Marginalisation and Cardiovascular Disease Among Rural Sami in Northern Norway: a Population-based Cross-sectional Study

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2013 May 31

PMID 23718264

Citations 9

Authors

Bent-Martin Eliassen

Marita Melhus

Ketil Lenert Hansen

Ann Ragnhild Broderstad

Affiliations

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Abstract

Background: Like other indigenous peoples, the Sami have been exposed to the huge pressures of colonisation, rapid modernisation and subsequent marginalisation. Previous studies among indigenous peoples show that colonialism, rapid modernisation and marginalisation is accompanied by increased stress, an unhealthy cardiovascular risk factor profile and disease burden. Updated data on the general burden of cardiovascular disease among the Sami is lacking. The primary objective of this study was to assess the relationship between marginalisation and self-reported lifetime cardiovascular disease (CVD) by minority/majority status in the rural Sami population of Norway.

Methods: A cross-sectional population-based study (the SAMINOR study) was carried out in 2003-2004. The overall participation rate was 60.9% and a total of 4027 Sami individuals aged 36-79 years were included in the analyses. Data was collected by self-administrated questionnaires and a clinical examination.

Results: The logistic regression showed that marginalised Sami living in Norwegian dominated areas were more than twice as likely to report CVD as non-marginalised Sami living in Sami majority areas (OR 2.10, 95% CI: 1.40-3.14). No sex difference was found in the effects of marginalisation on self-reported life-time cardiovascular disease. Moderate to no intermediate effects were seen after including established CVD risk factors.

Conclusions: This study showed that marginalised Sami living in Norwegian dominated areas were more than twice as likely as non-marginalised Sami from Sami majority areas to report lifetime cardiovascular disease (CVD). Moderate to no intermediate effects were seen after including established CVD risk factors, which suggest little difference in lifestyle related factors. Chronic stress exposure following marginalisation may however be a plausible explanation for some of the observed excess of CVD.

Citing Articles

Stress and Cardiometabolic Disease Risk for Indigenous Populations throughout the Lifespan.

Lewis M, Volpert-Esmond H, Deen J, Modde E, Warne D Int J Environ Res Public Health. 2021; 18(4).

PMID: 33668461 PMC: 7918141. DOI: 10.3390/ijerph18041821.

Coronary heart disease and stroke in the Sami and non-Sami populations in rural Northern and Mid Norway-the SAMINOR Study.

Siri S, Eliassen B, Broderstad A, Melhus M, Michalsen V, Jacobsen B Open Heart. 2020; 7(1).

PMID: 32404487 PMC: 7228651. DOI: 10.1136/openhrt-2019-001213.

Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health-An integrative review.

Osei Baah F, Teitelman A, Riegel B Nurs Inq. 2018; 26(1):e12268.

PMID: 30488635 PMC: 6342665. DOI: 10.1111/nin.12268.

Sami yoik, Sami history, Sami health: a narrative review.

Hamalainen S, Musial F, Salamonsen A, Graff O, Olsen T Int J Circumpolar Health. 2018; 77(1):1454784.

PMID: 29580190 PMC: 5912196. DOI: 10.1080/22423982.2018.1454784.

Violence Affects Physical and Mental Health Differently: The General Population Based Tromsø Study.

Friborg O, Emaus N, Rosenvinge J, Bilden U, Olsen J, Pettersen G PLoS One. 2015; 10(8):e0136588.

PMID: 26317970 PMC: 4552864. DOI: 10.1371/journal.pone.0136588.

