Changes to acute-care hospitalizations among Indigenous children and youth: Results from the 2006 and 2011 Canadian Census Health and Environment Cohorts.

Background: This study described the differences in the hospitalization rates of First Nations children and youth living on and off reserve, Inuit children and youth living in Inuit Nunangat (excluding Nunavik), and Métis children and youth, relative to non-Indigenous children and youth and examined rate changes across 2006 and 2011. Data and methods: The 2006 and the 2011 Canadian Census Health and Environment Cohorts provided five years of hospital records that Statistics Canada linked to peoples' self-reported Indigenous identity as recorded on the census. Causes of hospitalizations were based on the most responsible diagnosis coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada, aggregated by chapter code. Age-standardized hospitalization rates (ASHRs) were calculated per 100,000 population. Rate ratios (RRs) were reported for each Indigenous group relative to non-Indigenous children and youth. Results: For the 2006 and the 2011 cohorts, ASHRs were generally higher among Indigenous children and youth than among non-Indigenous children and youth. For some health conditions, hospitalization patterns also varied across the two time periods within the given Indigenous groups. Among children, leading elevated RRs occurred for diseases of the respiratory system, the digestive system and injuries. Elevated mental health-related RRs were observed among all Indigenous groups for both cohort years of youth. Significant increases in mental health-related ASHRs were observed in 2011 compared with 2006 among all youth groups, except for Inuit youth living in Inuit Nunangat, possibly due in part to data limitations. Among Indigenous youth, elevated RRs were observed for pregnancy, childbirth and the puerperium, and for injuries. For all youth (except Inuit), childbirth-related ASHRs decreased in 2011 compared with 2006. Interpretation: Findings align with previously observed hospitalization disparities between Indigenous and non-Indigenous children and youth. These data enabled the tracking of changes over time to partly address national information gaps about population health outcomes for children and youth, namely hospitalization.

Do cancer incidence and mortality rates differ among ethnicities in Canada?

BACKGROUND: Cancer incidence rates have been shown to vary by ethnicity, and the increasing awareness of and interest in reporting ethnic health inequalities have been growing internationally. The objective of this study was to assess cancer incidence and mortality rates by ethnicity in Canada. DATA AND METHODS: The study used the 2006 Canadian Census Health and Environment Cohort, linked to the Canadian Cancer Registry and the Canadian Vital Statistics-Death Database, to determine cancer cases and mortality from 2006 to 2016. Ethnicity was categorized as non-Indigenous North American (NINA); European; Caribbean; Latin, Central and South American (LCSA); African; East Asian; South Asian; and West Central Asian and Middle Eastern. RESULTS: Europeans had the highest standardized incidence rates, while NINA had the highest mortality rates. Rates varied substantially by ethnicity and immigrant status. The top three cancers accounted for 46.5% to 61.9% of all new cancers, while the top three cancer deaths accounted for 36.1% to 61.9% of all deaths. The distribution of cancers within the top 10 cancers and the top 10 cancer deaths also differed; e.g., stomach cancer was found to be more prevalent in the East Asian, LCSA, African and Caribbean groups. Non-immigrant African males had the highest cancer incidence rates, and non-immigrant South Asian females had the highest mortality rates. DISCUSSION: There is considerable variability in cancer incidence and cancer mortality rates by ethnicity, and this study addresses the knowledge gap in Canada in this area. Establishing baseline indicators, such as cancer rates by ethnicity, is essential to understanding the differences within the diverse Canadian population and to informing targeted interventions that may help reduce health inequalities.

Acute-care hospitalizations among First Nations people, Inuit and Métis: Results from the 2006 and 2011 Canadian Census Health and Environment Cohorts.

BACKGROUND: The objective of this study was to describe sex-specific hospitalization rates among Indigenous people in Canada (excluding Quebec), separately for First Nations people living on and off reserve, Inuit living in Inuit Nunangat (excluding Nunavik), Métis, and the non-Indigenous population. DATA AND METHODS: The 2006 and 2011 Canadian Census Health and Environment Cohorts (CanCHECs) were used, allowing hospital records to be examined by Indigenous identity as reported on the census. Five years of hospitalization data were used for each CanCHEC. Causes of hospitalization were based on the most responsible diagnosis and coded at the chapter level according to the International Classification of Diseases (ICD-10-CA). Age-standardized hospitalization rates (ASHRs) were calculated per 100,000 population, and rate ratios (RRs) were calculated for each Indigenous group relative to non-Indigenous people. RESULTS: ASHRs were higher among Indigenous people than among non-Indigenous people; this was true for females and males from both the 2006 and the 2011 cohorts. Hospitalization patterns varied by sex and Indigenous group. The greatest disparities with the non-Indigenous population were observed among on-reserve First Nations females and males from both cohorts. Elevated RRs were observed for diseases of the endocrine, nutritional and metabolic system among First Nations females and males living on reserve; hospitalizations for mental health among First Nations females and males living off reserve and Inuit males; and diseases of the respiratory system among Inuit females. For Métis females and males, equally elevated RRs were observed for diseases of the endocrine system and mental health. ASHRs for most causes decreased between the 2006 and 2011 cohorts, with the exception of ASHRs for mental health among First Nations females and males living on reserve, which increased. DISCUSSION: Findings are consistent with recognized health disparities between Indigenous and non-Indigenous people. Further research is warranted to understand reported differences in hospitalization patterns.

