) 9.2% (8.9-9.6)  8.8% (8.7-8.9) † 14.7% (14.2-15.3) ‡ Preterm 17.3% (15.4-19.3) 1.2% (1.1-1.3)  0.7% (0.6-0.7) † 0.6% (0.5-0.8) ‡ Stillbirth 2.1% (1.5-2.9)  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 Rate First Nations Non-First Nations ratio * 1.6 † Gestational diabetes 6.1% (6.0-6.1) 3.8% (3.7-3.9) Pre-existing 2.5 † 1.5% (1.4-1.5) 0.6% (0.6-0.6) diabetes * 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 10 First Nations * Only significant increase over time: 9 Non First Nations 8 Gestational diabetes in non-First Rate, % 7 Nations 6 5 4 3 2 1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Pre-existing diabetes 30 First Nations Non First Nations 25 Rate per 1000 20 15 10 5 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Oster RT et al. BMC Pregnancy Childbirth. 2014 Apr 10;14:136

► Recent projects Diabetes in pregnancy Support Challenges Control Awareness Positives and Resources • 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 Oster RT et al. Qualitative Health Research. 2014 Nov;24(11):1469-80 .

► Recent projects Secondary analyses - Stillbirths First Nations Non-First Nations 2.5 2 Prevalence 1.5 1 0.5 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year • 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 Oster RT & Toth EL. Journal of Obstetrics and Gynecology Canada. Accepted 2014

► Recent projects 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 Age-adjusted LBW ( ≤ 2500g) prevalence over time by ethnicity Age- adjusted Very LBW (≤ 1500g) prevalence over time by ethnicity First Nations Non First Nations First Nations Non First Nations 12 3.5 3 10 2.5 8 2 6 1.5 4 1 2 0.5 0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Oster RT & Toth EL. In preparation

► Recent projects 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 Age-adjusted HBW ( ≥ 4000g) prevalence over time by Age- adjusted Very HBW (≥ 4000g) prevalence over time by ethnicity ethnicity First Nations Non First Nations First Nations Non First Nations 25 5 4.5 20 4 3.5 15 3 2.5 10 2 1.5 5 1 0.5 0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 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 Healthy Nations “Every Nation in this country Intergenerational trauma has been gifted with that ability to (heal themselves)” “ Diabetes is a cultural thing” Cultural Continuity “livelihood” “The success is how solid they “being who we are” are as a community in their “sacred” culture” “everything” Western Society “respect” “way of life” Self-Determination “who we are is determined “ Self-determination means through our language” self- sustaining” “Not depend on anybody” Government Policies “Self sustaining is tied right back to our culture, our source of life” Oster RT et al. Qualitative Health Research. 2014 Nov;24(11):1469-80 .

► Recent projects Cultural continuity and diabetes • Generalizing obscures differences in diabetes prevalence 20 15 10 5 0 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 20 R-squared = 0.338 Adjusted R2 = 0.218 F (4, 22) = 2.81 P-value = 0.005 15 10 5 0 0 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 Chandler MJ & Lalonde CE. Horizons. 2003;10 generalizing policies and (1):68-72 approaches