title: The long-term risks of end stage renal disease and mortality among First Nations and non-First Nations people with youth-onset diabetes.
abstract: OBJECTIVE
  To compare the long-term risks of end stage renal disease and death among First Nations and non-First Nations people with youth-onset diabetes.
  
  
  METHODS
  Using Saskatchewan Ministry of Health administrative databases covering the period between 1980 and 2005, we conducted a retrospective cohort study of end stage renal disease and death among youth with diabetes diagnosed before age 20. We developed Fine and Gray sub-distribution hazards models and cumulative incidence functions for the 2 outcomes by First Nations status and duration of diabetes.
  
  
  RESULTS
  Incident cases of youth-onset diabetes were diagnosed in 352 First Nations and 2288 non-First Nations people. Mean ages at diabetes diagnoses were 11.7 and 11.2 years, respectively (p=0.13). Adjusted for sex and age at diabetes diagnosis, the risk for end stage renal disease was 2.59 (95% CI, 1.11-6.04) times higher, and the risk for death 2.64 (95% CI, 1.44-4.87) times higher for First Nations compared to non-First Nations people. After 25 years, the cumulative incidence of end stage renal disease was 12.3% for First Nations people compared to 4.3% in their non-First Nations counterparts. Corresponding mortality rates were 14.6% and 7.2%, respectively.
  
  
  CONCLUSIONS
  First Nations people with youth-onset diabetes experience higher long-term risks for end stage renal disease and death than their non-First Nations counterparts. Early identification of type 2 diabetes and secondary prevention of diabetic nephropathy are feasible short-term goals for this high-risk group. More effective primary prevention initiatives and programs to delay diabetes onset are imperative to reverse current trends.
authors.affiliation: Department of Medicine, University of Saskatchewa, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewa, Saskatchewan, Canada. Electronic address: roland.dyck@usask.ca.
authors.forename: Roland F
authors.initials: RF
authors.lastname: Dyck
authors.affiliation: Ontario Cancer Institute, Toronto, Ontario, Canada.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Community Health and Epidemiology, University of Saskatchewa, Saskatchewan, Canada; Department of Computer Science, University of Saskatchewan, Saskatchewan, Canada.
authors.forename: Nathaniel D
authors.initials: ND
authors.lastname: Osgood
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D006801:Humans; D007198:Indians, North American; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality*; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012525:Saskatchewan / Q000453:epidemiology
keywords: First Nations; Premières Nations; canada; diabète juvénile; disparities; disparités; end stage renal disease; epidemiology; indigenous; indigène; insuffisance rénale terminale; mortality; mortalité; youth-onset diabetes; épidémiologie