Suchergebnisse

IntroductionFirst Nation peoples (FNs) were unable to track their own health care trends due to limitations in datasets. The key linked file enables FNs to identify themselves within administrative datasets and work with Crown governments to bring equity in all services and departments to support FNs understanding of wellness.
Objectives and ApproachFirst Nations Health and Social Secretariat of Manitoba (FNHSSM) was established by 2013 resolution of Assembly of Manitoba Chiefs (AMC) and incorporated in 2014. FNHSSM leads and supports research according to FNs criteria approved by the Chiefs in Assembly. Information Sharing Agreements (ISA) have been developed with federal and provincial governments to mandate the processes for data linkage. The ISA allows Indian Status Register (ISR) data of Department of Indigenous Services Canada (DISC) to be transferred to FNHSSM to provide oversight, and link to Provincial Personal Health Information Numbers (PHINs) to create the de-identified, scrambled, and encrypted Key Linked file.
ResultsPrevious linkages were done in early 2000s with FNs approval and oversight. The 2018 linkage is the first time that ISAs have been formally developed. ISA-1 is between FNHSSM and Manitoba Health Seniors and Active Living (MHSAL) to create Key Linked file. ISA-2 is between FNHSSM, MHSAL and Manitoba Centre for Health Policy (MCHP) at University of Manitoba, to create the FNs Research File. This research file can only be accessed with application to and approval by the MFNs Health Information Research Governance Committee. This key linked file allows FNHSSM to prepare community health profiles specifically and only for each FN, to respect FNs Data Governance under Chief and Council. A regional report on Manitoba FNs will be created for all MFNs, FNHSSM and MHSAL.
Conclusion/ImplicationsLinking datasets helps to strengthen FNs data governance in re-building nations, recognizing FNs inherent right to self-determination. Linking files help to provide meaningful data to advocate for FNs rights and access to the resources and social determinants of health needed to achieve equity in Manitoba.

First Nations (FN) and Indigenous Peoples around the world face significant challenges in navigating the complexities of Western research systems, particularly in the context of data sovereignty and research about their people and communities; the same can be said for Western researchers navigating Indigenous research space. We examine the intersection of Western research and FN data to explore opioid use amongst FN in Manitoba and highlight the ethical imperative of utilizing decolonizing frameworks when working with Indigenous data.
Indigenous researchers led a retrospective cohort study linking the Manitoba FN research file to population-level data held at the Manitoba Centre for Health Policy. We centred Indigenous voices, knowledge, protocols, and contextually informed interpretation and fostered meaningful partnerships with academic researchers to ensure we utilized robust statistical methods while prioritizing community-driven questions, needs, and aspirations.
Study period from 2015 to 2019 and included all Manitobans eligible for Manitoba Health Services. We found downward trends in opioid-related use, dispensation, hospitalization, and mortality rates for both FN and all other Manitobans (AOM), but a significant gap was found between FN and AOM for most indicators. Indigenous governance, ownership, engagement, collaboration, reciprocity, and respect for cultural and intellectual property rights are key concepts in ethical research practices that prioritize Indigenous self-determination and data sovereignty.
We underscore the transformative potential of Indigenous-led research and use of decolonizing frameworks in fostering community empowerment to address opioid use in First Nation communities. We upheld the rights of Indigenous peoples to govern their data and undertake their own research.

IntroductionIndigenous populations are known to have poor health and health outcomes in many countries. Indigenous peoples continue to be the subjects of unethical research. Research that is undertaken without their consent, involvement in the design, delivery and interpretation of results that perpetuates negative stereotypes ignoring the historical and ongoing impacts of colonialism.
Objectives and ApproachIn order to understand the health status and health system use of First Nations people in Manitoba Canada we developed a partnership between the First Nations Social Secretariat of Manitoba and researchers to link First Nations identifiers with administrative data. This partnership was based on long-standing relationships with researchers who were affiliated with the Manitoba Centre for Health Policy.
ResultsA tripartite data sharing agreement set out the parameters of sharing data that supported the linkage of the Federal Registered First Nations database to the Manitoba Population Research Data Repository. The DSA facilitated direct First Nations input into the indicators chosen, the reporting cohorts, the interpretation of results and the language of the report.
Conclusion / ImplicationsDSAs can be used as a tool to facilitate partnerships with Non-indigenous researchers and Indigenous Nations that lead to meaningful partnerships and lay the foundation for respectful and ethical research. The research presents findings the health of First Nations and shines a light on the underlying colonialism and racism that contributes to the health inequities. These findings have the potential to influence health and well-being of First Nation peoples in Manitoba. This model of collaboration can be used a model in other jurisdictions.

IntroductionA 2002 report described the gap in health status between First Nations (FN) and all other Manitobans (AOM). That report was widely quoted in the context of other initiatives recognizing the inequities in Canadian society.
Objectives and ApproachWe analyzed linked administrative data held in the Manitoba Population Research Data Repository to determine the health status and health care use of First Nations people. To provide context to the findings we compared First Nations to all other Manitobans, disaggregated by on-reserve off-reserve status, and presented our findings by Region and Tribal Council area. The 35 indicators were chosen to address First Nations priorities and providecomparisons with the previous study. Results were age and sex adjusted.
ResultsThe gap between FN and AOM has grown. Premature mortality rates are 3x higher for FN compared to AOM. Rates of death by suicides and suicide attempts are 5x higher for FN compared to AOM. Rates of opioid prescribing are 2.5x higher for single prescription, and 4.5x higher for multiple prescriptions for FN compared to AOM. Colorectal cancer screening rates are 2x higher among all other Manitobans compared to FN. Continuity of care is much lower in FN than in AOM. For FN, primary care is less likely to be provided close to home than for AOM
Conclusion / ImplicationsDespite initiatives like the Truth and Reconciliation Commission, and Indian Residential School survivors pursuing healing, the gap in health outcomes has increased. Underlying causes such as ongoing systemic racism and colonialism within health governance should be addressed.

