Coronary Artery Disease in Manitoba Indigenous People
Manitoba stands out in Canada for its significant Indigenous population, with the province having the highest percentage of Indigenous people among all Canadian provinces. The city of Winnipeg, in particular, has the largest Indigenous population of any large Canadian city. This demographic reality brings unique healthcare challenges, especially concerning coronary artery disease (CAD), which remains a prevalent and critical health issue within the Indigenous communities of Manitoba.
Research conducted at the University of Manitoba, led by Dr. Anette Schultz, demonstrated that First Nations (FN) peoples in Manitoba had higher coronary artery disease mortality in the first five years following coronary angiography compared to non-Indigenous Manitobans. During those five years, FN people had fewer physician visits. This mortality disadvantage remained after adjusting for sociodemographic characteristics, comorbidity, revascularizations, and medication use (Canadian Journal of Cardiology 34; 2018:1333-1340). A recent analysis by the ACS Network determined that the rates of coronary angiography (CAG) and angioplasty were approximately double in those with FN postal codes compared to non-FN postal codes.
The rates of acute myocardial infarction (AMI) among Indigenous people in Manitoba are alarmingly high, contributing to a broader pattern of health disparities faced by these communities. Several factors drive the increased prevalence of AMI, including socio-economic conditions, limited access to healthcare services, and higher rates of comorbidities such as diabetes, hypertension, and obesity. These conditions are often exacerbated by the social determinants of health, which include inadequate housing, food insecurity, and lower levels of education and income.
Historical and ongoing systemic issues also play a significant role in the health outcomes of Manitoba’s Indigenous population. The legacy of colonialism and the resulting intergenerational trauma have led to higher levels of mental health issues and substance abuse, further increasing the risk factors for CAD. Additionally, cultural barriers and a lack of culturally competent healthcare services contribute to delays in seeking treatment and lower adherence to medical advice, leading to poorer outcomes for Indigenous patients with coronary artery disease.
Efforts to address CAD among Indigenous people in Manitoba must be multifaceted, involving not only healthcare interventions and access to medical care, but also policies aimed at improving social determinants of health. Community-led initiatives and culturally tailored healthcare programs are essential in bridging the gap and providing effective and respectful care. Collaborative approaches that involve Indigenous leaders and healthcare professionals are crucial in creating sustainable solutions that honor the unique needs and perspectives of Manitoba’s Indigenous population.
