Publications

2022 The epidemiology of cardiovascular disease among Pacific people in New Zealand

Presentation

Julie Winter-Smith, a Tongan PhD candidate in Manawataki Fatu Fatu, will be presenting her research at the School of Population Health, University of Auckland Doctoral Showcase on Wednesday 22 June, 2-4:30pm.

  • BibTex Key
  • Authors J. Winter-Smith
  • Tags Pacific health

    2022 The impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study

    Journal Article

    Citation:

    Thompson, S.G., Barber, P.A., Gommans, J.H., Cadilhac, D.A., Davis, A., Fink, J.N., Harwood, M., Levack, W., McNaughton, H., Feigin, V.L. and Abernethy, V., 2022. The impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study. The Lancet Regional Health-Western Pacific20, p.100358.

    Summary

    Background

    Ethnic inequities in stroke care access have been reported internationally but the impact on outcomes remains unclear. In New Zealand, data on ethnic stroke inequities and resultant effects on outcomes are generally limited and conflicting.

    Methods

    In a prospective, nationwide, multi-centre observational study, we recruited consecutive adult patients with confirmed stroke from 28 hospitals between 1 May and 31 October 2018. Patient outcomes: favourable functional outcomes (modified Rankin Scale 0-2); quality of life (EQ-5D-3L); stroke/vascular events; and death at three, six and 12 months. Process measures: access to reperfusion therapies, stroke-units, investigations, secondary prevention, rehabilitation. Multivariate regression analyses assessed associations between ethnicity and outcomes and process measures.

    Findings

    The cohort comprised 2,379 patients (median age 78 (IQR 66-85); 51·2% male; 76·7% European, 11·5% Māori, 4·8% Pacific peoples, 4·8% Asian). Non-Europeans were younger, had more risk factors, had reduced access to acute stroke units (aOR=0·78, 95%CI, 0·60-0·97), and were less likely to receive a swallow screen within 24 hours of arrival (aOR=0·72, 0·53-0·99) or MRI imaging (OR=0·66, 0·52-0·85). Māori were less frequently prescribed anticoagulants (OR=0·68, 0·47-0·98). Pacific peoples received greater risk factor counselling. Fewer non-Europeans had a favourable mRS score at three (aOR=0·67, 0·47-0·96), six (aOR=0·63, 0·40-0·98) and 12 months (aOR=0·56, 0·36-0·88), and more Māori had died by 12 months (aOR=1·76, 1·07-2·89).

    Interpretation

    Non-Europeans, especially Māori, had poorer access to key stroke interventions and experience poorer outcomes. Further optimisation of stroke care targeting high-priority populations are needed to achieve equity.

    Funding

    New Zealand Health Research Council (HRC17/037).

    Keywords

    Stroke

    Disparities

    Ethnicity

    Indigenous

    Health services research

    Epidemiology

    Outcome resarch

     

     

     

    • BibTex Key
    • Authors M. Harwood
    • Tags ethnicity | stroke
    • DOI Number https://doi.org/10.1016/j.lanwpc.2021.100358
    • Publisher The Lancet Regional Health Western Pacific

      2021 Bula Sautu – A window on quality 2021: Pacific health in the year of COVID-19

      Technical Report

      ‘Bula Sautu’ is a Fijian saying expressing an aspirational goal for ‘good health that is lived to its full potential; a life of abundance’.

      However, Pacific peoples living in Aotearoa New Zealand are suffering from some of the worst inequities in health in the country. Many are even worse than those of our wider Pacific whānau who are tangata whenua.

      Pacific peoples live six fewer years of life than non-Māori, non-Pacific, and the gap is widening.

      See the full report here: Bula Sautu – A window on quality 2021: Pacific health in the year of COVID-19 | He mata kounga 2021: Hauora Pasifika i te tau COVID-19 (hqsc.govt.nz)

      • BibTex Key
      • Authors A. Talemaitoa | C. Grey | D. Ryan
      • Tags Pacific health
      • Publisher Health Quality & Safety Commission. 2021 Wellington. 2021

        2022 Contrasting trends in heart failure incidence in younger and older New Zealanders, 2006–2018

        Journal Article

        Abstract

        Objective Studies indicate that age-standardised heart failure (HF) incidence has been decreasing internationally; however, contrasting trends in different age groups have been reported, with rates increasing in younger people and decreasing in the elderly. We aimed to describe age-specific trends in HF incidence in New Zealand (NZ).

