Ethnic belonging and chronic disease in indigenous populations in Canada

Indigenous peoples in Canada endure health inequalities and cultural erosion due to colonial legacies. This study examines the relationship between ethnic belonging and chronic disease patterns among three Indigenous groups: First Nations, Inuit, and Métis. We analyzed data from the 2017 Indigenous Peoples Survey of Canada, performing latent class analysis to identify distinct classes among 12 chronic disease indicators. We used multinomial logistic regression to examine the relationship between ethnic belonging and subtypes of chronic diseases, also employing average marginal effects to interpret heterogeneity. All analyses incorporated complex survey weights to ensure national representativeness. The final sample comprised 19,621 individuals. Four distinct subgroups were identified: Relatively Healthy, Physical Illness, Mental Illness, and Severe Illness groups. Descriptive statistics revealed that up to 35.0 % of the Indigenous population is in a suboptimal health state. Regression outcomes demonstrated that a strong sense of cultural belonging significantly reduces the odds of both Mental Illness (OR = 0.82, 95 % CI [0.76,0.88]) and Severe Illness (OR = 0.92, 95 % CI [0.84,0.99]). Heterogeneity analyses revealed that the positive association between belonging and health outcomes was stronger in the adult age group, among men, and within First Nations and Inuit groups. This study underscores the critical role of ethnic belonging in enhancing health among Indigenous populations, particularly in reducing odds associated with mental and severe health conditions. Policies and community practices should focus on strengthening Indigenous peoples' community belonging and cultural connections.