Demographic risk factors for fracture in First Nations people.
BACKGROUND
Recently, First Nations people were shown to be at high fracture risk compared with the general population. However, factors contributing to this risk have not been examined. This analysis focusses on geographic area of residence, income level, and diabetes mellitus as possible explanatory variables since they have been implicated in the fracture rates observed in other populations.


METHODS
A retrospective, population-based matched cohort study of fracture rates was performed using the Manitoba administrative health data (1987-1999). The First Nations cohort included all Registered First Nations adults (20 years or older) as indicated in either federal and/or provincial files (n = 32,692). Controls (up to three for each First Nations subject) were matched by year of birth, sex and geographic area of residence. After exclusion of unmatched subjects, analysis was based upon 31,557 First Nations subjects and 79,720 controls.


RESULTS
Overall and site-specific fracture rates were significantly higher in the First Nations cohort. Income quintile, geographic area of residence, and diabetes were fracture determinants but the excess fracture risk of First Nations ethnicity persisted even after adjustment for these factors.


CONCLUSIONS
First Nations people are at high risk for fracture but the causal factors contributing to this are unclear. Further research is needed to evaluate the importance of other potential explanatory variables.
Leslie
William D
WD
Department of Medicine, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6. bleslie@sbgh.mb.ca
Derksen
Shelley A
SA
Metge
Colleen
C
Lix
Lisa M
LM
Salamon
Elizabeth A
EA
Steiman
Pauline Wood
PW
Roos
Leslie L
LL
D000328:Adult; D017677:Age Distribution; D016022:Case-Control Studies; D016001:Confidence Intervals; D003920:Diabetes Mellitus; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007182:Income; D007198:Indians, North American; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution