Introduction
Diabetes is a severe long-term condition that significantly affects individuals’, families’ and communities’ well-being globally. It is among the leading causes of adult deaths, estimated at four million deaths in 2017 worldwide (Saeedi et al., 2019). In recent years there has been an increase in the global prevalence of Diabetes and dysfunctional glucose tolerance in adults. The drastic diabetes prevalence change has been influenced by urbanization and people shifting to a sedentary lifestyle. The World Health Organization approximated one hundred and eight million persons to be diabetic in 1980, which increased four times in 2014 estimates (Cho et al., 2018). Against this background of increasing diabetes prevalence, it is appropriate to establish the lifetime risks of individuals residing within a given locality. This paper reviews an article on lifetime risks of Diabetes among First Nations and Non-First Nation people for Alberta residents in Canada. The article is best for review as it provides wider epidemiological aspects of Diabetes. Reviewing this article will also be effective in identifying the most suitable approach or methodology for estimating lifetime risks for other diseases in various regions. An approximation of lifetime risks is also a mitigation process for the yearly rising prevalence rate of Diabetes worldwide.
Article Summary
The lifetime risk of Diabetes among First Nations and non-First Nations People is a study conducted in Alberta Province of Canada. Lifetime risk refers to a relatively straightforward measure utilized to inform disease burden, portraying a summation of risk of a given outcome for the remaining duration of a person’s life right from the disease-free index age. Diabetes prevalence has immensely increased in Canada, leading to an annual implication of nine billion US. Dollars annual cost. The burden is particularly viewed as high among the First Nation individuals in Canada, with a three to five times higher prevalence than the non-First Nations people. It is, therefore, appropriate to inform the public in the simplest manner possible that will avail an understanding of Diabetes health risks. Decreasing the risk of Diabetes mellitus requires both individual and population oriented interventions to aim at lifestyle factors and medical social aspects. Lifetime risk, which is also the likelihood of an illness-free person developing the illness for the remaining part of his or her life, is highly informative to the general public and stakeholders compared to estimates of incidence and prevalence that only provide information on community disease burden but lacks adequate information on individual risk.
In the methodology, the study population consisted of 2 897 299 participants who were residents of Alberta and had registered to Alberta Health insurance cover between 1st April 1997 and 31st March 2008. The participants were aged eighteen years and above, made up of 1,436,324 males and 1,460,975 females, and their first day at Alberta Health was recorded as the study entry date. The scientists determined the First Nations status of the participants via the Alberta Health Registry file indicator variable that specifies persons registered in the Aboriginal Affairs and Nothern Development Canada under the Indian Act. A participant with First Nations Identifier was categorized as First Nations while others were grouped as non-First Nations people. The Metis and unregistered First Nations were considered as part of non-First Nations. Participants were followed from the start of study entry to the outcome, migration from Alberta, death or end of study duration. Diabetes diagnosis relied on the previous definition validated by National Diabetes Surveillance System. In the measurement of cohort features, socioeconomic levels were determined by the researchers following Canada’s 2001 and 2006 census data statistics. Risk estimation began at the indexed age of twenty years through the decades to sixty years. Participants below twenty years old waited until they attained the indexed age for analysis. The authors calculated diabetes index age-specific incidence and estimates of lifetime risks via a modified survival analysis technique. SAS version 9.1 was use3d to perform statistical analysis. The study was approved by the Conjoint Health Research Ethics Board Board of the University of Calgary.
During the study period, a total of 160 549 participants developed Diabetes. The diabetes lifetime risk-adjusted for competing for death risk for men twenty years old was 75.6% in the First Nations category and 55.6% in the non-First Nations category. Women twenty years old recorded 87.3% for the adjusted lifetime risk in the First Nations group and 46.5% in the non-First Nations group. In all index age classifications, women recorded a lower diabetes lifetime risk than men in the non-First Nation group. On the contrary, women had a higher diabete4s lifetime risk than men in the First Nations group for all index age categories. The disparity can be slightly be explained by the fact that First Nations women have higher chances of becoming obese than men. There was a graded increase in Diabetes risk with a horizontal increase in time observed for both genders in the First Nations and non-First Nations, just as expected. Under the residence, the First Nations group had a higher diabetes risk than non First Nations across both urban and rural areas.
