Remote Dwelling Location Is a Risk Factor for CKD Among Indigenous Canadians

Oksana Harasemiw, Shannon Milks, Louise Oakley, Barry Lavallee, Caroline Chartrand, Lorraine McLeod, Michelle Di Nella, Claudio Rigatto, Navdeep Tangri, Thomas Ferguson, Paul Komenda, Oksana Harasemiw, Shannon Milks, Louise Oakley, Barry Lavallee, Caroline Chartrand, Lorraine McLeod, Michelle Di Nella, Claudio Rigatto, Navdeep Tangri, Thomas Ferguson, Paul Komenda

Abstract

Introduction: Rural and remote indigenous individuals have a high burden of chronic kidney disease (CKD) when compared to the general population. However, it has not been previously explored how these rates compare to urban-dwelling indigenous populations.

Methods: In a recent cross-sectional screening study, 1346 adults 18 to 80 years of age were screened for CKD and diabetes across 11 communities in rural and remote areas in Manitoba, Canada, as part of the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) program. An additional 284 Indigenous adults who resided in low-income areas in the city of Winnipeg, Manitoba, Canada were screened as part of the NorWest Mobile Diabetes and Kidney Disease Screening and Intervention Project.

Results: Our findings indicate that a gradient of CKD and diabetes prevalence exists for Indigenous individuals living in different geographic areas. Compared to urban-dwelling Indigenous individuals, rural-dwelling individuals had more than a 2-fold (2.1, 95% CI = 1.4-3.1) increase in diabetes whereas remote-dwelling individuals had a 4-fold (4.1, 95% CI = 2.8-6.0) increase, and more than a 3-fold (3.1, 95% CI = 2.2-4.5) increase in CKD prevalence.

Conclusion: Although these results highlight the relative importance of geography in determining the prevalence of diabetes and CKD in Indigenous Canadians, geography is but an important surrogate of other determinants, such as poverty and access to care.

Keywords: Indigenous Canadians; chronic kidney disease; remoteness; rurality; screening; social determinants of health.

Figures

Figure 1
Figure 1
Initial risk classification of urban-dwelling Indigenous Canadian individuals, using the Kidney Disease: Improving Global Outcomes (KDIGO) classification system. eGFR, estimated glomerular filtration rate.
Figure 2
Figure 2
Initial risk classification of rural-dwelling Indigenous Canadian individuals, using the Kidney Disease: Improving Global Outcomes (KDIGO) classification system. eGFR, estimated glomerular filtration rate.
Figure 3
Figure 3
Initial risk classification of remote-dwelling Indigenous Canadian individuals, using the Kidney Disease: Improving Global Outcomes (KDIGO) classification system. eGFR, estimated glomerular filtration rate.

