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The interaction of ethnicity and chronic disease as risk factors for osteoporotic fractures: a comparison in Canadian Aboriginals and non-Aboriginals

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Abstract

Introduction

Efforts to develop global methods for absolute fracture risk prediction are currently limited by uncertainty over the validity of these models in non-White populations. Aboriginal Canadians have higher fractures rates than non-Aboriginals. This analysis examined the interaction of ethnicity with diabetes mellitus, disease comorbidity and substance abuse as possible explanatory variables.

Methods

A retrospective, population-based matched cohort study of fracture rates was performed using Manitoba administrative health data (1984–2003). The study cohort consisted of 27,952 registered Aboriginal adults (aged 20 years or older) and 83,856 non-Aboriginal controls (matched three to one for year of birth and gender). Diabetes mellitus, number of ambulatory disease groups (ADGs), substance abuse and incident fractures were based upon validated definitions. Poisson regression analyses of fracture rates modelled the explanatory variables as main effects and two-way interactions with ethnicity.

Results

Osteoporotic fracture rates were approximately twofold higher in the Aboriginal cohort (p<0.0001). Diabetes, greater number of ADGs and substance abuse were all more common in the Aboriginal cohort (all p<0.0001). These factors were associated with increased fracture rates (all p<0.0001) and significantly higher population attributable risk percent in the Aboriginal cohort (all p<0.0001). However, no significant interactions between the risk factors and ethnicity were observed (p>0.1 for all interaction effects).

Conclusion

Greater prevalence of diabetes, comorbidity and substance abuse contributes to higher rates of fracture. The relative risk of fracture for these factors is similar for both Aboriginal and non-Aboriginals despite large differences in absolute fracture risk and risk factor prevalence.

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Notes

  1. In Canada, the terms Aboriginal or Native are used to refer to “Indians” and include First Nations, Metis and Inuit peoples. First Nations are Aboriginal peoples signatory to treaties and/or recognized by the federal government as a fiduciary responsibility. This paper reports on data derived exclusively from First Nations populations which represent the large majority of Aboriginal persons living in Canada.

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Acknowledgements

Supported by a research grant from the Canadian Institutes for Health Research. The authors are indebted to Manitoba Health for providing the data used in this study, to the First Nations and Inuit Health Branch and Indian and Northern Affairs Canada for permission to use the Status Verification System, and to the Health Information Research Committee of the Assembly of Manitoba Chiefs for actively supporting this work. The results and conclusions are those of the authors, and no official endorsement by Manitoba Health or the Assembly of Manitoba Chiefs is intended or should be inferred.

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Authors and Affiliations

  1. Department of Medicine, University of Manitoba, Winnipeg, Canada

    W. D. Leslie

  2. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada

    S. Derksen, H. J. Prior, L. M. Lix & C. Metge

  3. Centre for Aboriginal Health Research, University of Manitoba, Winnipeg, Canada

    J. O’Neil

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  1. W. D. Leslie
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  2. S. Derksen
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  3. H. J. Prior
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  4. L. M. Lix
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  5. C. Metge
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Correspondence to W. D. Leslie.

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Leslie, W.D., Derksen, S., Prior, H.J. et al. The interaction of ethnicity and chronic disease as risk factors for osteoporotic fractures: a comparison in Canadian Aboriginals and non-Aboriginals. Osteoporos Int 17, 1358–1368 (2006). https://doi.org/10.1007/s00198-006-0111-4

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