Abstract

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Background

Living in a community with lower socioeconomic status is associated with higher mortality. However, few studies have examined associations between community socioeconomic characteristics and mortality among the First Nations population.

Data and Methods

The 1991-to-2006 Census Mortality and Cancer Cohort follow-up, which tracked a 15% sample of Canadians aged 25 or older, included 57,300 respondents who self-identified as Registered First Nations people or Indian band members. The Community Well-Being Index (CWB), a measure of the social and economic well-being of communities, consists of income, education, labour force participation, and housing components. A dichotomous variable was used to indicate residence in a community with a CWB score above or below the average for First Nations communities. Age-standardized mortality rates (ASMRs) were calculated for First Nations cohort members in communities with CWB scores above and below the First Nations average. Cox proportional hazards models examined the impact of CWB when controlling for individual characteristics.

Results

The ASMR for First Nations cohort members in communities with a below-average CWB was 1,057 per 100,000 person-years at risk, compared with 912 for those in communities with an above-average CWB score. For men, living in a community with below-average income and labour force participation CWB scores was associated with an increased hazard of death, even when individual socioeconomic characteristics were taken into account. Women in communities with below-average income scores had an increased hazard of death.

Interpretation

First Nations people in communities with below-average CWB scores tended to have higher mortality rates. For some components of the CWB, effects remained even when individual socioeconomic characteristics were taken into account.

Keywords

Aboriginal health, age-standardized mortality rates, cohort studies, community, data linkage, indigenous, longitudinal studies, rate ratios, socioeconomic

Findings

Aboriginal groups in Canada experience higher rates of mortality and morbidity than do non-Aboriginal people. A number of studies have compared the health status of Aboriginal and non-Aboriginal populations, but few have explored the broader determinants of health and mortality among Aboriginal populations. [Full Text]

Authors

Lisa N. Oliver (lisa.oliver@canada.ca) is with the Statistics Canada Regional Office in Vancouver, British Columbia. Chris Penney is with Indigenous and Northern Affairs Canada. Paul A. Peters is with the Departments of Sociology and Economics at the University of New Brunswick.

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What is already known on this subject?

  • Living in a community with lower socioeconomic status is associated with higher mortality.
  • Aboriginal groups experience higher rates of mortality than do non-Aboriginal people.
  • Few studies have specifically examined the impact of community characteristics on mortality among Aboriginal populations in Canada.

What does this study add?

  • The Community Well-Being index (CWB) is a measure of social and economic conditions incommunities; it consists of education, labour force, income, and housing components.
  • Based on data for the 1991-to-2006 Census Mortality and Cancer Cohort, this study examines the influence of community factors as measured by the CWB and individual characteristics on the mortality of individuals identified as Registered First Nations people or Indian band members.
  • Living in a community with a below-average score on the CWB income component was associated with an increased hazard of death for men (20%) and women (15%), even when individual socioeconomic characteristics were taken into account.
  • For men, regardless of individual socioeconomic characteristics, residence in a community with a below-average score on the CWB labour force component was associated with an increase (7%) in the hazard of death; this was not the case for women.

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