References

    1. Young T.K., Reading J., Elias B., O’Neil J.D. Type 2 diabetes mellitus in Canada’s First Nations: status of an epidemic in progress. CMAJ. 2000;163:561–566.
    1. Dyck R., Osgood N., Hsiang T. Epidemiology of diabetes mellitus among First Nations and non-First Nations adults. CMAJ. 2010;182:249–256.
    1. Bruce S.G., Riediger N.D., Zacharias J.M., Young T.K. Obesity and obesity-related comorbidities in a Canadian First Nation population. Chron Dis Can. 2010;31:27–32.
    1. Gao S., Manns B.J., Culleton B.F. Prevalence of chronic kidney disease and survival among aboriginal people. J Am Soc Nephrol. 2007;18:2953–2959.
    1. Zacharias J.M., Young T.K., Riediger N.D. Prevalence, risk factors and awareness of albuminuria on a Canadian First Nation: a community-based screening study. BMC Public Health. 2012;12:1–8.
    1. Samuel S.M., Palacios-Derflingher L., Tonelli M. Association between First Nations ethnicity and progression to kidney failure by presence and severity of albuminuria. CMAJ. 2014;186:E86–E94.
    1. Black C., Sharma P., Scotland G. Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis. Health Technol Assess (Rockv) 2010;14:1–184.
    1. Gracey M., King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374:65–75.
    1. King M., Smith A., Gracey M. Indigenous health part 2: the underlying causes of the health gap. Lancet. 2009;374:76–85.
    1. Johnson J.A., Vermeulen S.U., Toth E.L. Increasing incidence and prevalence of diabetes among the status of Aboriginal population in urban and rural Alberta. Can J Public Health. 2009;100:231–236.
    1. Newbold K.B. Problems in search of solutions: health and Canadian Aboriginals. J Community Health. 1998;23:59–74.
    1. Richmond C.A.M., Ross N.A. The determinants of First Nation and Inuit health: a critical population health approach. Health Place. 2009;15:403–411.
    1. Lavallee B., Chartrand C., McLeod L. Mass screening for chronic kidney disease in rural and remote Canadian First Nations people: methodology and demographic characteristics. Can J Kidney Health Dis. 2015;2:1–10.
    1. Lavoie JG, Gervais L, Toner J, et al. Looking for aboriginal health in legislation and policies, 1970 to 2008: the Policy Synthesis Project. Prince George, British Columbia: The National Collaborating Centre for Aboriginal Health; 2011.
    1. Tangri N., Stevens L., Griffith J. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305:1553.
    1. Levey A.S., de Jong P.E., Coresh J. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int. 2011;80:17–28.
    1. Komenda P., Lavallee B., Ferguson T.W. The prevalence of CKD in rural Canadian Indigenous peoples: results from the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) Screen, Triage, and Treat Program. Am J Kidney Dis. 2016;68:582–590.
    1. Arora P., Vasa P., Brenner D. Prevalence estimates of chronic kidney disease in Canada: results of a nationally representative survey. CMAJ. 2013;185:E417–E423.
    1. Rosella L.C., Lebenbaum M., Fitzpatrick T., Zuk A., Booth G.L. Prevalence of prediabetes and undiagnosed diabetes in Canada (2007–2011) according to fasting plasma glucose and HbA1c screening criteria. Diabetes Care. 2015;38:1299–1305.
    1. Hillege H.L., Janssen W.M.T., Bak A.A.A. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med. 2001;249:519–526.
    1. Coresh J., Selvin E., Stevens L.A. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–2047.
    1. Takahashi S., Okada K., Yanai M. The Kidney Early Evaluation Program (KEEP) of Japan: results from the initial screening period. Kidney Int. 2010;77(suppl 116):S17–S23.
    1. Bello A.K., Nwankwo E., El Nahas A.M. Prevention of chronic kidney disease: a global challenge. Kidney Int Suppl. 2005;68:11–17.
    1. Obrador G.T., García-García G., Villa A.R. Prevalence of chronic kidney disease in the Kidney Early Evaluation Program (KEEP) México and comparison with KEEP US. Kidney Int. 2010;77(suppl 116):S2–S8.
    1. Crews D.C., McClellan W.M., Shoham D.A. Low income and albuminuria among REGARDS (Reasons for Geographic and Racial Differences in Stroke) study participants. Am J Kidney Dis. 2012;60:779–786.
    1. Mathew T.H., Corso O., Ludlow M. Screening for chronic kidney disease in Australia: a pilot study in the community and workplace. Kidney Int. 2010;77(suppl 116):S9–S16.
    1. Virani S., Strong D., Tennant M. Rationale and implementation of the SLICK project: Screening for Limb, I-eye, Cardiovascular and Kidney (SLICK) complications in individuals with type 2 diabetes in Alberta’s First Nations communities. Can J Public Health. 2006;97:241–247.
