Smoking Status and Cardiometabolic Conditions Among Indigenous Adults in Canada: A Cross-Sectional Study Using the 2022 Canadian Community Health Survey

Background: Cardiometabolic conditions remain a major public health concern among Indigenous populations in Canada. Smoking is a recognized risk factor; however, its independent association with conditions, such as hypertension and cardiovascular disease (CVD), among Indigenous populations remains unclear due to the influence of coexisting cardiometabolic factors, variations in exposure patterns, and the limited availability of population-specific evidence. Objective: To assess the association between smoking status and cardiometabolic conditions among Indigenous adults in Canada. Methods: This cross-sectional study used data from the 2022 Canadian Community Health Survey. The analysis included 1,099 Indigenous adults aged 35 years and older, representing a weighted population of 343,048 individuals. Smoking status was categorized as never, former, or current smoker. Outcomes included hypertension and CVD. Survey-weighted logistic regression models with bootstrap variance estimation were used to estimate adjusted odds ratios controlling for demographic and clinical covariates. Results: Smoking status was not associated with hypertension. Former smokers had an adjusted odds ratio of 1.14 with a 95% confidence interval of 0.51-2.54, and current smokers had an adjusted odds ratio of 1.12 with a 95% confidence interval of 0.45-2.79. Smoking status was also not associated with CVD, with adjusted odds ratios of 0.84 for former smokers and 1.09 for current smokers. Age was strongly associated with hypertension, with individuals aged 50-64 years having an adjusted odds ratio of 2.65 and those aged 65 years and older having an adjusted odds ratio of 4.25. High cholesterol was associated with hypertension at 2.51 and CVD at 4.80. Conclusion: This study highlights that smoking status was not independently associated with cardiometabolic conditions after adjustment, while age and metabolic factors showed stronger relationships. However, given the cross-sectional design, causal relationships cannot be established, and the findings should be interpreted as associations. These results support integrated risk assessment approaches and highlight the need for further longitudinal research.