ObjectivesGiven the impact of colonization and responding to Canada's Truth and Reconciliation Commission, we aimed to provide baseline measures of First Nations children's health and social outcomes in Manitoba, Canada. We also aimed to create a research process where Indigenous and non-Indigenous researchers work collaboratively and in culturally safe ways.
ApproachWe formed a team consisting of members of First Nation organizations and academic researchers. Knowledge Keepers from Anishinaabe, Cree, Anishininew, Dakota and Dene Nations guided the study, interpreted results and ensured meaningful knowledge translation. This retrospective cohort study utilized population-based health, social services, education and justice administrative data that allowed de-identified individual-level linkages across all databases through a scrambled health number. Adjusted rates and rate ratios were calculated using a generalized liner modeling approach to compare First Nations children (n=61,726) and all other Manitoba children (n=279,087) and comparing First Nations children living on and off-reserve.
ResultsLarge disparities between First Nations and other Manitoba children were found in birth outcomes, physical and mental health, health services, education, social services, justice system involvement and mortality. First Nations infants had higher rates of preterm births, large-for-gestational-age births, newborn readmissions to hospital and lower rates of breastfeeding initiation compared with other Manitoba infants. Suicide rates among First Nations adolescents were ten times higher than among other adolescents in Manitoba, yet we found few differences in diagnosis of mood and anxiety disorders between the groups. First Nations children were also seven times more likely to apprehended by child protection services and youth were ten times more likely to be criminally accused. Knowledge Keepers offered their perspectives on these findings.
ConclusionThese findings demonstrate that an enormous amount of work is required in virtually every area – health, social, education and justice – to improve First Nations children's lives. There is an urgent need for equitable access to services, and these services should be self-determined, planned and implemented by First Nations people.

ObjectivePost-acute COVID-19 (or 'long COVID') manifests as a wide range of long-lasting symptoms affecting multiple organ systems. We are developing criteria for identifying long COVID cases using administrative, clinical, survey and other data from Manitoba, Canada, with the ultimate goal of examining long COVID prevalence, risk factors, prognosis and recovery.
ApproachGiven the lack of an accepted clinical definition and resulting lack of diagnostic codes, we are adopting several different creative and complementary strategies to identify long COVID cases. We are examining administrative and clinical data sources (laboratory data, physician claims, drug prescriptions, and electronic medical records) for information on positive COVID tests, common symptoms and complaints, and treatment provided. To identify people with long COVID who may not have sought healthcare, we are collecting survey data from a convenience community sample (members of a medical health fitness facility) and mining data on long COVID symptoms from Twitter.
ResultsThe combination of approaches we have adopted and the expanding scientific literature on long COVID are contributing to a more comprehensive understanding of the impacts of long COVID in Manitoba. Through preliminary work on the laboratory data (positive COVID tests March 2020-June 2021), we have developed and characterized a COVID-positive cohort (n=47,515). Work is now underway to develop an algorithm for long COVID using symptoms from free text in electronic medical records, ICD-9 codes, and changes in health-seeking behaviour (compared to the pre-positive COVID test period and a matched sample). This population data-driven approach will then allow us to examine how multiple underlying health conditions, COVID illness severity, COVID vaccination status, and various socio-demographic factors are related to risk of long COVID.
ConclusionThis research is generating actionable information by identifying risk factors to support clinical diagnosis of long COVID, making it easier for clinicians to recognize this new illness and develop plans to manage it, and will inform healthcare system planning by quantifying the burden of long COVID at the population level.

ObjectivesFirst Nations (FN) organizations worked with public health and governments to improve FN access to COVID-19 vaccines by prioritizing FN communities in vaccination initiatives. FN researchers and data scientists partnered to test whether these efforts were associated with increased access to COVID-19 vaccines among FN compared with all other Manitobans.
ApproachThis retrospective cohort study linked whole-population administrative data from (i) the First Nations research file, (ii) COVID testing and vaccination data, and (iii) health and social services for sociodemographic data and information on potential confounders. Several public health policies were created to improve access to COVID vaccines among FN; we tested whether FN received their 1st and 2nd vaccines sooner than all other Manitobans (AOM) using restricted mean survival time models. We adjusted for sociodemographic characteristics, comorbidities, and whether FN lived on- or off-reserve. We conducted sex-specific and effect modification analyses to test whether associations differed by sex.
ResultsPrioritizing FN to receive vaccines was associated with increased vaccine uptake compared with AOM. After adjusting for various confounders, FN received their first dose 15.5 (95% CI 14.9 – 16.0) days sooner than AOM and their second dose 13.9 (13.3 – 14.5) days sooner than AOM. Sex-stratified and subsequent effect modification analyses using interaction terms, found that differences were greater for males than for females: FN males received their first dose 18.1 (17.3 – 18.8) days sooner than AOM males and FN females received their first dose 12.9 (12.2 – 13.7) days sooner than AOM females. This pattern held for second doses as well. FN with comorbidities also received vaccines sooner than AOM with similar comorbidity levels 20.9 days (23.1 – 18.8) among those with 3+ comorbidities.
ConclusionPartnerships between public health entities and FN organizations that respect FN community sovereignty were instrumental in supporting FN health and well-being during COVID-19. Policies and programs that prioritized FN people for vaccines improved uptake saving lives. This partnership-based COVID-19 response can provide a framework for future public health efforts.