The effect of Māori ethnicity misclassification on cervical screening coverage
These researchers examined data from Waitemata District Health Board’s two Primary Health Organisations (PHOs) to identify the population of Waitemata domiciled women aged 25–69 years eligible for cervical screening. Their cervical screening status was obtained from the National Cervical Screening Programme register (NCSP-R). Auckland and Waitemata DHB data were used to determine the women’s ethnicity in the National Health Index (NHI). Ethnicity codes from the three sources (PHO registers, NCSP-R and NHI) were compared to identify women classified as non-Māori in the NCSP-R but Māori in either of the other two data sources. Of a total of 6718 women identified as Māori on the NCSP, 5242 had been screened within the last 3 years and 1476 had not. An additional 2075 women who identified as Māori in either the PHO or NHI databases but not in the NCSP-R had been screened within the preceding 3 years, and a further 2094 had not been screened. Moreover, 797 women identified as Māori in the NHI or PHO datasets who were not on the NCSP-R (and therefore were not screened). After adjusting ethnicity data to include all screened women classified as Māori from any source, the Waitemata DHB Māori screening coverage rate increased from 49.3% to 68.8% (or to 61.0% and 63.2%, respectively, after adjusting for just PHO or NHI Māori).
The findings are of particular importance for those PHOs and practices with large numbers of Māori women. Hopefully, the NCSP team overseeing the register will be able to address the problem.
Reference: N Z Med J 2013;126(1372):55-65
Binge drinking among Māori secondary school students in New Zealand: associations with source, exposure and perceptions of alcohol use
These researchers investigated factors and outcomes associated with patterns of alcohol use among a sample of 1702 Māori secondary school students from the 2007 national youth health survey. Among current drinkers, 31.5% reported binge drinking (5–9 drinks) and 30.4% reported heavy binge drinking (≥10 drinks) in a 4-hour session in the past 4 weeks. Compared with non-binge drinkers, binge drinkers more frequently reported ‘drinking alcohol was okay for people their age’ (ORbinge 1.9; ORheavy binge 2.4), p<0.0001), had friends that drank alcohol (ORbinge 2.4; ORheavy binge 4.0, p<0.0001), had sourced alcohol from friends (ORbinge 1.7; ORheavy binge 1.2; p=0.002) or from ‘other adults’ (ORbinge 1.6; ORheavy binge 1.7; p=0.0004) and buying their own alcohol (ORbinge 1.7; ORheavy binge 2.8; p<0.0001). Binge drinking was associated with poorer school performance, unsafe sex, unwanted sex, an injury, injuring someone else, motor vehicle crashes and ‘doing things that could cause trouble’. Binge and heavy binge drinkers reported greater difficulty accessing drug and alcohol services (ORbinge 2.30; ORheavy binge 4.97; p<0.0001).
Binge drinking is associated with major risks, especially in adolescents, of cognitive impairments and possible irreversible brain damage – urgent action has been recommended. There is some evidence that interventions by schools and employers, such as health and lifestyle checks, psychosocial skills training and peer referral, can reduce the level of binge drinking. Conducting interviews in emergency departments of young people suspected of harmful drinking patterns and trying to persuade them to accept individual counselling in youth addiction counselling services are also effective strategies for reducing the harm of binge drinking.
Reference: N Z Med J 2013;126(1370):55-69
Prevalence of diagnosed and undiagnosed diabetes and prediabetes in New Zealand: findings from the 2008/09 Adult Nutrition Survey
Data were obtained from the 2008/09 New Zealand Adult Nutrition Survey, a nationally representative, cross-sectional survey of 4721 subjects aged ≥15 years. Self-reported diabetes and the 2010 American Diabetes Association cut-offs for HbA1c were used to define diagnosed diabetes, undiagnosed diabetes and prediabetes. Prevalence rates were calculated and age-specific diagnosed diabetes rates were compared with those from the Virtual Diabetes Register, which counts known diabetes cases as follows: individuals with diabetes are identified using the NHI from 6 databases with information about hospital admissions, attendance at diabetes outpatients or retinal screening, diabetes-specific medication prescriptions, laboratory HbA1c testing and mortality. Overall prevalence rates of diabetes and prediabetes were 7.0% and 18.6%, respectively. Diabetes was more prevalent in men (8.3%) than in women (5.8%) and among the obese (14.2%) compared with the normal-weight group (2.4%). Pacific people had the highest prevalence of undiagnosed diabetes (6.4%), followed by Māori (2.2%) and New Zealand European and Others (1.5%).
Robust and kaupapa Māori research is required to build evidence and then develop and implement approaches to prediabetes.
Reference: N Z Med J 2013;126(1370):23-42
Ethnic, socioeconomic and geographical inequalities in road traffic injury rates in the Auckland region
These researchers describe substantial ethnic, socioeconomic and geographical inequalities in road traffic injury (RTI) risk in the Auckland region. They analysed rates of RTI deaths and non-fatal hospital admissions using the New Zealand Mortality Collection and the National Minimum Data Set 2000–2008. Poisson regression examined the association of age, gender, prioritised ethnicity and small area deprivation (New Zealand Index of Deprivation) with RTI rates, and RTI rates were mapped for 21 local board areas within the Auckland region. RTI rates increased with levels of deprivation in all age groups, with the steepest gradient among children (9% increase/decile) and adults aged 25–64 years (11% increase/decile). In all age groups, RTI risk was highest among Māori (all ages). Pacific children had an elevated risk of RTI compared with the NZ European/ Other group, but Pacific youth (15–24 years) and adults (25–64 years) had a lower risk. While RTI rates were generally higher for those living in rural local board areas, all but one local board in the southern Auckland urban area had among the highest rates.