References

Yusuf S, Reddy S, Ounpuu S, Anand S . Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001; 104(23):2855-64. DOI: 10.1161/hc4701.099488. View

Sattar N, McConnachie A, Shaper A, Blauw G, Buckley B, de Craen A . Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet. 2008; 371(9628):1927-35. DOI: 10.1016/S0140-6736(08)60602-9. View

Galloway J . Cardiovascular health among American Indians and Alaska Natives: successes, challenges, and potentials. Am J Prev Med. 2006; 29(5 Suppl 1):11-7. DOI: 10.1016/j.amepre.2005.07.023. View

Brustad M, Parr C, Melhus M, Lund E . Dietary patterns in the population living in the Sámi core areas of Norway--the SAMINOR study. Int J Circumpolar Health. 2008; 67(1):82-96. View

Utsi E, Bonaa K . [Coronary heart diseases among Lapps and Norwegians in Finnmark]. Tidsskr Nor Laegeforen. 1998; 118(9):1358-62. View

Sundstrom J, Riserus U, Byberg L, Zethelius B, Lithell H, Lind L . Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: prospective, population based cohort study. BMJ. 2006; 332(7546):878-82. PMC: 1440609. DOI: 10.1136/bmj.38766.624097.1F. View

Sjolander P . What is known about the health and living conditions of the indigenous people of northern Scandinavia, the Sami?. Glob Health Action. 2011; 4. PMC: 3195409. DOI: 10.3402/gha.v4i0.8457. View

Broderstad A, Melhus M, Lund E . Iron status in a multiethnic population (age 36-80 yr) in northern Norway: the SAMINOR study. Eur J Haematol. 2007; 79(5):447-54. DOI: 10.1111/j.1600-0609.2007.00929.x. View

Brotman D, Golden S, Wittstein I . The cardiovascular toll of stress. Lancet. 2007; 370(9592):1089-100. DOI: 10.1016/S0140-6736(07)61305-1. View

10.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F . Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364(9438):937-52. DOI: 10.1016/S0140-6736(04)17018-9. View

11.

Brown A, Morrissey M, Sherwood J . Uncovering the determinants of cardiovascular disease among Indigenous people. Ethn Health. 2006; 11(2):191-210. DOI: 10.1080/13557850500485485. View

12.

Daniel M, Lekkas P, Cargo M, Stankov I, Brown A . Environmental risk conditions and pathways to cardiometabolic diseases in indigenous populations. Annu Rev Public Health. 2011; 32:327-47. DOI: 10.1146/annurev.publhealth.012809.103557. View

13.

Hansen K, Sorlie T . Ethnic discrimination and psychological distress: a study of Sami and non-Sami populations in Norway. Transcult Psychiatry. 2012; 49(1):26-50. DOI: 10.1177/1363461511433944. View

14.

Lund E, Melhus M, Hansen K, Nystad T, Broderstad A, Selmer R . Population based study of health and living conditions in areas with both Sámi and Norwegian populations--the SAMINOR study. Int J Circumpolar Health. 2007; 66(2):113-28. DOI: 10.3402/ijch.v66i2.18241. View

15.

Tynes T, Haldorsen T . Mortality in the Sami population of North Norway, 1970-98. Scand J Public Health. 2007; 35(3):306-12. DOI: 10.1080/14034940701226159. View

16.

Engstad T, Bonaa K, Viitanen M . Validity of self-reported stroke : The Tromso Study. Stroke. 2000; 31(7):1602-7. DOI: 10.1161/01.str.31.7.1602. View

17.

Curtis T, Kvernmo S, Bjerregaard P . Changing living conditions, life style and health. Int J Circumpolar Health. 2006; 64(5):442-50. DOI: 10.3402/ijch.v64i5.18025. View

18.

Jorgensen M, Bjerregaard P, Kjaergaard J, Borch-Johnsen K . High prevalence of markers of coronary heart disease among Greenland Inuit. Atherosclerosis. 2007; 196(2):772-8. DOI: 10.1016/j.atherosclerosis.2007.01.008. View

19.

Nystod T, Utsi E, Selmer R, Brox J, Melhus M, Lund E . Distribution of apoB/apoA-1 ratio and blood lipids in Sami, Kven and Norwegian populations: the SAMINOR study. Int J Circumpolar Health. 2008; 67(1):67-81. View

20.

Broderstad A, Melhus M, Brustad M, Lund E . Iron stores in relation to dietary patterns in a multiethnic population: the SAMINOR study. Public Health Nutr. 2011; 14(6):1039-46. DOI: 10.1017/S1368980010003289. View