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Access to Healthcare May Lead to Lower Amputation Rates for First Nations Communities

Canadian First Nations people are at much higher risk for type 2 diabetes and its risk factors than the overall Canadian population.

First Nations people in Manitoba have a life expectancy that is 8 years lower than other Manitobans (males: 68.4 vs 76.1 years and females: 73.2 vs 81.4 years). Canadian First Nations people are at much higher risk for type 2 diabetes and its risk factors than the overall Canadian population.

Diabetes in Manitoba affects around 20 per cent of First Nations adults compared to around 5 per cent of non-First Nations adults. Amputation rates are very high amongst First Nations people, at 18 times the rate compared to other Manitobans.

What affects these rates? Does where you live and your income play a role? A new study published in the September issue of the Canadian Journal of Diabetes finds that both these factors are contributors to health outcomes of First Nations people in Manitoba.

“This study is a ‘first look’ at variations among First Nations living on-reserve and the underlying relationships to determinants of health,” says lead author is Dr. Patricia Martens, Director and Senior Researcher at the Manitoba Centre for Health Policy (MCHP) at the University of Manitoba. The research team includes Dr. Bruce Martin (J.A. Hildes Northern Medical Unit), Dr. John O’Neil (Centre for Aboriginal Health Research) and Melanie MacKinnon (former Intergovernmental Committee on First Nations Health, Assembly of Manitoba Chiefs and now with Medicine Creek Solutions).

Diabetes rates were compared amongst nine First Nations geographical areas and also separated into North and South areas of the province.

Even within First Nations areas diabetes was found to be associated with household income, that is, the higher the income of the area, the lower the percent of the population with diabetes. As well, diabetes rates in the north were lower than in the south (18 per cent vs 22 per cent).

The high amputation rates for on-reserve First Nations people was found to be highly associated with access to specialist care (being referred to a specialist for care). Those First Nations areas with better access had lower amputation rates, an indicator that their diabetes was probably better managed.

“It is troublesome to think that people who may be in need of care may not be able to access it,” said Martens. “Some people assume that those in remote northern communities would have less access to specialist care. Our study found that this was not the case. The southern communities had lower referral rates than the northern communities. We believe this is related to the models of care in place in remote northern communities, for example, the J.A. Hildes Northern Medical Unit system of integrating community-based health providers.”

This study points to the need for further research to understand barriers to healthcare access and models of care that will remove these barriers.

The study is available online at: http://www.diabetes.ca/files/PMartens-Aug232007.pdf

For more information, contact:
Janine Harasymchuk
Communications Officer
Manitoba Centre for Health Policy
jharasym@cpe.umanitoba.ca.
Phone: (204) 789-3669
Fax: (204) 789-3910