Article Critique
The study design adopted in this article is a cross-sectional study design which is a well-designed tool for purposes of descriptive epidemiology. The study adequately provides the prevalence of Diabetes within the Alberta community and associating the high or low prevalence to various lifestyle behaviours. Health outcomes are adequately assessed, whether a participant has developed Diabetes or not in the course of the study and diabetes lifetime risks are effectively calculated that reveal a clear picture of the rate at which the disease occurs within the Alberta community. The diabetic lifetime risk or exposure levels explain the high prevalence of Diabetes in the region. However, the study design does not separate risk factors for the disease occurrence from risk factors for the disease survival or disease incidence from prevalence. Strict admission of only the disease-free participants does not lead to the description of the disease causation.
In the study, despite high lifetime risks in both First Nations and non-First Nations groups, the First Nations group record a higher lifetime risk. The cause is inequalities in economic, social, historical, political and cultural health determinants, inaccessibility to nutritionally adequate diet and improper healthcare. Income, racial identity and gender may relate to one another and with medical indicators such as Diabetes. The finding is valid to some extent; combinations of income, racial identities and gender influence the vulnerability to Diabetes and hypertension in the Canadian society (Gagné & Veenstra, 2017). In the First Nations group, youths at the age of 20years had a higher diabetes lifetime risk, with men at 75.6% and women at 87.3%. Prediabetes and diabetes mellitus is becoming a severe health issue for the young Aboriginal Canadians (Amed et al., 2018). Recent immigrants, especially females and settlers of AFRICAN AND South Asian origin, have a high risk of Diabetes compared to the routine residents of Ontario. The risks begin to manifest early, indicating that diabetes prevention programs should be advanced and targeted to immigrants of all age groups (Bird et al., 2015 ). Stakeholders can integrate the study into practice to estimate the lifetime risk of various diseases for individuals in a given locality. Lifetime risk estimation is essential in deciding the best lifestyle habits to reduce the risk of developing a disease. Other lifestyle diseases such as hypertension and stroke could be assessed by scholars for their possible risk utilizing this study model.
The strength of the article is observed in its broad elaboration of Diabetes lifetime risks. The participants were sampled from one given locality and were people who had registered with Alberta Health. It means that there would be limited movement of participants out of the system. Tracing and assessing participants would also be easily thereby validating the results obtained to be of much accuracy. The number of participants was also sufficient to affect the long investigation process over the years if some left or possibly died. However, limitations that arise are that lifetime risks are restricted to the patient level hence are mitigated by personal diabetes risk factors. Another limitation is that the study considers a constant age and demographic framework, thereby preventing heterogeneity of the information obtained. Homogenous information limits the scope of decision making by stakeholders. The last limitation is the inability to identify the unregistered First Nations people leading to misclassification of non-First Nation participants.
Future research should advance into the associations between risks and disease incidence. It will enable in formulating the actual cause of a disease in a given locality. Establishing whether the prevalence of Diabetes in an area is due to lifestyle or genetic inheritance is of great significance.
Conclusion
Lifetime risks are good indicators of disease prevalence in an area. However, more research should be conducted by scholars to associate the risks to disease cause. Further research into these aspects will enable the general public to take precautionary measures and assist administrators in decision making.
Reference
Amed, S., Islam, N., Sutherland, J., & Reimer, K. (2018). Incidence and prevalence trends of youth‐onset type 2 diabetes in a cohort of Canadian youth: 2002‐2013. Pediatric Diabetes, 19(4), 630-636.
Bird, Y., Lemstra, M., Rogers, M., & Moraros, J. (2015). The relationship between socioeconomic status/income and prevalence of Diabetes and associated conditions: A cross-sectional population-based study in Saskatchewan, Canada. International journal for equity in health, 14(1), 1-8.
Cho, N., Shaw, J. E., Karuranga, S., Huang, Y., da Rocha Fernandes, J. D., Ohlrogge, A. W., & Malanda, B. (2018). IDF Diabetes Atlas: Global estimates of Diabetes prevalence for 2017 and projections for 2045. Diabetes research and clinical practice, 138, 271-281.
Gagné, T., & Veenstra, G. (2017). Inequalities in hypertension and Diabetes in Canada: intersections between racial identity, gender, and income. Ethnicity & disease, 27(4), 371.
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., … & IDF Diabetes Atlas Committee. (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice, 157, 107843.
