Diabetes, Co-morbidities and Health Service Utilization among Miawpukek First Nation

June 2008

KD Collins ,T O'Keefe, D MacDonald, K Sikdar, M Murphy, A Roberts, M Organ, D Benoit

Study Objective and Setting

To examine the prevalence of diabetes, rates of co-morbidities and health service utilization patterns among Miawpukek First Nation living in Newfoundland and Labrador.

Methodology

• Ethics approval

• Written consent

• Chart review– Diabetes Screening– Local health centre

•Data linkage – Chart review– National Diabetes Surveillance System (NDSS)

• Hospitalization data• Physicians claims data

• Analysis– Diabetes prevalence– Comorbidities– Health service utilization

Results

• All Miawpukek aged 20+ in NL were invited to participate• 97% response rate• 95% population included

Study Sample

Contacted Consent Final Sample (linked)

475 460 (96.8%) 453 (95.4%)

Results

Sample Demographic Characteristics

SexAGE

GROUPSAMPLE

n %

Male

20-39 153 33.8

40-64 77 17.0

65+ 16 3.5

Total 246 54.3

Female

20-39 115 25.4

40-64 77 17.0

65+ 15 3.3

Total 207 45.7

Total

20-39 268 59.2

40-64 154 34.0

65+ 31 6.8

Total 453 100.0

Fifty-four per cent 54.3% of the sample were male.

Majority of the sample (59.2%) were 20 to 39 years of age.

Results

Overall prevalence 13%.

Highest among 65+ (45.2%).

Prevalence for females (17.9%) twice that of males (8.9%)

Diabetes Prevalence, 2002/2003

Age Group

Male % (n)

Female% (n)

Total % (n)

20-39 2.6 8.7 5.2 (14)

40-64 15.6 24.7 20.1 (31)

65+ 37.5 53.3 45.2 (14)

Total 8.9 (22) 17.9 (37) 13.0 (59)

Results

Diabetes prevalence among Miawpukek First Nation approx 1.5 times that of the total NL population.

Among females rate more than double.

*Source: National Diabetes Surveillance System

8.9

17.9

13

8.28.4 8.3

0

2

4

6

8

10

12

14

16

18

perc

enta

ge

Miawpukek Newfoundland and Labrador

Diabetes Prevalence, ages 20+, Miawpukek First Nation (on-reserve)

and Newfoundland and Labrador*, 2002/03

Male Female Total

Results

Average number of visits to the local health center was 4.3 per year.

Overall, average number of visits per year was 10.1 and similar for males and females.

Average number of outpatient visits per year was higher for those age 40 years and older.

1

3

5

7

9

11

13

15

Num

ber o

f Vis

its

95/96 96/97 97/98 98/99 99/00 00/01 01/02 02/03

Average Number of Outpatient Visits, Miawpukek Diabetes Population , Age 20 years and older, 1995/96 - 002/03

Local clinic All Visits

* All visits includes visits to local health centre and fee-for-service physicians

Results

Majority of visits were to a nurse (approx 75%) for both males and females.

Physician visits (GP and Specialist) accounted for small proportion of visits (15.3%).

Distribution of Visits by Provider Type, Conne River Health and Social Services, Miawpukek Diabetes

Population, 1995/96-2002/03

9.9%5.4%

9.8%

74.9%

GP Specialist Nurse Dietitian

Note: Nurse includes RN, nurse practitioner and LPN

0

10

20

30

40

50

60

70

80

90

100

Perc

enta

ge

Hypertension Heart Disease Foot Disorder Renal Dysfunction Eye Disorder

Comorbidity Rates, Miawpukek Diabetes Population, 1995/96 - 2002/03

Male Female Total

Results

97% had at least one comorbidity

Most common comorbidities - hypertension (97%) - renal dysfunction (85%)

*percentage having two or more visits to the local health center for the specified condition. If an individual had more than two visits related to the condition over the study period, he/she was counted only once.

Results

Hospitalizations by diabetes status and sex, 1995/96 – 2002/03

*eight year average, expressed per 100,000 population aged 20+

SexDiabetes Cases (n = 59) Non-Diabetes Cases (n = 394)

No. Rate* No. Rate*

Male 35 159,090 81 36,160

Female 44 118,918 140 82,353

Total 79 133,898 221 56,091

Average hospitalization rate was considerably higher for those with diabetes.

Results

Distribution of Hospitalizations by Cause* and Diabetes Status, 1995/96 – 2002/03

Diabetes Non-Diabetes

Disease Chapter % Disease Chapter %

Complications of Pregnancy/Childbirth

19.0 Complications of Pregnancy/Childbirth

37.7

Digestive System Diseases 16.5 Digestive System Diseases 15.4

Circulatory System Diseases 13.9 Respiratory System Diseases 6.1

Other 50.6 Other 40.8

*Most responsible diagnosis; acute care separations only

Hospitalization due to circulatory system diseases was higher among those with diabetes (14% vs 5%).

Limitations• Data on visits to the local health center were collected only for

those who had confirmed diabetes through screening.

• Diabetes screening did not exclude pregnant women, thus diabetes cases identified through screening may include individuals with gestational diabetes.

• Case definition for capturing cormorbidities not validated.

• Average annual rates may include data before and after an individual was identified as a diabetes case.

• Unique isolated population, findings may not be generalizable.

• Given the small population size, not possible to calculate age-standardized prevalence of diabetes.

Facilitators of Success

• Inclusion of the local Director of Health and Social Services and Miawpukek Chief and Council in proposal development.

• Developing a Memorandum of Understanding (MOU).

• Utilizing research staff internal to Conne River Health and Social Services.

• Regular communications between research staff at both sites.

• Discussion of the study results with Miawpukek prior to release.

Summary and Implications• Results support the observation that diabetes is higher in

Aboriginal populations, however lower than reported elsewhere.

• Findings being used by Miawpukek First Nation to support chronic disease and health information management strategies.

• Study can be built upon for continued diabetes surveillance/research, as well as an expansion to other chronic diseases.

• Important partnerships were formed that will be maintained and built upon in future research.

For more information, contact:

Kayla CollinsManager, Research and Evaluation

Newfoundland and Labrador Centre for Health Information

kaylac@nlchi.nl.ca 709-752-6045

www.nlchi.nl.ca