Chapter 4: Life with arthritis in Canada: a personal and public health challenge – Arthritis among First Nations, Métis and Inuit

Chapter Four: Arthritis among First Nations, Métis and Inuit

Table of Contents

• Introduction
• First Nations
  • First Nations People Living On-Reserve
  • First Nations People Living Off-Reserve
• Métis
• Inuit
• Summary

Introduction

According to the 2006 census, over one million people in Canada identify themselves as First Nations (698,025 status and non-status), as Métis (389,780) or Inuit (50,480) which represents about 3.6% of the total Canadian population. This percentage, however, likely underestimates the true numbers due to the fact that enumeration was not completed on 22 reserves.^{Footnote 1}

Of the three Aboriginal populations, the Métis experienced the greatest increase in population (91%) between 1996 and 2006. This is more than three times the increase in the number of First Nations people (29%) and the Inuit (26%) population.^{Footnote 1} Several factors contributed to the large increases observed in the Aboriginal populations (particu- larly in the Métis population) including a high birth rate, an increase in the number of individuals self- identifying as Aboriginal (in response to political and social events) and an increase in the number of completely enumerated First Nations reserves.

First Nations

The majority of First Nations currently live in Ontario and the western provinces and approximately 60% live off-reserve. Half of the First Nations people living across Canada are under 25 years of age.^{Footnote 1}

The two sources of data used to provide information on arthritis among First Nations in Canada are: the Canadian Community Health Survey (CCHS) for people who self-identified as being First Nations and who lived off-reserve; and the First Nations Regional Longitudinal Survey (RHS) for people living on-reserve.

First Nations People Living On-Reserve

According to the RHS, the top five most widely reported conditions among First Nations adults in 2002-2003 were arthritis/rheumatism, allergies, high blood pressure, diabetes and chronic back pain - conditions that are also very common in the non-Aboriginal adult population.^{Footnote 2}

In 2002-2003, 19% of First Nations adults aged 20 years and older living on-reserve (79,400 people) reported having been diagnosed with arthritis/rheumatism. The percentage of individuals with arthritis/rheumatism increased with increasing age and arthritis was more common among women than men in every age group (Figure 4-1). Close to two-thirds (64%) of First Nations adults living on-reserve who had arthritis/rheumatism were 30–59 years of age.

The 2002-2003 age-standardized (adjusted for differences in age distribution) prevalence estimate for arthritis/rheumatism in on-reserve First Nations adults aged 20 years and older was 1.3 times higher than the 2003 age-standardized estimate for arthritis in the Canadian population aged 20 years and older.

Among First Nations adults living on-reserve who had arthritis/rheumatism, 60% (55% men and 64% women) reported the need to limit either their amount or kind of activities as a result of their condition. Similar findings were reported by the Manitoba First Nations Regional Longitudinal Health Survey (MFN Survey) which also showed a high frequency of activity limitations among First Nations with arthritis living on-reserve (68% reported limitations due to any type of arthritis).^{Footnote 3}

Fifty-three percent of First Nations adults living on- reserve who had arthritis/rheumatism (47% women and 57% men) stated that they were currently receiving treatment or taking medications for their condition. Health status and access to health care services are influenced by geography.^{Footnote 4} Since on- reserve health services may be provided in the form of a resident community health representative and a doctor who flies in on a semi-regular basis, not all services can be obtained in the communities in which people live.^{Footnote 2 Footnote 4} First Nations populations living on-reserve, especially those who live in rural and remote communities, often face barriers in accessing medical care. These barriers can include high transportation costs, language issues and lack of available services.^{Footnote 2}

First Nations People Living Off-Reserve

In 2007-2008, 17.7% of First Nations adults aged 15 years and older living off-reserve (71,704 people) reported having been diagnosed with arthritis. The percentage of individuals with arthritis increased with increasing age (Figure 4-2) and overall arthritis was more commonly reported in women (19.9%) compared to men (15.3%). Close to two-thirds (61%) of First Nations adults living off-reserve who had arthritis were between 30 to 59 years of age.

The 2007-2008 age-standardized prevalence estimate for arthritis in off-reserve First Nations adults aged 15 years and older was 1.3 times higher than the 2007-2008 age-standardized estimate for arthritis in the Canadian population aged 15 years and older.

