Academic journal article Canadian Journal of Public Health

Incidence and Prevalence of Type 2 Diabetes in the First Nation Community of Kahnawá:ke, Quebec, Canada, 1986-2003

Academic journal article Canadian Journal of Public Health

Incidence and Prevalence of Type 2 Diabetes in the First Nation Community of Kahnawá:ke, Quebec, Canada, 1986-2003

Article excerpt


Background: Type 2 diabetes is an increasing global health concern, most notably for Aboriginal peoples living in Canada among whom prevalence rates are 3 to 5 times those of the general population. The objective of this study is to determine the incidence and prevalence of type 2 diabetes among adults living in a First Nation community from 1986 to 2003.

Methods: Kahnawá:ke is a Kanien'kehá:ka (Mohawk) community in Quebec, Canada. Numerators for incident and prevalent cases were derived from the community hospital Diabetes Registry. Denominators were derived from population distributions provided to Kahnawá:ke by Indian and Northern Affairs Canada. Rates were standardized to 2000/01 Canadian population.

Results: From 1986-88 to 2001-03, incidence rates per 1000 for those 18 years and over decreased from 8.8 to 7.0 in males, and 8.8 to 5.2 in females. Prevalence rates increased from 6.0% to 8.4% in males and 6.4% to 7.1% in females. The prevalence rate among Kahnawá:ke men aged 45-64 years was 14%, twice the corresponding rate among Canadian men. Male to female ratios for both incidence and prevalence rates were above 1.0.

Discussion: Kahnawá:ke incidence rates are much lower than those of First Nation peoples of Manitoba. Kahnawá:ke prevalence rates are midway between national Aboriginal and general Canadian populations. Kahnawá:ke incidence rates and gender ratios are closer to those of the Canadian population. The results highlight the variations of type 2 diabetes between individual communities, and may reflect Kahnawá:ke's socio-economic status, ongoing diabetes education, clinical care and diabetes primary prevention efforts.

MeSH terms: Type 2 diabetes mellitus; incidence; prevalence; Indians: North American

Incidence and prevalence of type 2 diabetes are increasing and the average age of onset is decreasing worldwide.1-5 For Aboriginal peoples* in Canada, the ageand sex-adjusted prevalence of type 2 diabetes is three to five times higher compared to the general population,6,7 and the only prior incidence study documented a high incidence of type 2 diabetes.8

Kateri Memorial Hospital Centre (KMHC) is the largest health care facility in Kahnawá:ke, a Kanien'kehá:ka (Mohawk) community (population 7,153 in 2001) located 15 kilometres southwest of Montreal. In the mid-1980s, studies documented a high prevalence of Type 2 diabetes and associated macro-vascular complications in the community.9-11

Resulting increased awareness of diabetes from these studies12,13 prompted development and implementation of planned diabetes primary and secondary prevention efforts.14,15 Persons with diabetes (type 1, 2, or gestational) or prediabetes are routinely offered referral to the Diabetes Nurse Educator who, starting in 1985, has maintained a Diabetes Registry that includes name, gender, date of birth, type of diabetes or pre-diabetes, and date of diagnosis. Using the Diabetes Registry, this descriptive study was undertaken to document the incidence and prevalence of diabetes in Kahnawá:ke from 1986 to 2003, compare incidence in Kahnawá:ke with another Aboriginal diabetes incidence study in Canada, and to compare prevalence with previous Canadian and Kahnawá:ke studies.9


Case ascertainment

The cases are patients listed on the KMHC Diabetes Registry who met inclusion criteria: Kahnawá:ke community members, aged 18 years and over, and diagnosed with type 2 diabetes according to national guidelines. The KMHC Diabetes Registry was computerized in 2004, when the hospital charts of all 694 individuals entered onto the registry were reviewed for date of birth, date of diagnosis, gender, and age of death when appropriate.

Validation of KMHC Diabetes Registry

In 1999, to determine the completeness of the KMHC Diabetes Registry, 12% (n=648) of KMHC hospital charts for patients aged 15 years and over for 1985-1997 were systematically reviewed for Type 2 diabetes by Kanien'kehá:ka nurses blinded to the registry. …

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