Māori Health Review Issue 47

This New Zealand study estimated the effects of price changes on consumer demand for major commonly consumed food groups, by income and ethnicity, using food expenditure data from national household economic surveys in 2007/08 and 2009/10 and Food Price Index data from 2007 and 2010. According to the study’s calculations, targeted food pricing policies have the potential to alter the diets and nutritional health of low-income and priority ethnic groups, such as Māori, to a greater extent compared with those of high-income and majority ethnic groups. This New Zealand study estimated the effects of price changes on consumer demand for major commonly consumed food groups, by income and ethnicity, using food expenditure data from national household economic surveys in 2007/08 and 2009/10 and Food Price Index data from 2007 and 2010. According to the study’s calculations, targeted food pricing policies have the potential to alter the diets and nutritional health of low-income and priority ethnic groups, such as Māori, to a greater extent compared with those of high-income and majority ethnic groups.

This study examined the association between socially-assigned ethnicity (how an individual is classified by others ethnically/racially) and individual experience of racial discrimination, and socially-assigned ethnicity and health (self-rated health, psychological distress [Kessler 10-item scale]) in this analysis of data from 3160 adult participants (aged ≥15 years) in the 2006/07 New Zealand Health Survey who self-identified their ethnicity as Māori. Those who were socially-assigned as European-only had significantly less experience of racial discrimination (adjusted odds ratio [OR] 0.58, 95% CI 0.44 to 0.78) than Māori who were socially-assigned as non-European. Being socially-assigned as European-only was also associated with health advantage compared to being socially-assigned non-European: more likely to respond with self-rated very good/excellent health (age, sex adjusted OR 1.39; 95% CI 1.10 to 1.74), and lower Kessler 10 scores (age, sex-adjusted mean difference –0.66, 95% C I = –1.22 to –0.10). These results were attenuated following adjustment for socioeconomic measures and experience of racial discrimination.

These researchers sought to determine differential dispensing of medicines by ethnicity in New Zealand, using anonymised prescription medicines dispensing claims data from the financial year 1 July 2006 to 30 June 2007. In needs-adjusted analyses, prescription dispensing (script) rates overall for Māori were similar to those of non-Māori in a small number of areas that included substance use disorders, hepatitis B/C treatments and anti-rheumatoid agents. However, the data suggest important and potentially remediable differences that need to be addressed. Differences in dispensing included areas of high health need such as heart disease, infections, diabetes, mental health and respiratory disease, where dispensing was 19–37% lower overall for Māori than for non- Māori, with a net difference of nearly 1 million scripts. Importantly, Māori were both less likely to access medicines, and then after first dispensing had fewer subsequent scripts.

This study recruited 593 patients undergoing gastroscopy between February 2012 and October 2012 and determined the prevalence of primary Helicobacter pylori (H. pylori) infection from all Campylobacter-like organism (CLO) tests performed. All patients were attending the Counties Manukau District Health Board (South Auckland) Endoscopy Service. The prevalence of H. pylori infection by ethnic group was 7.7% in Europeans, 34.8% in Māori, 31.3% in Pacific peoples and 23.8% in Orientals. Almost half (49.3%) of all isolates were metronidazole-resistant, 16.4% were clarithromycin-resistant and 9.5% were moxifloxacin-resistant. No isolates were resistant to tetracycline. Clarithromycin resistance (≥15%) was prevalent among Māori, Pacific peoples and Orientals. Significant increases were observed in metronidazole resistance from 32.7% in 1999 to 49.3% in 2012 (p=0.011) and clarithromycin resistance from 7% in 1999 to 16.4% in 2012 (p=0.021). In an intent-to-treat analysis, the eradication rate with standard omeprazole, amoxicillin and clarithromycin therapy was 85.7% in ethnic groups where clarithromycin resistance was <15% versus 64.9% in groups where clarithromycin resistance was ≥15% (p=0.024).

Results are reported from this nationwide 24-month study conducted between 2007 and 2009 by the New Zealand Paediatric Surveillance Unit in order to define epidemiology and clinical features of acute post-streptococcal glomerulonephritis (APSGN) in children aged 0–14 years hospitalised with the illness. The study involved 215 paediatricians who reported 176 new hospitalised cases fulfilling a case definition of definite (haematuria with low C3 and high streptococcal titres or biopsy-proven APSGN; n=138) or probable (haematuria with low C3 or high streptococcal titres; n=38). Of all cases, 63% were residing in the Auckland metropolitan region and 67% were in the most deprived quintile. The annual incidence was 9.7/100,000 and overrepresented by Pacific and Māori children (45.5 and 15.7) compared with 2.6/100,000 European/other and 2.1/100,000 Asian. The highest annual incidence was recorded in the South Auckland Metropolitan region (31/100 000), versus 14.9 in Central Auckland, 5.9 in the West/North Auckland metropolitan region and 5.5 for the remainder of New Zealand. The highest age-specific incidence was among children aged 5–9 years (15.1/100,000). Reduced serum complement C3, gross haematuria, hypertension, impairment of renal function and heavy proteinuria were found in 93%, 87%, 72%, 67% and 44% of patients, respectively. Severe hypertension was closely associated with either symptoms of an acute encephalopathy or congestive heart failure.

These researchers calculated and ranked unintentional child injury death rates based on external cause of injury, with the aim of developing recommendations for child unintentional injury prevention. NZ’s score for each of the 12 domains (based on external causes of injury) from the New Zealand Child and Adolescent Report Card was compared to scoring from 25 European countries. Death as a motor vehicle occupant accounts for 49% of all child unintentional injury deaths, followed by pedestrian (10%) and drowning deaths (8%). According to the overall score of the NZ Report Card, NZ ranks as 15th among the participating European countries. NZ is yet to implement important policy and legislative actions.

These University of Auckland researchers describe a process of ideological legitimation of inequality, whereby intergroup contact between the disadvantaged and dominant groups perpetuates political attitudes that are detrimental to the interests of the disadvantaged group. They illustrate their argument with a nationally representative sample of 1008 Māori (a disadvantaged group in NZ). Positive intergroup contact with the dominant group (NZ Europeans) predicted increased opposition to a topical reparative policy (Māori ownership of the foreshore), whereas contact with ingroup members had the opposite effect of increasing support for reparative policy by reducing subscription to meritocratic ideology.

This paper describes the incidence, diagnostic clinical manifestations and severity of juvenile systemic lupus erythematosus (jSLE) in a cohort of New Zealand Māori and Pacific Island children compared to European children. A review of charts for 32 children with jSLE seen by the Starship paediatric rheumatology and/or renal services between January 2000 and November 2010 revealed an annual incidence of 0.52/100,000 per year. The incidence of jSLE was higher among Māori and Pacific (0.67/100,000 per year; p=0.06) and significantly higher among Asian children (1.17/100,000 per year; p=0.01) than among European children (0.31/100,000 per year). At presentation, lupus nephritis was diagnosed significantly more often in Māori and Pacific children compared with European children (80% vs 40%; p=0.09, as was severe (WHO class 4 or 5) renal lesions (60% vs 40%, p=0.43). Similarly, at any time during the study, lupus nephritis (100% vs 40%; p=0.001) and severe (WHO class 4 or 5) renal lesions (73.3% vs 40%; p=0.12) were more frequent among Māori and Pacific compared with European children. In retrospective analyses of British Isles Lupus Assessment Group (BILAG) scores, severe “Category A” disease occurred more often in Māori and Pacific children compared with European children (56.8% vs 22.7%; p=0.17) and was predominantly renal in nature (73.3% vs 40%; p=0.12).