Māori Health Review Issue 57

These researchers investigated ethnic differences in acute hospital admissions for otitis media (OM) and elective admissions for ventilation tubes in New Zealand children aged 0–14 years. They also reviewed first attendances at Ear Nose and Throat (ENT) Outpatient appointments during 2007–2008 by ethnicity. Records were examined from all hospital admissions of children aged 0–14 years during 2002–2008 that met the following criteria: acute admissions with an ICD–10-AM primary diagnosis code of OM; elective admissions with a primary procedure code of ventilation tube insertion. Among 0–4 year olds, acute admissions for OM were more likely among Māori and Pacific children than European children. In contrast, both Māori and Pacific children had lower rates of elective admissions for ventilation tube insertion, with ethnic differences being most marked for children from the most deprived areas. In those aged 5–14 years, Māori and Pacific children again had higher acute OM admission rates than European children. However, in contrast to the younger age group, they also had higher rates of ventilation tube insertion. ENT outpatient data for children 0–4 years revealed similar first appointment rates for European and Māori children, but lower rates for Pacific and Asian children. For the 5–14 age group, first appointment rates were higher for Māori and Pacific children than for European children. However, Māori and Pacific children in both age groups had higher rates of non-attendance at their first ENT appointments than European children.

The wahakura, a simple woven flax bassinet-like structure capable of being used in the parental bed, enables a separate sleeping surface in the bedsharing environment and is being promoted as a means to minimise the risk of sudden unexpected death in infancy (SUDI) amongst Māori. In this study, 12 Māori mothers and 10 key informants who had wahakura experience participated in face-to-face, semi-structured interviews, following Māori cultural protocols, which explored their experiences and views on the wahakura. The data were analysed using thematic analysis. The wahakura was valued for its practical appeal: its portability, for enabling bedsharing and making breastfeeding easier. It also had considerable cultural and spiritual appeal because of its native flax composition and traditional origin. Moreover, health professionals found that it facilitated antenatal engagement of Māori women. The study affirmed the acceptability of the wahakura in engaging Māori mothers and families in reducing SUDI risk.

This Auckland-based group of researchers explored family and whānau carers’ experiences of the financial impact of caring within a palliative care context. Semi-structured interviews were held with 30 family/whānau caregivers who were either currently caring for a person with palliative care needs or had done so in the past year. The data were analysed using narrative analysis, which identified impacts and costs at the personal, interpersonal, sociocultural and structural levels. Participants reported significant costs involved in caregiving, resulting in debt for some people or even bankruptcy. A range of direct (transport, food and medication) and indirect costs (related to employment, cultural needs and own health) were reported. A multi-level qualitative analysis revealed how costs operated at a number of levels (personal, interpersonal, sociocultural and structural). The palliative care context increased costs, as meeting needs were prioritised over cost. In addition, there was confusion among caregivers as to what statutory (government) help was available in the context of ‘being palliative’.

For this study, primary care data were examined from a large national multi-ethnic cohort of patients with type 2 diabetes in New Zealand and linked hospital records. The primary outcome was time from initial data collection to first lower limb amputation. There were 892 lower limb amputations recorded among 62,002 patients (2.11 amputations per 1000 person-years), followed for a median of 7.14 years (422,357 person-years). In Cox proportional hazards analyses that adjusted for demographic and socioeconomic variables, Māori had the highest risk of lower limb amputation in comparison with Europeans (hazard ratio [HR] 1.84; 95% CI, 1.54 to 2.19), whereas East Asians (HR 0.18; 95% CI, 0.08 to 0.44) and South Asians (HR 0.39; 95% CI, 0.22 to 0.67) had the lowest risk. Adjusting for available clinical variables (smoking status, height and weight, blood pressure, HbA1c, total cholesterol/HDL ratio and albuminuria)

These researchers investigated the presentation, management and survival of stomach cancer in a cohort of newly diagnosed Māori and non-Māori patients. They reviewed the clinical notes of all Māori from the North Island diagnosed between 2006 and 2008, and a random equivalent sample of non-Māori (final cohort n=335). Compared to non-Māori, Māori patients had a younger average age at diagnosis, a higher prevalence of congestive heart failure and renal disease, and were more likely to be diagnosed with distal disease (43% Māori vs 26% non-Māori; p=0.004). Stage and grade distributions were similar between ethnic groups. Two-thirds (66%) of stage I–III patients had definitive surgery; rates were similar rates between Māori and non-Māori (71% vs 68%). Māori were less likely to have surgery performed by a specialist upper gastrointestinal surgeon (38% Māori vs 79% non-Māori; p<0.01) and less likely to be treated in a main centre (44% Māori vs 87% non-Māori; p<0.01). In multivariate analyses adjusted for age, sex, stage, tumour site and comorbidity, survival was poorer among Māori (hazard ratio 1.27; 95% CI, 0.96 to 1.68).