Life expectancy of First Nations, Métis and Inuit household populations in Canada.

BACKGROUND: The Truth and Reconciliation Commission of Canada has called upon the federal government to provide data on a number of health indicators, including life expectancy among First Nations people, Métis and Inuit. In Canada, estimating the life expectancy of Indigenous populations is methodologically challenging since death registrations do not usually collect information on whether the deceased was Indigenous. For the first time in Canada, a series of census-mortality linked datasets has been created that can be used to estimate life expectancies among Indigenous household populations enumerated by a census. DATA AND METHODS: Life expectancy is the average number of years a person at a given age would be expected to live if the mortality rates observed for a specific period persisted into the future. For this study, abridged period life tables (based on five-year age groups) were calculated for self-reported First Nations, Métis, Inuit and non-Indigenous males and females. RESULTS: Life expectancy was substantially and consistently shorter for First Nations, Métis and Inuit household populations compared with the non-Indigenous household population across all time periods. In 2011, life expectancy at age 1 for the male household population was 72.5 years for First Nations, 76.9 years for Métis, 70.0 years for Inuit and 81.4 years for non-Indigenous people. Among the female household population, life expectancy at age 1 was 77.7 years for First Nations, 82.3 years for Métis, 76.1 years for Inuit and 87.3 for non-Indigenous people. DISCUSSION: With the creation of a series of census-mortality linked datasets, it is now possible to produce national mortality and life expectancy estimates starting at age 1 for Indigenous household populations. The routine monitoring of longevity by population group can inform policy development and planning intended to advance health equity.

Smoking correlates among Inuit men and women in Inuit Nunangat.

BACKGROUND: Although rates of daily smoking among Inuit have been decreasing since 1991, Inuit are still much more likely to smoke relative to the Canadian population as a whole. However, little population-based empirical research has identified characteristics associated with cigarette use among this population. DATA AND METHODS: Based on data from the 2012 Aboriginal Peoples Survey, sex-specific logistic regression analyses, informed by an Inuit social determinants of health framework, described associations between current smoking and selected socio-demographic characteristics among Inuit men and women aged 18 or older who resided in Inuit Nunangat. RESULTS: In 2012, 75% of Inuit men and 74% of Inuit women reported that they smoked cigarettes either daily or occasionally. Inuit men and women had lower odds of smoking if they were high school graduates. Among Inuit men, the odds of smoking were lower for those in higher-income households. Among Inuit women, the odds of smoking were lower for those who had postsecondary education or lived in food-secure households; odds were higher for women who had attended a residential school. Inuit of both sexes had significantly higher odds of smoking if they lived in crowded conditions or in homes where a regular smoker was present. DISCUSSION: Some correlates of smoking among Inuit in Inuit Nunangat appear to be sex-specific. Findings from this study identify some of the protective and risk factors for smoking among this population and can help inform smoking prevention and cessation programs.

Family networks and health among Métis aged 45 or older.

BACKGROUND: Social networks are important for promoting and maintaining health and well-being. Social networks, including family and friendship ties, are sources of emotional, practical and other support that enhance social participation and help combat isolation and loneliness. Aboriginal seniors have been identified as a population at risk of social isolation. DATA AND METHODS: The data are from the 2012 Aboriginal Peoples Survey, a national survey of First Nations people living off reserve, Métis, and Inuit. Frequencies, cross-tabulations, and logistic regression models were used to look at family networks and self-perceived general and mental health among Métis aged 45 or older. RESULTS: An estimated 48% of Métis men and 60% of Métis women aged 45 or older had strong family networks. Older age, lower education, and non-participation in the labour force were associated with strong networks. Métis men and women with strong family networks had higher odds than did those with weak networks of reporting positive mental health, even when potential confounders were taken into account. Among Métis men, a relationship between strong family networks and positive general health was also observed. DISCUSSION: Strong family networks are associated with positive self-perceived general and mental health among Métis adults. In addition to individual behaviours, family well-being is important for general health promotion.

