To assess the level of agreement in aspirin use measured by self-report and dispensing data.We assessed preventive cardiovascular medication use (prescription-only statins and blood pressure-lowering therapy; and aspirin-also available over-the-counter) at baseline in participants in the New Zealand IMPACT trial for whom these medications were prescribed by their general practitioner. A trial nurse not involved in their ongoing health care obtained participants' self-reported aspirin use data. We obtained dispensing data from the national pharmaceutical dispensing database and assessed agreement between the two measures using kappa coefficients.Of the 513 trial participants, 36% were women, 50% were of Māori ethnicity, and 45% had a history of cardiovascular disease. The level of agreement between self-reported aspirin use and dispensing data was substantial (kappa 0.75, 95% CI 0.69 to 0.82). The level of agreement in aspirin use measured by these two sources of data was similar to that for statin and blood pressure-lowering therapy use, for all participants combined, for subgroups according to ethnicity (Māori and non-Māori) and history of cardiovascular disease.Despite its availability over-the-counter, aspirin use in patients for whom cardiovascular medications are indicated can be assessed accurately from dispensing data.
Background A significant reduction in perinatal mortality among births ≥1000 g has been observed in New Zealand. Aim To determine, in a national cohort, if perinatal mortality has reduced in small for gestational age (SGA) and non‐SGA babies. Materials and methods Retrospective cohort, 2008–2016, of singleton non‐anomalous births and perinatal deaths from 26+0 weeks gestation at birth in New Zealand. Perinatal deaths from the Perinatal and Maternal Mortality Review Committee data set were merged with the Ministry of Health national maternity data set. SGA was defined as less than the 10th customised birthweight centile using New Zealand coefficients. Perinatal mortality was defined as stillbirth from 26 weeks gestation and neonatal death up to the 27th day of life. Results There was a 30% reduction in perinatal mortality among SGA singleton non‐anomalous babies at 26 weeks or more from 10.38/1000 births in 2008 to 7.28/1000 in 2016 ( P = 0.046) but no significant change in mortality among appropriate and large for gestational age babies. Conclusion(s) There has been a significant reduction in perinatal mortality among SGA babies in New Zealand. The mechanism for this reduction is unclear.
aim: To compare age-stratified public health service utilisation in Aotearoa New Zealand across the rural–urban spectrum. methods: Routinely collected hospitalisation, allied health, emergency department and specialist outpatient data (2014–2018), along with Census denominators, were used to calculate utilisation rates for residents in the two urban and three rural categories in the Geographic Classification for Health. results: Relative to their urban peers, rural Māori and rural non-Māori had lower all-cause, cardiovascular, mental health and ambulatory sensitive (ASH) hospitalisation rates. The age-standardised ASH rate ratios (major cities as the reference, 95% CIs) across the three rural categories were for Māori 0.79 (0.78, 0.80), 0.83 (0.82, 0.85) and 0.80 (0.77, 0.83), and for non-Māori 0.87 (0.86, 0.88), 0.80 (0.78, 0.81) and 0.50 (0.47, 0.53). Residents of the most remote communities had the lowest rates of specialist outpatient and emergency department attendance, an effect that was accentuated for Māori. Allied health service utilisation by those in rural areas was higher than that seen in the major cities. conclusions: The large rural–urban variation in health service utilisation demonstrated here is previously unrecognised and in contrast to comparable international data. New Zealand’s most remote communities have the lowest rates of health service utilisation despite high amenable mortality rates. This raises questions about geographic equity in health service design and delivery and warrants further in-depth research.
Abstract Objectives To investigate ethnic‐specific deprivation gradients in early childhood dental caries experience considering different domains of deprivation. Methods We used cross‐sectional near whole population‐level data on 318 321 four‐year‐olds attending the “B4 School check,” a national health and development check in New Zealand, across 6 fiscal years (2010/2011 to 2015/2016). The “ lift the lip ” screening tool was used to estimate experience of any caries and severe caries. We investigated deprivation gradients using the Index of Multiple Deprivation ( IMD ), which measures seven domains of deprivation across 5958 geographical areas (“data zones”). Ethnicity was categorized into five groups: (i) Māori, (ii) Pacific, (iii) Asian, (iv) Middle Eastern, Latin American and African ( MELAA ) and (v) European & Other (combined). We used a random intercepts model to estimate mutually adjusted associations between deprivation, ethnicity, age, fiscal year, and evidence of any dental caries experience. Results Reports of any caries experience decreased from 15.8% (95% CI : 15.7; 15.9%) to 14.7% 95% CI : 14.4; 14.8%), while reports of severe caries experience increased from 3.0% (95% CI : 3.0; 3.1%) to 4.4% (95% CI : 4.3; 4.5%) from 2010/2011 to 2015/2016. This varied by ethnicity with larger increases in severe caries for Pacific children from 7.1% (95% CI : 6.8; 7.4%) to 14.1% (95% CI : 13.7; 14.5%). There were deprivation gradients in dental caries experience with considerable variation by ethnicity and by domain of deprivation. The association between deprivation and dental caries experience was weakest for Asian children and was most pronounced for Pacific and Māori children. Conclusion Socioeconomic gradients in dental caries experience are evident by age 4 years, and these gradients vary by ethnicity and domain of deprivation.
There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. racism has an important role. This study aimed to use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis. Critical Race Theory informed the methods used. Twenty-three Indigenous participants participated in 4 family focus group interviews and 13 individual interviews, comprising of 9 youth, 10 family members and 4 mental health professionals. An analysis of the data was undertaken using deductive structural coding to identify descriptions of racism, followed by inductive descriptive and pattern coding. Participant experiences revealed how racism operates as a socio-cultural phenomenon that interacts with institutional policy and culture across systems. This is described across three themes: (1) selective responses based on racial stereotypes, (2) race related risk assessment bias and (3) institutional racism in the mental health workforce. The impacts of racism were reported as inaction in the face of social need, increased coercion and an under resourced Indigenous workforce. These findings indicate that organizational cultures may differentially impact Indigenous and minority people and that social responsiveness, risk discourse and the distribution of workforce expenditure are important targets for anti-racism efforts.
Background: Outcome measurement in child and adolescent mental health services in New Zealand became mandatory in 2005 and little is known about how this is perceived by service users. Aims: This study aimed to ascertain what service users think about routine outcome measurement in child and adolescent mental health services. Method: Nine semi-structured focus groups of child and adolescent service users ( n=34) and family members ( n=21) were held in different sites in New Zealand to determine their views on outcome measures. Results: Consumers supported outcome assessment with some provisos that have important implications for clinical services: the method of collecting information is critical to acceptance; assessment should be done in the context of an established relationship with the clinician; care is needed over the timing and context of assessment, access to information and feedback of results; and measures should be brief and holistic and their limitations recognised. Conclusion: Service users support outcome measures but their implementation requires care and consultation.
Full recognition of Maori rights as tangata whenua, as reflected in the Treaty ofWaitangi, is an important driver towards the goal of Maori having at least the samestandard of health as non-Maori. Disparities also reflect the fact that Maori healthstatus has not been afforded the ‘protection’ the crown intends under the Treaty ofWaitangi, using the government’s health framework of the guiding principles of theTreaty.
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