Māori Health Review Issue 15

A total of 2812 adults who reported childhood maltreatment were matched with 3356 adults who reported no childhood maltreatment, and compared using propensity score methods. Health-related quality-of-life data (or “utilities”) were imputed from the Medical Outcomes Study 36-Item Short Form Health Survey using the Short Form–6D preference-based scoring algorithm. The combined strata-level effects of maltreatment on Short Form–6D utility was a reduction of 0.028 per year (p<0.001). All utility losses differed significantly between the two groups by age level: 18–39 years, p<0.042; 40–49 years, p<0.038; 50–59 years, p<0.023; 60–69 years, p<0.016; ≥70 years, p<0.025.

These researchers sought to better understand underlying causes of ethnic disparities relating to diabetes, by using data from the 2003 National Inpatient Sample to analyse the correlation between the primary diagnosis on patient admission and the likelihood that the condition represented poorly controlled diabetes or a diabetes-related complication. They found that minorities were more likely to be admitted through the emergency department and for a condition directly related to diabetes progression. Minorities were also more likely to be admitted for acute hyperglycaemia and acute hypoglycaemia.

Data from the 1990 National Health Interview Survey’s Health Promotion and Disease Prevention Supplement, involving 40,335 US adults, were linked to prospective National Death Index mortality data through 1997, to determine whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. High baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population as well as among people with low socioeconomic status (SES), but not those with middle or high SES.

In chapter 13 of Hauora: Mäori Standards of Health IV, Sarah-Jane Paine, Ricci Harris and Kara Mihaere discuss sleep and sleep disorders in New Zealand. They highlight the fact that Mäori are more likely to suffer from insomnia and obstructive sleep apnoea syndrome than non-Mäori and that Mäori have more risk factors for the development of sleep problems than non-Mäori. The chapter acknowledges that disparities in sleep problems between Mäori and non-Mäori may impact on disparities in other health outcomes and the authors recommend that Mäori needs are prioritised in the development, planning, and purchase of sleep services, which need to be appropriate and accessible to Mäori. The chapter ends with a framework for understanding health inequities including the direct and indirect effects of racism.

In this retrospective analysis, records were examined from 1375 patients attending six ambulatory care clinics in England who were appropriate candidates for investigation by coronary angiography, to determine whether they received the angiogram or not. Overall, 69% of patients deemed appropriate for angiography did not receive it. According to multivariate analyses, patients who were aged >64 years, were women, of south-Asian origin and were in the most deprived fifth of the population were less likely to receive coronary angiography than those who were aged <50 years, were men, were white, or were living in the other four fifths. Not undergoing angiography when it was deemed appropriate was associated with higher rates of coronary event.

This study assessed data from an audit of secondary care management in Auckland-Northland of 565 lung cancer patients diagnosed in 2004, to determine entry routes into and transit times in secondary care. Most patients (198; 35%) entered secondary care via the emergency department (ED), especially those with metastatic disease. The median time from entry to diagnosis was 22 days overall, but only 11 days when entry occurred via ED. The median time from entry to treatment was 64 days; 59 days for palliative treatment and 76 days for curative treatment. Initiation of treatment within internationally recommended timeframes occurred for 41% patients undergoing surgical resection, 36% receiving definitive (56% palliative) radiation therapy and 40% receiving chemotherapy. In multivariate analysis, factors that influenced these times included the entry route, the presenting symptoms, the investigations performed, the tumour type, multidisciplinary discussion and Mäori ethnicity.