Māori Health Review Issue 17

This study used data from the 1996, 2001 and 2006 New Zealand Census of Population and Dwellings and the corresponding New Zealand Index of Deprivation to describe trends in the distribution of New Zealand’s major ethnic groups (Māori, Pacific, Asian or European/Other) by small area deprivation and trends in the ethnic composition of each deprivation category. Throughout the observation period, Māori and Pacific ethnic groups were over-represented at the more deprived and underrepresented at the less deprived end of the deprivation spectrum. The European ethnic group displayed less marked skewing, and in the opposite direction, while the Asian ethnic group showed close to the expected uniform distribution. Little change occurred in either the deprivation distribution of any ethnic group or the ethnic composition of any deprivation decile between 1996 and 2006.

This study sought to determine whether children who have mothers with a regular source of dental care at baseline have greater dental use in the subsequent year than children with mothers without a regular source, in a cohort of 11,305 children aged 3 to 6 years in low-income families covered by Medicaid. There were 4 racial/ethnic groups: black (3791), Hispanic (2806), white (1902), and other racial/ethnic groups (2806). Approximately 38% of the mothers had a regular source of dental care (RSDC) at baseline. Having a mother with an RSDC at baseline was associated with greater odds of the child’s receiving dental care in the subsequent year, after controlling for potentially confounding variables. Mothers’ RSDC was also associated with children’s receiving more preventive services. These associations were found for children with black and Hispanic mothers; for children with white mothers, the relationships were in the same direction but not statistically significant.

These researchers explored ethnic stereotypes of UK medical students in the context of academic underachievement of medical students from ethnic minorities, in a cohort of Year 3 medical students and their clinical teachers, purposively sampled for ethnicity and sex. They participated in one to one interviews and focus groups. Analyses revealed that the clinical teachers as well as the medical students themselves had negative stereotypes about UK Asian medical students, who were perceived as being over-reliant on book learning and excessively quiet in class. Students also reported being unable to learn from unenthusiastic or intimidating teachers. No evidence of direct discrimination was found.

Outcomes are reported from a Graduation Questionnaire administered to 20,112 graduating medical students (64% of all graduating students in 2003 and 2004) from 118 US-based allopathic medical schools. It sought to determine whether student body racial and ethnic diversity is associated with diversity-related outcomes among US medical students. White students in the highest diversity quintile, as assessed by the proportion of under-represented minority (URM) students, were more likely to rate themselves as highly prepared to care for minority populations than those in the lowest diversity quintile (61.1% vs 53.9%, respectively; p<0.001). This association was strongest in schools in which students perceived a positive climate for inter-racial interaction. White students in the highest URM quintile were also more likely to have strong attitudes endorsing equitable access to care (54.8% vs 44.2%, respectively; p<0.001). No such significant associations were seen between student body URM proportions and diversity-related outcomes for nonwhite students. Intent to practice in an underserved area was greatest among URM students than among white or nonwhite/non-URM students (48.7% vs 18.8% vs 16.2%, respectively).

These researchers investigated the effects of installing non-polluting, more effective heating (heat pump, wood pellet burner, flued gas) before winter in the homes of 409 children aged 6–12 years with doctor-diagnosed asthma; a control group received a replacement heater at the end of the trial. Although there were no significant improvements in lung function, there were significant reductions in asthma symptoms and time lost from school and reductions in dry cough at night and sleep disturbed by wheeze, among children in the intervention group compared with those in the control group. In addition, the intervention was associated with higher indoor temperatures and lower nitrogen dioxide levels delivered by the heating than measurements taken from the control households.

These researchers systematically reviewed research published between 1997 and 2008 evaluating the effectiveness of behavioural interventions for arthritis, to determine whether these interventions are effective with, and appropriately utilised by, minority participants. Among 25 randomised intervention studies, only 2 reported on whether the intervention was similarly effective for white and black patients (equal effectiveness was found), and 6 studies reported examining differences in attrition by race (higher attrition in nonwhites was found in 1 study). Most studies did not report the percentage of participants from specific minority groups, and in many studies the percentage of minority participants was small. There were no reports of attempts to make interventions culturally appropriate.

These researchers examined the relation between socioeconomic inequalities and delivered quality of clinical care under the quality and outcomes framework, a financial incentive scheme that remunerates general practices in the UK for their performance against a set of quality indicators. Overall levels of achievement, defined as the proportion of patients who were deemed eligible by the general practices for whom the targets were achieved, were calculated for 48 clinical activity indicators during the first 3 years of the incentive scheme (from 2004–05 to 2006–07). Median overall reported achievement was 85.1% in year 1, 89.3% in year 2, and 90.8% in year 3. In year 1, median achievement was higher in least deprived areas (quintile 1; 86.8%) than in most deprived areas (quintile 5; to 82.8%). However, between years 1 and 3, median achievement increased by a greater amount in quintile 5 than in quintile 1 (4.4% vs 7.6%), and the gap in median achievement narrowed from 4.0% to 0.8%. A significant inverse association was observed between the increase in achievement during this time and practice performance in previous years (p<0·0001); no such association was seen with area deprivation (p=0.062).

This study assessed changes in clinical measures and proportions of patients with type 2 diabetes from different ethnic groups achieving guideline targets within a primary care diabetes annual review programme in New Zealand. A total of 7782 patients had data recorded at baseline in 2002–2003 and at follow-up two years later. A large proportion of Māori (47%) and Pacific (69%) patients had poor glycaemic control at baseline and only small improvements were made over the two years. In contrast, all ethnic groups experienced significant improvements in blood pressure and lipid management at two-year follow-up, at which time over 75% of Māori and Pacific patients received appropriate treatment with antihypertensive and lipid-lowering medication and many of the ethnic disparities in risk factors for complications were reduced.