Māori Health Review Issue 36

This US-based study randomised 390 obese adults in 6 primary care practices to one of three types of intervention: Usual care, consisting of quarterly primary care provider (PCP) visits that included education about weight management; Brief lifestyle counselling, consisting of quarterly PCP visits combined with brief monthly sessions (10- to 15-min encounters) with lifestyle coaches who instructed participants about behavioural weight control; or Enhanced brief lifestyle counselling, which provided the same care as described for the previous intervention but included meal replacements or weight-loss medication (sibutramine or orlistat), chosen by the participants in consultation with the PCPs, to potentially increase weight loss. All interventions were delivered by the PCPs over a 2-year period in collaboration with auxiliary health professionals (lifestyle coaches) in their practices. Over 85% of participants completed the trial, at which time, the mean weight loss with usual care, brief lifestyle counselling, and enhanced brief lifestyle counselling was 1.7, 2.9, and 4.6 kg, respectively. Initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively. For both of these measures of success, enhanced lifestyle counselling was superior to usual care; there were no other significant between-group differences. The benefits of enhanced lifestyle counselling remained even after excluding sibutramine recipients from the analyses.

In March 2009, PHARMAC widened access to oral isotretinoin for severe acne, granting prescribing rights to general practitioners. Formerly, only specialist dermatologists were entitled to prescribe isotretinoin, which was arguably due to the complexity of management and an appreciable risk of teratogenicity if given during pregnancy or within a month of conception. This funding restriction had the potential to create inequitable access barriers. These researchers report the outcomes of an audit on isotretinoin use in New Zealand by deprivation level and ethnicity, using dispensed prescription data for funded isotretinoin for the year ending June 2008. The researchers also analysed prescription data from the same period for cyproterone acetate with ethinyloestradiol, another acne pharmaceutical available on prescription with no funding restrictions. The data showed that people living in more deprived areas (as defined by NZDep Index) were less likely to use isotretinoin, as were Māori and Pacific people. The association with deprivation level was not present for cyproterone acetate with ethinyloestradiol, although disparities in use by ethnicity remained.

This study describes the epidemiology of unintentional home injuries resulting in death or admission to hospital among young and middle-age New Zealanders. The study authors selected cases from Ministry of Health public hospital discharge (2000–2009) and mortality data (1998–2007), and included all 20–64 year olds where the place of injury occurrence was classified as ‘home’. Only initial hospitalisations with a stay of ≥24 hours were included. The analysis revealed that on average 4,000 young and middle-age adults are admitted to hospital and 60 die annually as a result of unintentional injuries sustained at home. The highest mortality rates are associated with being male, older age (50 to 64 years), and Māori. Similarly, the highest hospitalisation rates are amongst males, older age groups (>40 years), and Māori. Poisoning, falls, and burns are the leading causes of unintentional home injury deaths. As age increased so did the incidence of hospital admission. The leading contributors resulting in admission to hospital were falls, cutting or piercing, overexertion, and poisoning. Falls-related injuries had the highest median length of hospital stay and in-hospital mortality rate. As deprivation increased so did the frequency of hospital admissions due to fall and cutting or piercing injuries.

This paper examined ethnic and socioeconomic differences and incidence trends for 18 adult cancers in New Zealand between 1981–2004, with 47.5 million person-years of follow-up. Compared to European/Other people in New Zealand, Māori and Pacific people are 1.5–2.5 times more likely to develop cervical, endometrial, stomach and pancreatic cancers; Māori, Pacific and Asian people are 5 times more likely to develop liver cancer. For European/Other, rates of colorectal, bladder and brain cancers were 1.5–2 times higher and melanoma rates 5–10 times higher than rates of other groups; Pacific and Asian kidney cancer rates were half those of Māori and European/Other. Trends over time revealed faster decreases in rates of cervical cancer in Māori and Pacific people, whereas and Māori rates of colorectal and breast cancer increased faster, than European/Other rates. Male lung cancer rates decreased for European/Other, were stable for Māori and increased for Pacific. Female lung cancer rates increased for all ethnic groups. Other than lung (rate ratio 1.35 men, 1.56 women), cervical (1.35) and stomach cancer (1.23), differences in incidence by income were modest or absent.

These researchers examined the prevalence in New Zealand of self-reported pregnancy among sexually experienced high school students, and the association between teenage pregnancy and access to primary health care, using data collected between March and October 2007 at 96 high schools nationwide participating in Youth’07, a Health and Wellbeing survey. A total of 2,620 (1,217 females and 1,403 males) year 9 through 13 students reported ever having sexual intercourse and responded to a question about whether they had ever been pregnant or ever caused a pregnancy. Nationwide, 10.6% of sexually experienced high school students self-reported that they had been pregnant (11.6%) or caused a pregnancy (9.9%). Māori (15.3%) and Pacific Island (14.1%) students had the highest self-reports of pregnancy. Foregone health care was reported by 24.2% of sexually experienced students. Students who self-reported pregnancy reported greater difficulty accessing health care (41.7% vs 20.6%; OR 2.6); however, when they accessed care, the majority received confidential care (67.4%) as compared with pregnancy-inexperienced peers (51.6%). Concern about privacy was the most common reason for not accessing health care. Other barriers included uncertainty about how to access care and lack of transportation (all p values <0.05).

In this investigation into the influence of ethnicity on continuous positive airway pressure (CPAP) adherence in New Zealand, 126 CPAP-naïve patients (19.8% Māori, mean apnoea-hypopnoea index 57.9 events/h, CPAP 11.1 cm H2O) underwent a 4-week supervised home trial of CPAP following pressure titration. After 1 month, objective CPAP adherence was significantly lower among Māori than non-Māori (median 5.11 h/night vs 5.71 h/night; p=0.05). In a multivariate logistic regression model incorporating 5 variables (ethnicity, eligibility for government-subsidised healthcare, individual deprivation scores, income, and education), non-completion of tertiary education, and high individual socioeconomic deprivation remained significant independent predictors of average CPAP adherence not reaching ≥4 h (OR 0.25, p=0.02; OR 0.10, p=0.04, respectively). The overall model explained approximately 23% of the variance in adherence

These researchers surveyed 758 postpartum women in hospitals and birthing centres across New Zealand about folic supplement use and bread intake in the periconceptional period. Criteria for the adequate intake of folic acid through proposed mandatory fortification were the habitual consumption of three or more slices of bread/day (118–150 μg folic acid/day) in the month prior to conception, and during the first trimester of pregnancy. Thirty-three percent of women reported having used folic acid supplements as recommended during the periconceptional period; with mandatory fortification, the proportion of women who would have achieved adequate folic acid intake increased to 59%. In a model of mandatory fortification, sociodemographic predictors of poor folic acid intake from supplements, including younger maternal age, increasing parity, minority ethnicity status, lower education and less income, were rendered either non-significant or appreciably attenuated. The fully adjusted odds ratio for pregnancy planning was reduced from 17.24 to 2.61 (both p<0.001).