Métis

The Métis population was formed from the community of French fur traders and Cree women in the Prairies, and of English and Scottish traders and Dene women in the North. Currently, most individuals who self-identify as being Métis mainly live in urban centres in Ontario (73,605), Manitoba (71,805), Saskatchewan (48,120), Alberta (85,495) and British Columbia (59,445). Half of the Métis living in Canada are under 30 years of age.^{Footnote 1}

According to the 2006 Aboriginal Peoples Survey (APS) the most commonly reported chronic health conditions among Métis aged 15 years and older were arthritis/rheumatism (21%) followed by high blood pressure (16%) and asthma (14%). Métis women were more likely than men to report arthritis/rheumatism (24% and 18%, respectively). The prevalence of arthritis/rheumatism increased with increasing age (Figure 4-3).^{Footnote 5}

The 2006 prevalence estimate for self-reported arthritis/rheumatism in Métis adults was 1.6 times higher than the 2005 CCHS estimate for arthritis/rheumatism in the total Canadian population after adjusting for the younger Métis population.^{Footnote 5}

Inuit

Most Inuit live in the northern regions of Canada — including Nunavut (24,635), Nunavik in northern Quebec (9,565), the Inuvialuit region in the Northwest Territories (3,115) and Nunatsiavut in northern Labrador (4,715). Approximately 17% (8,582) of all Inuit live in large urban centres in southern Canada. Half of the Inuit living in Canada are under 22 years of age.¹

The 2006 APS collected information from Inuit people in the four Inuit regions across the north and from those in southern Canada and provides arthritis estimates at the national level.^{Footnote 6}

According to the 2006 APS, the most commonly reported diagnosed chronic conditions among Inuit adults aged 15 years and older were arthritis/ rheumatism (13%) and high blood pressure (12%). These figures were similar to those of the total Canadian population after adjusting for differences in age. Arthritis/rheumatism were more common among Inuit women compared to men (16% and 10% respectively).^{Footnote 6} The lower prevalence estimate for arthritis/rheuma- tism in the Inuit population compared to the other Aboriginal populations may be due to under diagnosis. The majority of Inuit live in the Canadian Arctic where there is less contact with health care professionals so many may go undiagnosed.^{Footnote 6 Footnote 7} As well, the Inuit population is younger than the other Aboriginal populations and generally, those in younger age groups are less likely to report chronic conditions.^{Footnote 7} Furthermore, the Inuit's genetic predisposition as well as their high dietary intakes of fish (i.e., omega-3) may have a protective effect against inflammatory and autoimmune disorders.^{Footnote 8 Footnote 9}

The true prevalence of arthritis for all three Aboriginal populations is likely underestimated, as those who do not see a health care professional for their symptoms and whose symptoms remain undiagnosed will not be included in these estimates.^{Footnote 7} Similar to the overall Canadian population, Aboriginal men are generally less likely than women to have contact with health care professionals.^{Footnote 10} Furthermore, it is possible that individuals may not realize that some health conditions such as gout or lupus are forms of arthritis and, consequently, not report that they have arthritis.

Summary

• Arthritis is one of the most prevalent chronic diseases in First Nations, on-and off-reserve (19% and 18% respectively), Inuit (13%) and Métis (21%).
• The arthritis prevalence estimate for First Nations adults living on-reserve, First Nations adults living off-reserve, and Métis adults was 1.3-1.6 times higher than the national estimate for arthritis in the Canadian adult population, after adjusting for differences in the age distribution in these populations.
• The prevalence estimate of arthritis/rheumatism in the Inuit population was similar to the total Canadian population after age standardization.
• The prevalence of arthritis was higher among women compared to men in all three Aboriginal populations.
• Close to two-thirds of First Nations living on- and off-reserve reporting arthritis were between 30–59 years of age (64% and 61%, respectively).
• Sixty percent of First Nations living on-reserve reported the need to limit either the amount or kind of activities as a result of arthritis/rheumatism.
• Fifty-three percent of First Nations living on-reserve stated that they were currently receiving treatment or taking medications for arthritis/rheumatism.
• All three Aboriginal populations have a young and growing population as a result, the prevalence of arthritis is expected to increase over time.