Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Can J Public Health. 2024 Nov;115(Suppl 2):288-300. doi: 10.17269/s41997-022-00669-x. Epub 2022 Aug 9.
Studies have highlighted the inequities between the Indigenous and non-Indigenous populations with respect to the burden of cardiovascular disease and prevalence of predisposing risks resulting from historical and ongoing impacts of colonization. The objective of this study was to investigate factors associated with cardiovascular disease (CVD) within and specific to the Indigenous peoples living in Toronto, Ontario, and to evaluate the reliability and validity of the resulting model in a similar population.
The Our Health Counts Toronto study measured the baseline health of Indigenous community members living in Toronto, Canada, using respondent-driven sampling. An iterative approach, valuing information from the literature, clinical insight and Indigenous lived experiences, as well as statistical measures was used to evaluate candidate predictors of CVD (self-reported experience of discrimination, ethnic identity, health conditions, income, education, age, gender and body size) prior to multivariable modelling. The resulting model was then validated using a distinct, geographically similar sample of Indigenous people living in Hamilton, Ontario, Canada.
The multivariable model of risk factors associated with prevalent CVD included age, diabetes, hypertension, body mass index and exposure to discrimination. The combined presence of diabetes and hypertension was associated with a greater risk of CVD relative to those with either condition and was the strongest predictor of CVD. Those who reported previous experiences of discrimination were also more likely to have CVD. Further study is needed to determine the effect of body size on risk of CVD in the urban Indigenous population. The final model had good discriminative ability and adequate calibration when applied to the Hamilton sample.
Our modelling identified hypertension, diabetes and exposure to discrimination as factors associated with cardiovascular disease. Discrimination is a modifiable exposure that must be addressed to improve cardiovascular health among Indigenous populations.
研究强调了在心血管疾病负担和由于殖民化的历史和持续影响而导致的易患风险的流行方面，原住民和非原住民之间的不平等。本研究的目的是调查安大略省多伦多市的原住民人群中与心血管疾病（CVD）相关的因素，并评估该模型在类似人群中的可靠性和有效性。
使用 respondent-driven sampling 方法，我们的健康计数多伦多研究衡量了生活在加拿大多伦多的原住民社区成员的基线健康状况。采用迭代方法，重视文献、临床见解和原住民生活经验以及统计措施中的信息，评估 CVD 的候选预测因素（自我报告的歧视经历、族裔认同、健康状况、收入、教育、年龄、性别和体型），然后进行多变量建模。然后使用加拿大安大略省汉密尔顿市的一个独特的、地理位置相似的原住民人群样本对所得模型进行验证。
与普遍 CVD 相关的风险因素的多变量模型包括年龄、糖尿病、高血压、体重指数和歧视暴露。与仅存在一种疾病的人相比，同时患有糖尿病和高血压的人患 CVD 的风险更高，并且是 CVD 的最强预测因素。那些报告以前有过歧视经历的人也更有可能患有 CVD。需要进一步研究确定体型对城市原住民人群 CVD 风险的影响。最终模型在应用于汉密尔顿样本时具有良好的判别能力和足够的校准。
我们的模型确定了高血压、糖尿病和歧视暴露是与心血管疾病相关的因素。歧视是一种可改变的暴露，必须加以解决，以改善原住民人口的心血管健康。
