• Jennifer D Walker, Morgan Slater, Carmen R Jones, Baiju R Shah, Eliot Frymire, Shahriar Khan, Kristen Jacklin, and Michael E Green.
• School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; ICES Central (Walker, Shah), Toronto, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; ICES Queen's (Frymire, Khan, Green), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn. jenniferwalker@laurentian.ca.
• CMAJ. 2020 Feb 10; 192 (6): E128E135E128-E135.

BackgroundDiabetes mellitus is an established health concern in First Nations communities and is associated with complex influences of colonization. This study, a partnership between First Nations and academic researchers, was undertaken to determine patterns of diabetes prevalence, incidence and mortality in Ontario.MethodsUsing health services and population data from Ontario for 1995 to 2014, linked with the federal Indian Register, we calculated age- and sex-adjusted annual estimates of diabetes prevalence, incidence and mortality for First Nations people (living within and outside First Nations communities) and other people in Ontario. We also examined age- and sex-specific crude diabetes prevalence.ResultsBetween 1995 and 2014, the prevalence of diabetes increased and the incidence decreased somewhat in all populations. Both prevalence and incidence were substantially higher among First Nations people than among other people in Ontario. In particular, First Nations women had higher prevalence than other women (4.2% v. 1.6% for ages 20-34 yr and 17.6% v. 6.0% for ages 35-49 yr). The lifetime risk of diabetes was higher among First Nations people than among other people in Ontario (57.0%, 95% confidence interval [CI] 56.3%-57.6% v. 44.5%, 95% CI 44.4%-44.6%). Over time, all-cause mortality for those with diabetes declined but remained consistently higher for First Nations people than for other people in Ontario.InterpretationDiabetes is more common among First Nations people than among other people in Ontario, particularly at younger ages and in women. First Nations-led approaches to address the high prevalence of diabetes in younger First Nations women have the potential to improve metabolic health across generations.© 2020 Joule Inc. or its licensors.

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