Authors: W D Leslie S Derksen H J Prior L M Lix C Metge J O’Neil
Publish Date: 2006/06/13
Volume: 17, Issue: 9, Pages: 1358-1368
Abstract
Efforts to develop global methods for absolute fracture risk prediction are currently limited by uncertainty over the validity of these models in nonWhite populations Aboriginal Canadians have higher fractures rates than nonAboriginals This analysis examined the interaction of ethnicity with diabetes mellitus disease comorbidity and substance abuse as possible explanatory variablesA retrospective populationbased matched cohort study of fracture rates was performed using Manitoba administrative health data 1984–2003 The study cohort consisted of 27952 registered Aboriginal adults aged 20 years or older and 83856 nonAboriginal 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 twoway interactions with ethnicityOsteoporotic fracture rates were approximately twofold higher in the Aboriginal cohort p00001 Diabetes greater number of ADGs and substance abuse were all more common in the Aboriginal cohort all p00001 These factors were associated with increased fracture rates all p00001 and significantly higher population attributable risk percent in the Aboriginal cohort all p00001 However no significant interactions between the risk factors and ethnicity were observed p01 for all interaction effectsGreater 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 nonAboriginals despite large differences in absolute fracture risk and risk factor prevalenceSupported 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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