    1. Shah V.O., Scavini M., Stidley C.A. Epidemic of diabetic and nondiabetic renal disease among the Zuni Indians: the Zuni Kidney Project. J Am Soc Nephrol. 2003;14:S1320–S1329.
    1. Hoy W., Jim S., Warrington W. Urinary findings and renal function in adult Navajo Indians and associations with type 2 diabetes. Am J Kidney Dis. 1996;28:339–349.
    1. Nelson R.G., Kunzelman C.L., Pettitt D.J. Albuminuria in type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance in Pima Indians. Diabetologia. 1989;32:870–876.
    1. Menec V., Sirski M., Attawar D. Does continuity of care matter in a universally insured population? Health Serv Res. 2005;40:389–400.
    1. Menec V., Roos N., Black C., Bogdanovich B. Characteristics of patients with a regular source of care. Can J Public Health. 2001;92:299–303.
    1. Starfield B., Shi L., Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502.
    1. Pong R.W., DesMeules M., Lagace C. Rural-urban disparities in health: how does Canada fare and how does Canada compare with Australia? Aust J Rural Health. 2009;17:58–64.
    1. Cass A., Cunningham J., Snelling P. Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians. Soc Sci Medi. 2004;58:767–785.
    1. Rucker D., Hemmelgarn B.R., Lin M. Quality of care and mortality are worse in chronic kidney disease patients living in remote areas. Kidney Int. 2011;79:210–217.
    1. Smith K.B., Humphreys J.S., Wilson M.G.A. Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research? Aust J Rural Health. 2008;16:56–66.
    1. Czyzewski K. Colonialism as a broader social determinant of health. Int Indig Policy J. 2011;2:1–14.
    1. Marrone S. Understanding barriers to health care: a review of disparities in health care services among indigenous populations. Int J Circumpolar Health. 2007;66:188–198.
    1. Willows N.D., Veugelers P., Raine K., Kuhle S. Prevalence and sociodemographic risk factors related to household food security in Aboriginal peoples in Canada. Public Health Nutr. 2008;12:1150–1156.
    1. Banerjee T., Crews D.C., Wesson D.E. Food insecurity, CKD, and subsequent ESRD in US Adults. Am J Kidney Dis. 2017;70:38–47.
    1. Seligman H.K., Jacobs E.A., Lopez A. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care. 2012;35:233–238.
    1. Skinner K., Hanning R.M., Tsuji L.J. Prevalence and severity of household food insecurity of First Nations people living in an on-reserve, sub-Arctic community within the Mushkegowuk Territory. Public Health Nutr. 2014;17:31–39.
    1. Thompson S., Kamal A.G., Wiebe J. Community development to feed the family in Northern Manitoba communities: evaluating food activities based on their food sovereignty, food security, and sustainable livelihood outcomes. Can J Nonprofit Soc Econ Res. 2012;3:43–66.
    1. Martens P.J., Martin B.D., O’Neil J.D., MacKinnon M. Diabetes and adverse outcomes in a First Nations population: associations with healthcare access, and socioeconomic and geographical factors. Can J Diabetes. 2007;31:223–232.
    1. Martens P., Sanderson D., Jebamani L. Health services use of Manitoba First Nations people: is it related to underlying need? Can J Public Health. 2005;96:S39–S44.
    1. Tang S.Y., Browne A.J. “Race” matters: racialization and egalitarian discourses involving Aboriginal people in the Canadian health care context. Ethn Health. 2008;13:109–127.
    1. Goodman A., Fleming K., Markwick N. “They treated me like crap and I know it was because I was Native”: the healthcare experiences of Aboriginal peoples living in Vancouver’s inner city. Soc Sci Med. 2017;178:87–94.
    1. Allan B, Smylie J. First Peoples, Second Class Treatment: The Role of Racism in the Health and Well-Being of Indigenous Peoples in Canada. Toronto, ON: The Wellesley Institute; 2015.
    1. Bourassa C., McKay-McNabb K., Hampton M. Racism, sexism, and colonialism: the impact on the heath of Aboriginal women in Canada. Can Woman Stud. 2004;24:23–30.
    1. Wilk P., Maltby A., Cooke M. Residential schools and the effects on Indigenous health and well-being in Canada—a scoping review. Public Health Rev. 2017;38:1–23.
    1. Ferguson T.W., Tangri N., Tan Z. Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective. Kidney Int. 2017;92:192–200.
    1. Bailie J., Schierhout G., Laycock A. Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians. BMJ Open. 2015;5:e008103.
    1. Komenda P., Ferguson T.W., Macdonald K. Cost-effectiveness of primary screening for CKD: a systematic review. Am J Kidney Dis. 2014;63:789–797.

Source: PubMed

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