Māori Health Review Issue 48

To examine time trends and ethnic disparities in hepatocellular carcinoma (HCC) incidence, risk factors, comorbidity and treatment pathways, data from Jan 1 2006 to Dec 31 2008 were analysed and identified 97 Māori and 92 non-Māori patients with HCC for hospital note review. Time trends were determined from NZ population (1981–2004) cohorts linked probabilistically to cancer registry records. The incidence of liver cancer was higher in Māori across all time periods. In comparison with non-Māori, Māori males had almost a 5-fold higher rate of liver cancer (RR 4.79; 95% CI 4.14-5.54), while Māori females had a 3-fold higher rate (RR 3.02; 95% CI 2.33-3.92). Tumour characteristics and treatment of Māori and non-Māori patients with HCC did not differ. Hypertension was more common in Māori (51% vs 25%) while cirrhosis was more common in non-Māori (62% vs 41%). Hepatitis B prevalence in Māori patients was double that of non-Māori (56% vs 27%), while the HR for cancer-specific death was 1.36 (95% CI 0.96-1.92) for Māori versus non-Māori.

This literature review aimed to identify factors used to attract indigenous students into medical careers, interventions required to achieve graduation and factors that encourage entry into specialist training programmes and faculty appointments. All medical schools studied used elements of a ‘pipeline approach’ including secondary school contact to encourage aspirational goals and subject selection. Bridging courses are used to ensure students have appropriate skills before entering medical training and extensive practical help is provided. Elements required for primary medical qualification are also necessary for postgraduate achievement success (dedicated and focused study, development of appropriate skills, mentoring, support and institutional and collegial commitment).

This qualitative exploratory study, employing general inductive techniques informed by a Kaupapa Māori approach, considered the access of seven Māori sole mothers’ to health services for personal health needs, particularly focussing on primary health care. The major barrier to health care access was cost. Additional barriers included compounding cost, transport difficulties, service location and scheduling. Child-related issues that acted as a barrier to access, included the prioritisation of children’s needs and childcare over personal health.

This research examined the experience of cancer screening, diagnosis, treatment, survival and palliative care of 12 Māori patients and their whanau through semi-structured interviews to identify factors that facilitate or inhibit use of cancer care services. Key areas identified include the experience of support, continuity of care and the impact of financial and geographic constraints. In conjunction with interpersonal rapport, a more positive experience was facilitated by a long-term relationship with a primary health provider, suggesting that those with a ‘medical home’ are more satisfied with their care and report fewer service coordination problems.

This analysis of data from three surveys between 2001 and 2012 aimed to describe indicators of wellbeing and health of secondary school students in New Zealand. Significant reductions (adjusted OR) between 2001 and 2012 were reported for cigarette use (0.27; 95% CI 0.23-0.32), alcohol use (0.39; 95% CI 0.33-0.46), marijuana use (0.37; 95% CI 0.31-0.43), sexual abuse (0.52; 95% CI 0.46-0.58), fighting (0.63; 95% CI 0.55-0.73), seatbelt use (1.47; 95% CI 1.31-1.65) and risky driving behaviours (0.39; 95% CI 0.33-0.45). There were also improvements (adjusted OR) in positive connections to school for variables including the perception that the school cares (1.22; 95% CI 1.10-1.35), liking school (1.55; 95% CI 1.33-1.82) and good family relationships (1.83; 95% CI 1.70-1.97). Parameters that failed to improve and were poor in comparison with international estimates were condom use at last sexual intercourse (adjusted OR 0.77; 95% CI 0.68-0.87), daily physical activity (0.88; 95% CI 0.78-0.99) and being overweight/obese (1.09; 95% CI 0.92-1.31). Other indicators that did not improve were exposure to family violence (adjusted OR 1.37; 95% CI 1.11-1.68) and depressive symptoms (1.03; 95% CI 0.91-1.17).

Researchers from Christchurch studied sociodemographic and clinical factors predicting hospital admission after early intervention for psychosis services treatment in 231 patients between 2000 and 2005. Most patients (78%) were admitted before or during treatment, while 29% were admitted after completing the program. Māori ethnicity, older age, a domestic partner at referral, a lower Global Assessment of Functioning score, and hospitalisation before and during treatment significantly predicted the number of post-treatment hospital admissions.

A systematic review was conducted to examine the burden of stomach cancer among indigenous peoples worldwide. Increased rates of stomach cancer incidence and mortality were observed in almost all indigenous peoples considered (indigenous Australians, Māori, circumpolar indigenous peoples, native Americans and Alaskan natives, and the Chilean Mapuche) when compared to the corresponding non-indigenous population in the same region or countries, particularly among the Inuit in the circumpolar region (standardised incidence ratios; males 3.9, females 3.6) and Māori (males: 2.2, females: 3.2).

This systematic review evaluated the association between perceived racial discrimination and hypertensive status including systolic, diastolic and ambulatory blood pressure (BP). A total of 44 published studies including a total of 32,651 subjects were included in the analysis. Perceived racial discrimination was associated with hypertensive status (Fisher’s Z score for hypertension 0.048; 95% CI 0.013-0.087), but not with resting BP (systolic 0.011; 95% CI -0.006-0.031), diastolic 0.016, 95% CI -0.006-0.034). Factors that amplified the relationship included male sex, Black race, older age, lower education and hypertensive status. Nighttime ambulatory BP was most strongly associated with perceived discrimination, especially among Blacks.

This study examined the effectiveness of the Healthy Babies Healthy Start maternal health program that emphasises racial equity and home visitation, in improving birth outcomes for Black relative to White women using Michigan state- and Kalamazoo County-level birth certificate records from 2008-10. In spite of a 2-fold higher smoking rate, Black health program participants delivered higher birth-weight infants than did Black nonparticipants (p = 0.05). Although White participants received significantly more prenatal care than White nonparticipants, they experienced similar birth outcomes.

This review of empirical research indicates that racism adversely affects health in a non-dominant racial population. Institutional racism results in policies and procedures that reduce access to housing, neighborhood and educational quality, employment opportunities and other societal resources. Cultural racism harms economic status and health through the creation of a hostile policy environment, initiating negative stereotypes and discrimination that foster damaging psychological responses. Experiences of racial discrimination are also an important psychosocial stressor that leads to adverse changes in health status and alters behavior to increase health risks.