Acute care hospitalization of Aboriginal children and youth.

BACKGROUND: Research that has examined Aboriginal children's hospitalization rates at the national level has been limited to analyses of areas with large percentages of Aboriginal residents, rather than of Aboriginal individuals. This study uses linked census and administrative data to describe hospitalization patterns among children and youth aged 0 to 19, by Aboriginal identity, for all provinces and territories except Quebec. DATA AND METHODS: The 2006 Census was linked to the 2006/2007-to-2008/2009 Discharge Abstract Database, which contains hospital records from all acute care facilities (except Quebec). Hospital records were examined by Aboriginal identity, as reported to the census, according to International Classification of Diseases chapters based on "the most responsible diagnosis." Age-standardized hospitalization rates (ASHRs) were calculated per 100,000 population, and age-standardized rate ratios (RRs) were calculated for Aboriginal groups relative to non-Aboriginal people. RESULTS: ASHRs were consistently higher among Aboriginal children and youth relative to their non-Aboriginal counterparts; rates for children aged 0 to 9 were 1.4 to 1.8 times higher; for youth aged 10 to 19, 2.0 to 3.8 times higher. For all children aged 0 to 9, the leading cause of hospitalization was "diseases of the respiratory system," but RRs for Aboriginal children ranged from 1.7 to 2.5, compared with non-Aboriginal children. Disparities between Aboriginal and non-Aboriginal 10- to 19-year-olds were pronounced for injuries due to assaults (RRs from 4.8 to 10.0), self-inflicted injuries (RRs from 2.7 to 14.2), and pregnancy, childbirth and the puerperium (RRs from 4.1 to 9.8). INTERPRETATION: Additional research is needed to examine reasons for the disparities in hospitalization rates between Aboriginal and non-Aboriginal children and youth.

Smoking prevalence among Inuit in Canada.

Using data from the 1991, 2001 and 2012 Aboriginal Peoples Survey, this study examines the prevalence of smoking among Inuit aged 15 or older, by location of residence, sex and age group. Overall, the prevalence of daily smoking was significantly lower in 2012 than in 1991; this was true for Inuit living inside and outside Inuit Nunangat, for men and women, for most age groups, and for those in all Inuit regions except Nunavik. The average number of cigarettes smoked per day by daily smokers decreased steadily and significantly over time, except among those living outside Inuit Nunangat or in Nunavik, and those aged 55 or older. The average age of daily smoking initiation remained stable at 15.

Acute care hospitalization by Aboriginal identity, Canada, 2006 through 2008.

BACKGROUND: National data about acute care hospitalization of Aboriginal people are scarce. This study addresses that information gap by describing patterns of hospitalization by Aboriginal identity for leading diagnoses for all provinces and territories except Quebec. DATA AND METHODS: The 2006 Census was linked to the 2006/2007-to-2008/2009 Discharge Abstract Database, which contains hospital records from all acute care facilities in Canada (excluding Quebec). With these linked data, hospital records could be examined by Aboriginal identity, as reported to the census. Hospitalizations were grouped by International Classification of Diseases (ICD-10) chapters based on "the most responsible diagnosis." Age-standardized hospitalization rates were calculated per 100,000 population, and rate ratios (RR) were calculated for Aboriginal groups relative to non-Aboriginal people. RESULTS: Hospitalization rates were almost invariably higher for First Nations living on and off reserve, Métis, and Inuit living in Inuit Nunangat than for the non-Aboriginal population, regardless of ICD diagnostic chapter. The ranking of age-standardized hospitalization rates by frequency of diagnoses varied slightly by Aboriginal identity. RRs were highest among First Nations living on reserve, especially for endocrine, nutritional and metabolic diseases (RR = 4.9), mental and behavioural disorders (RR = 3.6), diseases of the respiratory system (RR = 3.3), and injuries (RR = 3.2). As well, the rate for endocrine, nutritional and metabolic diseases was high among First Nations living off reserve (RR = 2.7). RRs were also high among Inuit for mental and behavioural disorders (RR = 3.3) and for diseases of the respiratory system (RR = 2.7). INTERPRETATION: Hospitalization rates varied by Aboriginal identity, and were consistent with recognized health disparities between Aboriginal and non-Aboriginal people. Because many factors besides health affect hospital use, further research is required to understand differences in hospital use by Aboriginal identity. These national data are relevant to health policy formulation and service delivery planning.

Validation of the 10-item Kessler Psychological Distress Scale (K10) in the 2012 Aboriginal Peoples Survey.