Interventions or strategies that are effective at reducing ethnic or socioeconomic inequalities in RTI rates are required, particularly in South Auckland and for rural areas. The authors raise an interesting point in their discussion that Auckland’s walking school buses (an intervention expected to reduce child pedestrian injuries) found substantially lower coverage in the southern Auckland urban area, despite the fact that children living in this area are at high risk.
Reference: Aust N Z J Public Health 2013;37(2):162-7
Ethnic density and area deprivation: Neighbourhood effects on Māori health and racial discrimination in Aotearoa/New Zealand
This study analysed the Māori sample from the 2006/07 New Zealand Health Survey to examine the association between increased Māori ethnic density, area deprivation, health, and experiences of racial discrimination. The results of the study showed that whereas ethnic density is protective of the health and exposure to racial discrimination of Māori, this effect is concealed by the detrimental effect of area deprivation, signalling that the benefits of ethnic density must be interpreted within the current socio-political context.
As identified by the authors, whilst Māori ethnic density is associated with improved Māori health and reduced racial discrimination, these benefits are buried by the detrimental effect of area deprivation. Factors that drive and maintain deprivation in areas where Māori live must be eliminated in order for us to fully realise the advantages of living in self-determined communities.
Reference: Soc Sci Med 2013;88:76-82
Finding a living kidney donor: experiences of New Zealand renal patients
This paper discusses the barriers to living donor kidney transplantation (LDKT) in New Zealand. While LDKT is the preferred treatment for many people with end-stage renal failure (ESRF), a significant and growing gap exists between the number of people who might benefit from a transplant and those who receive one in New Zealand. One hundred and ninety-three patients on the New Zealand waiting list for a kidney transplant responded to a postal survey about live transplantation. Their responses provide evidence about patterns of donor recruitment activity amongst New Zealand patients. While many patients are willing to discuss LDKT with family and friends, most are reluctant to go on to ask others directly to consider live donation. Patients who have not discussed LDKT with others are significantly less likely to have received even one offer from a potential donor. Pākehā and Māori are more likely to have received an offer to donate and to have had someone go on to be tested for compatibility than either Pacific or Other ethnic groups. Information gaps, ineffective donor recruitment strategies, donor incompatibility and donor medical unsuitability appear to be major barriers to LDKT. Many barriers are amenable to intervention and the implications for policy and practice are discussed.
An interesting paper, given the higher rates of ESRF in Māori and Pacifica peoples; the lower rates of kidney transplants for Māori and Pacifica peoples compared with NZ Europeans; and the fact that views from the Māori and Pacifica participants in this study varied significantly, when we are often grouped together.
Reference: Aust Health Rev 2013;37(1):48-53
Reducing smoking among indigenous populations: new evidence from a review of trials
This systematic review of the literature identified five trials that recruited nonindigenous and indigenous participants in tobacco control interventions – three interventions tested the effectiveness of enhanced Quitline protocols with cessation products over usual Quitline care, and two trialled a culturally adapted cessation counselling intervention using mobile phones. Three studies did not demonstrate a significant effect of the intervention for both indigenous and nonindigenous participants; two were pharmacotherapy studies using nicotine replacement therapy and the third was a trial of a multimedia phone intervention. The fourth study found a significant effect of a behavioural intervention using text messaging for indigenous and nonindigenous participants. The final study found a significant effect in favour of very low nicotine cigarettes compared with usual care; results were similar across ethnic groups.
A great review on ‘what works’ to help indigenous peoples quit smoking. I agree with the authors’ recommendations that any study of cessation products or support must over-sample Māori, for as Māori participants have indicated, they are more likely to consider quitting even when they just participate in smoking cessation research. Importantly, a focus on developing a ‘culturally appropriate’ service may miss the point. Evidence shows that NZ Europeans are more likely to be prescribed NRT than other ethnicities. This gap increases after adjusting for smoking prevalence. Research to address inequities in clinical practice may therefore be more important.
Reference: Nicotine Tob Res 2013 Mar 21. [Epub ahead of print]
A structured, group-based diabetes self-management education (DSME) programme for people, families and whanau with type 2 diabetes (T2DM) in New Zealand
Outcomes are discussed from a group-based diabetes self-management education (DSME) programme specifically tailored for New Zealand’s social and ethnic environment. A total of 107 patients aged 18–80 years (mean age 56.7 years) with type 2 diabetes from diverse cultural backgrounds were recruited from primary care. The mean duration of diabetes was 7.5 years and ethnic backgrounds consisted of NZ European (44%), Māori (24%), Pacific (16%) and Indian (16%).Seventeen groups of six weekly education sessions were conducted. Responses to a self-administered questionnaire on diabetes knowledge and self-management behaviours revealed that the programme improved confidence in self-managing diabetes, regular examination of feet, physical activity levels and smoking rates. HbA1C was improved from 64.9 mmol/mol (8.07%) at baseline to 59.9 mmol/mol (7.62%) at 6 months (p<0.05), but was no different to baseline at 9 months. Systolic BP reduced from 131.9 to 127.4 mmHg (p<0.05) at 6 months, but increased to baseline levels by 9 months. Diastolic BP, triglycerides and urine microalbumin:creatinine ratio were significantly reduced at 3, 6 and 9 months.
Interesting follow-up of DSME delivered in primary care. As the authors note, many of the gains made at 6 months were lost at 9 months; a refresher course is recommended. A similar evaluation of the ‘Whānau Ora’ type of DSME would provide even more useful information.
Reference: Prim Care Diabetes 2013 Mar 18. [Epub ahead of print]
