Māori Health Review Issue 18

A lifetime cost-effectiveness analysis was developed to evaluate the costs, health gains, and cost-effectiveness (dollars per quality-adjusted life year [QALY] gained, relative to no intervention) of seven population-wide strategies to promote physical activity in healthy adults. All of the interventions were found to be cost-effective in reducing coronary heart disease, ischaemic stroke, colorectal and breast cancers, and type 2 diabetes. Cost-effectiveness ratios ranged between $US14,000 and $US69,000 per QALY gained, relative to no intervention.

This study sought to determine whether greenness and residential density were independently associated with 2-year changes in the BMI of 3831 children and youth aged 3–16 years who lived at the same address for 24 consecutive months and received well-child care from a US-based clinic network between 1996 and 2002. According to multiple linear regression analyses, those living in greener neighbourhoods had lower BMI z-scores in Year 2, regardless of residential density characteristics. Higher greenness was also associated with lower odds of BMI z-scores increasing over the 2-year study period (OR, 0.87).

These researchers compared income-related health inequality in areas of England with different amounts of green space. Individuals younger than retirement age were divided into groups on the basis of income deprivation and access to green space. Mortality data for 2001–05 revealed that the populations with the most access to green space had the weakest associations between income-related deprivation and both allcause and circulatory disease mortality. The investigators estimated that areas with the most green space saved 1,328 lives per year in the three lower income quartiles. Green space did not have any effect on deaths from lung cancer (p=0.0996) or intentional self-harm (p=0.1030).

This study used national hospitalisations and mortality datasets between 1998 and 2007 and the National Pharmaceutical data collection from 2001–2007 to describe the prevalence of cardiovascular disease (CVD) in New Zealand by ethnicity and socioeconomic status. In 2007, Māori had the highest age-standardised prevalence (7.41%) compared to non-Māori, non-Pacific, and non-Indians (4.45%). Māori males and females had the highest age-specific prevalence of CVD across virtually all age groups. People living in most deprived areas had consistently higher age-specific CVD prevalence than people living in less deprived areas. The corresponding age-specific CVD prevalence among the least deprived quintile of Māori and the most deprived quintile of ‘Other’ New Zealanders were almost identical up to 79 years of age. Between ages 40–59 years, the most deprived quintile of Māori had consistently ≥240% higher CVD prevalence than the least deprived quintile of ‘Other’ New Zealanders.

Using data from patients presenting to Auckland’s Middlemore Hospital Coronary Care Unit with an acute cardiovascular disease (CVD) event from July 2004 to June 2006, this study investigated the burden of modifiable CVD risk factors by age, ethnicity, and socioeconomic status. Of 973 patients, 34% were <55 years and 10% were <45 years, 24.8% were women, and 44.6% lived in areas classified as most deprived. 61.5% were European/ other, 13.0% NZ Māori, 15.2% Pacific, and 10.3% South Asian. Younger patients, regardless of ethnicity, were much more likely to be smokers, be obese, have elevated LDL and trigyceride, and low HDL levels. Across the age range, Māori and Pacific patients were more likely than European/other patients to smoke, have diabetes, obesity, elevated triglycerides, and low HDL. Increasing deprivation was associated with more smoking, obesity, hypertriglyceridaemia and diabetes, with the excess of smoking and obesity being most pronounced in younger patients.

Outcomes are reported from an electronic cardiovascular disease (CVD) risk assessment programme conducted over 12 months (between December 2006 and November 2007) at Tāmaki Healthcare, Auckland. Of 1522 people screened, clinical data were available for 1420, 425 (30.0%) of whom had a clinical or calculated 5-year CVD risk of ≥15%. Māori were significantly more likely to be at high CVD risk than non-Māori (OR, 2.07; p≤0.001). Despite high smoking rates and diabetes among Pacific peoples, there was not an overall increased likelihood of high CVD risk. For people at high CVD risk, across all ethnicities, prescribing rates were 78.1% for blood pressure lowering, 71.9% for lipid lowering, 65.3% for antiplatelet, and 50.3% for all three therapies. Of 451 people with either diabetes or established CVD, 65.9% and 66.1% were not attaining target blood pressure and lipid level recommendations respectively or were not prescribed guideline indicated therapies.

This UK study aimed to assess the level of BP monitoring and control among adult (≥45 years) primary care patients with chronic conditions attending general practices and sought to determine the effect of social deprivation on these levels. Data were retrospectively obtained from 8515 general practices in year 1 (2005), 8264 in year 2 (2006), and 8192 in year 3 (2007), located in the least deprived and most deprived areas of England. The proportion of patients who had a BP recording in the least deprived areas increased from 83% in 2005 to 88% by 2007, and from 81% to 88% in the most deprived areas. An initial 1.7% gap observed in mean BP recording levels between practices in the least and most deprived areas had decreased to 0.2% by 2007. In 2005, target BP levels were achieved by 69% and 72% of hypertensives in least deprived versus most deprived areas; corresponding rates were 71% and 69% for diabetics, and 85% and 82%, respectively, for coronary heart disease (CHD) patients. By 2007 these rates had increased to 77% and 78% for hypertensives, 79% and 79% for diabetics, 89% and 88% for CHD patients in the least versus most deprived areas respectively. Similar improvements in achieving target BP levels were seen for cerebrovascular disease and chronic kidney disease.

Daily nutrient intakes of 4007 European, Māori, Pacific, and Asian people aged 35 to 74 years living in Auckland were calculated from a self-administered food frequency questionnaire completed by participants during a health screening study carried out between 2002 and 2003. Compared with Europeans, Māori and Pacific men had higher total energy intakes per day, while Asians had lower intakes. The pattern was similar for carbohydrate and fat consumption. While protein and cholesterol consumption tended to be lower in Europeans than the other three ethnic groups, alcohol consumption and calcium intakes were highest among Europeans. Notably, expressing nutrient consumption as the percentage contribution to total energy intake attenuated many of the differences between ethnic groups, indicating that total food consumption was the major determinant of ethnic differences in nutrient intakes.

Pooled data were analysed for 8762 adults from 3 national surveys in this evaluation of differences in access to and quality of depression treatments between patients in racial-ethnic minority groups and non-Latino white patients. Among those with a past-year depressive disorder, 40% of non-Latino whites did not access any treatment, compared with 69% of Asians, 64% of Latinos, and 59% of African Americans. Disparities in the likelihood of both having access to and receiving adequate care for depression were significantly different for Asians and African Americans in contrast to non-Latino whites. The researchers conclude that “populations reluctant to visit a clinic for depression care may have correctly anticipated the limited quality of usual care”.