Māori Health Review Issue 32

These researchers used data from SoFIE-Health (wave 3), an add-on to the Statistics New Zealand-led longitudinal Survey of Family, Income and Employment (SoFIE) (n=18,320), to examine ethnic differences in financial barriers to access to prescription medication in New Zealand. Māori and Pacific people were more likely than NZ Europeans to defer buying a prescription at least once during the past 12 months because they could not afford the cost of the prescription (OR 2.98 vs OR 3.52). After adjusting for potential confounders the ORs were attenuated to 1.31 for Māori people and to 2.17 for Pacific people. Those who deferred buying medications because of cost were also more likely to report poor health status, high/very high psychological stress and the presence of two or more comorbid conditions.

To evaluate the safety and effectiveness of longer-acting penicillin to prevent recurrences of acute rheumatic fever (ARF), these researchers assessed historical data from the regional RF register for Auckland, New Zealand, in a 5–14-year-old population with ARF rates of ~40–80/100,000. Every 28 days, community nurses delivered free benzathine penicillin to consented patients; discharge was after 10 years of treatment or age 21 years, whichever was longer. First-episode and recurrent ARF cases were classified as definite (Jones criteria 1992) or probable (Jones criteria 1956). Of the 360 cases meeting the case definitions, 20 recurrences occurred in 19 people (median age 21 years). Age at first episode ranged from 2–52 years (median 21.3). After penicillin was discontinued, ARF recurred at 0–21 years; 72% of recurrent cases occurred within 5 years, and 12% between 5 years and 10 years. The 4-weekly long-acting penicillin failure rate (n=1) was 0.07/100 patient years. The programme failure rate (Auckland residents) was 1.4/100 patient years (n=20). Fifty-five percent of recurrences were attributed to patient non-adherence. Two recurrences after discharge from prophylaxis as per the New Zealand guidelines occurred after 3 years and 13 years.

The influence of socioeconomic status on the use of preoperative radiotherapy in rectal cancer was evaluated in this study, which linked individually attained data on civil status, education and income to the Swedish Rectal Cancer Registry 1995–2005 (n=16,713). Preoperative radiotherapy was given to 46% of the patients; the crude rate varied with age, gender, civil status, education and income as well as with sublocalisation, stage, type of hospital and health care region. Multivariate analysis revealed inequalities in use of preoperative radiotherapy by civil status: all civil status groups were less likely than married patients to have preoperative radiotherapy; the OR for unmarried patients was 0.67. The use of PRT was also linked to income; the OR for patients with income Q1 versus Q4 was 0.76. The inequalities by civil status and income remained unchanged in groups with a relatively stronger indication for adjuvant radiotherapy, i.e. younger patients and in low rectal cancer. Use of preoperative radiotherapy was not affected by education level: there was no difference in uptake between patients with secondary and university education and those with compulsory school (OR 1.04 and 0.92).

An interactive storytelling intervention involving DVDs was tested as a tool for health promotion among 230 African Americans with hypertension attending an inner-city safety-net clinic in the southern United States. Most patients (71.4%) were women, and the mean age was 53.7 years. The study intervention consisted of 3 DVDs that contained patient stories. Storytellers were drawn from the patient population. Patients assigned to the intervention (comparison group) received an attention control DVD; separate random assignments were performed for patients with controlled or uncontrolled hypertension. Among patients with baseline uncontrolled hypertension, significant reductions from baseline were seen at 3 months for both systolic (11.21 mm Hg; p=0.012) and diastolic (6.43 mm Hg; p=0.012) blood pressure in the intervention group. Patients with baseline controlled hypertension did not significantly differ over time between study groups. Blood pressure subsequently increased for both groups, but between-group differences remained relatively constant.

This Australian study estimated possible savings in primary care costs for hypertension, renal disease and diabetes associated with Aboriginal involvement in land management and Northern Territory Government-defined chronic disease outcomes. The study enrolled 298 Aboriginal adults aged 15–54 from a remote Aboriginal community. Land management participants were significantly less likely to have diabetes, renal disease or hypertension. Expected net annual savings for the community from involvement in land management amounted to $AU268,000, equating to a net present value of primary health care savings in chronic disease care for the sampled community over 25 years of $AU4.08 million. The researchers note that these estimated savings are in addition to the market and non-market economic benefits of a healthier population and environmental benefits.

When they searched for intervention studies designed to reduce ethnic disparities in trauma care, these researchers found no evaluations of such interventions in a systematic literature review. However, when they scanned the equivalent literature in other health care settings they discovered three strategies that could serve as promising interventions deserving further investigation in the trauma care setting: (1) improving cultural competency of service providers, (2) addressing the effects of health literacy on the quality of trauma care, and (3) quality improvement strategies that recognise equity as a key dimension of quality. The study authors suggest that a trauma coordinator role may help address some aspects relating to these themes. They add that reducing disparities is likely to require broader systemwide policies.

This investigation sought to determine the reasons underlying the declining response rates in New Zealand sleep health surveys, using data from four population surveys undertaken from 1999–2008. The surveys used the electoral roll as a sampling frame and sought to recruit equal numbers of Māori and non-Māori, consistent with the Kaupapa Māori principle of equal explanatory power. The survey method also included extensive follow-up. Successive surveys revealed fewer respondents in all age groups. Response rates from Māori were lower in all surveys and the percentage decline was greater than for non-Māori. By 2008, the response rates from the initial mail-out in 1999 had decreased by 50% and the proportion of the sample classified as uncontactable had increased by 50%. Explanatory factors included decreased currency of electoral roll address information, declining use of listed landline telephone numbers, and possibly declining willingness to participate from increasing respondent burden. Contributory study design features included a possible impact from a shift in leadership by a Māori health research centre to Māori researchers in a non-Māori research centre, increasing complexity of questions and saliency of the research topic to potential participants.