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Open Access Research article

Marginalisation and cardiovascular disease among rural Sami in Northern Norway: a population-based cross-sectional study

Bent-Martin Eliassen1*, Marita Melhus1, Ketil Lenert Hansen1 and Ann Ragnhild Broderstad12

Author Affiliations

1 Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway

2 Department of Medicine, University Hospital of Northern Norway, N-9480, Harstad, Norway

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BMC Public Health 2013, 13:522  doi:10.1186/1471-2458-13-522

Published: 29 May 2013

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.

Keywords:
Cardiovascular disease; Marginalisation; Stress; Indigenous; Sami; SAMINOR; Norway