BACKGROUND: The 10-item Kessler Psychological Distress Scale (K10) is a short measure of non-specific psychological distress, which has been shown to be a sensitive screen for the Diagnostic and Statistical Manual of Mental Disorders criteria for anxiety and mood disorders. The scale has yet to be validated as a measure of psychological distress for Aboriginal peoples in Canada. DATA AND METHODS: Using the 2012 Aboriginal Peoples Survey (APS), this study examined the psychometric properties of the K10 for First Nations people living off reserve, Métis, and Inuit aged 15 or older. The factor structure and internal consistency of the K10 were examined via confirmatory factor analysis and Cronbach's alpha, respectively. Descriptive statistics by sex, education, household income, and age group were provided for the scale. K10 construct validity was further assessed by examining associations with mental health variables in the 2012 APS: self-rated mental health, self-reported diagnosed mood and anxiety disorders, and self-reported suicidal ideation in the past 12 months. RESULTS: A unidimensional "Distress" model with correlated errors was a good fit to the data. Cronbach's alpha values were satisfactory. K10 mean scores were positively skewed, with most respondents reporting few or no distress symptoms. Females and respondents with lower education and household income levels had significantly higher distress. Respondents aged 55 or older had significantly lower distress than their younger counterparts. K10 mean scores were significantly higher for respondents who reported poor mental health, a diagnosed mood disorder, a diagnosed anxiety disorder, or suicidal ideation in the past 12 months. Results were consistent across all three Aboriginal groups. INTERPRETATION: Based on the 2012 APS, the total score of the K10 appears to be psychometrically sound for use as a broad measure of non-specific psychological distress for First Nations people living off reserve, Métis, and Inuit.

Housing and health among Inuit children.

BACKGROUND: Housing conditions have been associated with child health. Inuit children are generally in poorer health than other Canadian children. They are also more likely to live in crowded households, in dwellings that need major repair, and to be exposed to second-hand smoke in the home. DATA AND METHODS: This study uses the 2006 Aboriginal Children's Survey to examine associations between physical and psychosocial housing characteristics and physical and mental health outcomes of Inuit children aged 2 to 5. RESULTS: Physical and psychosocial housing characteristics were associated with selected indicators of Inuit children's health. The presence of a smoker in the home, homeownership, and parental housing satisfaction were associated with specific physical and/or mental health outcomes, even after adjusting for other housing factors and family and child sociodemographic characteristics. INTERPRETATION: Housing conditions were associated with the physical and mental health of young Inuit children, even when sociodemographic factors were taken into account. Homeownership and housing satisfaction appeared to be particularly important for young Inuit children's health.

Unintentional injury hospitalizations and socio-economic status in areas with a high percentage of First Nations identity residents.

BACKGROUND: Few national studies of hospitalizations due to injuries among the First Nations population have been conducted. DATA AND METHODS: Based on 2004/2005 to 2009/2010 data from the Discharge Abstract Database, this study examines associations between unintentional injury hospitalizations, socio-economic status and location relative to an urban core in Dissemination Areas (DAs) with a high percentage of First Nations identity residents versus a low percentage of Aboriginal identity residents. RESULTS: Unintentional injury hospitalization rates were higher in the less affluent and the most remote DAs. When DAs with the same socio-economic status and location were compared, the risk of hospitalizations was greater in high-percentage First Nations identity DAs relative to low-percentage Aboriginal identity DAs. INTERPRETATION: Socio-economic conditions and remote location accounted for some, but not all, of the differences in unintentional injury hospitalizations between high-percentage First Nations identity and low-percentage Aboriginal identity DAs. This suggests that characteristics not measured in this analysis--such as environmental, behavioural or other factors--play an additional role in DA-level unintentional injury hospitalization risk.

The cultural narratives of Francophone and Anglophone Quebecers: using a historical perspective to explore the relationships among collective relative deprivation, in-group entitativity, and collective esteem.

Responding to calls to contextualize social psychological variables in history, the present research examines the relationship between collective relative deprivation and collective esteem using a historical perspective. We hypothesized that collective relative deprivation perceived to be experienced during an important low-point in a group's history serves to define the group's current collective identity, which is in turn associated with collective esteem. In Study 1, cultural narrative interviews were conducted with Francophone and Anglophone Quebecers in order to identify key historical chapters for these groups and to examine the extent to which historical low-points were identity-defining features of their narratives. In Study 2, using the information obtained from these narratives, collective relative deprivation was explored across group members' perceived histories and related to current in-group entitativity and collective esteem. The relationship between collective relative deprivation thought to be experienced by one's group during a historical low-point and collective esteem was positive for both Anglophone and Francophone Quebecers and was mediated by in-group entitativity. Collective relative deprivation perceived to be experienced during a historical low-point serves to define one's collective identity, which is in turn associated with greater collective esteem.