Exploring the prevalence and factors associated with pain-related disabilities among Indigenous peoples in Canada: a scoping review and cross-sectional study of the 2017 Aboriginal Peoples Survey

Abstract

Pain-related disabilities (PRDs) are among the most commonly reported disabilities in Canada, yet little is known about their impact among Indigenous populations. The aim of my thesis was to determine the prevalence of PRDs and explore associated factors among Indigenous peoples in Canada. My thesis was guided by Etuaptmumk (Two-Eyed Seeing) and conducted in partnership with an Indigenous Advisory Committee that I put together to govern and support this work. I first conducted a scoping review of the peer-reviewed and grey literature. Of 5,902 peer-reviewed citations and 49 grey literature sources screened, two met the inclusion criteria: one epidemiological study describing PRD prevalence among First Nations people living off-reserve, Inuit, and Métis (FNIM), and one qualitative study exploring pain-related limitations in functioning. This demonstrated a significant gap in the literature. To address this, I analyzed the 2017 Aboriginal Peoples Survey (APS) to estimate PRD prevalence and identify associated factors among FNIM aged 15 years and older. PRDs were defined as pain-related activity limitations lasting ≥6 months. The sample included 9,115 First Nations people living off-reserve, 8,499 Métis, and 2,972 Inuit. I used person-level and bootstrap weights and applied modified Poisson regression with robust variance, guided by Indigenous-specific frameworks. PRDs were reported by 22.1% of First Nations people living off-reserve, 20.4% of Métis, and 11.1% of Inuit. Prevalence was higher among females, older age groups, and those with multiple co-existing disabilities. For First Nations and Métis peoples, prevalence was similar across geographic regions. Among Inuit, those living outside Inuit Nunangat reported higher PRD levels. Demographic, socioeconomic, health, historical, and cultural factors were associated with PRDs in each group. My thesis highlights the complex and multidimensional nature of PRDs among Indigenous peoples in Canada. Addressing these disabilities requires a holistic approach that considers the impacts of colonialism, social inequities and cultural disconnection. Limitations include possible differences between survey participants and non-participants, and the unknown validity and reliability of many APS variables, leading to potential misclassification bias. Future Indigenous-led research should be guided by Indigenous priorities, including qualitative studies exploring lived experiences of PRDs, and how culture, language, and social conditions influence well-being.