        Methods In this nationwide data linkage study, we used routinely collected hospitalisation data to identify incident HF hospitalisations in NZ residents aged ≥20 years between 2006 and 2018. Age-specific and age-standardised incidence rates were calculated for each calendar year. Joinpoint regression was used to compare incidence trends.

        Results 116 113 incident HF hospitalisations were identified over the 13-year study period. Between 2006 and 2013, age-standardised incidence decreased from 403 to 323 per 100 000 (annual percentage change (APC) −2.6%, 95% CI −3.6 to −1.6%). This reduction then plateaued between 2013 and 2018 (APC 0.8%, 95% CI −0.8 to 2.5%). Between 2006 and 2018, rates in individuals aged 20–49 years old increased by 1.5% per year (95% CI 0.3 to 2.7%) and decreased in those aged ≥80 years old by 1.2% per year (95% CI −1.7 to −0.7%). Rates in individuals aged 50–79 years old initially declined from 2006 to 2013, and then remained stable or increased from 2013 to 2018. The proportion of HF hospitalisations associated with ischaemic heart disease decreased from 35.1% in 2006 to 28.0% in 2018.

        Conclusion HF remains an important problem in NZ. The decline in overall incidence has plateaued since 2013 due to increasing rates of HF in younger age groups despite an ongoing decline in the elderly.

        Paper: Contrasting trends in heart failure incidence in younger and older New Zealanders, 2006–2018 | Heart (bmj.com)

        • BibTex Key 2022
        • Authors A. Kerr | C. Grey | D. Chan | K. Poppe | M. Ai Wei Lee | M. Lund | R. Doughty | V. Selak
        • Tags heart failure
        • Publisher BMJ Heart
        • Edition Volume 108, Issue 4

          2021 Dr Tua Taueetia-Su’a

          Presentation

          Dr Tua Taueetia-Su’a givens an interview for Samoa Capital Radio on 21 December 2021. The interview (in the Samoan language) can be viewed here (at 3:12:00 to 3.55.10) Facebook Live | Facebook

          • BibTex Key
          • Authors Dr Tua Taueetia-Su’a
          • Tags Pacific health

            2021 Prevalence and Predictors of Post-Traumatic Stress Disorder in a Cohort of 2200 Injured New Zealanders

            • BibTex Key
            • Authors S. Amertunga
            • Tags trauma

              2021 Kōkiri Te Oranga

              Online

              Panui:
              In association with Te Kura Kaupapa Māori o Hoani Waititi Marae, Auckland District Health Board, Hāpai Te Hauora, Procare we present ‘Kōkiri Te Oranga’ a series of live streams, kōrero from Māori Health Experts about Māori issues around health and wellbeing.
              E te whānau we are fortunate to have Dr Jin Russell who is a Development Pediatrician of 12-13years experience who works in starship. Accompanied by Dr Matire Harwood a General Practitioner and researcher into healthy outcomes for Māori and communities.
              Te Wā:
              Stream Live 6:00-6:30pm
              Wednesday 8 December 2021
              Ko Wai: Dr Jin Russell & Dr Matire Harwood
              Ngā Take Kōrero:
              1. Vaccination of 5yr-11yr in 2022.
              2. Traffic Light System and how we should treat it
              3. Isolation packs and planning for Covid while isolating at home.
              Mā wai tēnei pāpahotanga? Who is this broadcast for?
              For everyone but through a māori lens for Kura Kaupapa, Kura ā-Iwi, Kōhanga reo, Rūmaki, Reo-Rua, and hapori Māori of Tāmaki Makaurau.
              Its purpose to ensure our hapori Māori are kept up to date with kōrero around Covid vaccination, the next steps, and living in a covid world. It changes all the time so staying ahead of the wave can only better prepare you and give info as to where to get support.
              To further promote Māori solutions for Māori people and reaching out to those seeking kōrero from our own mātanga/tākuta.
              Recording here: Facebook
              • BibTex Key
              • Authors M. Harwood | matire
              • Tags Māori health

                2021 Māori and Pacific peoples’ experiences of a Māori-led diabetes programme

                Journal Article

                AIM: Type 2 diabetes mellitus (T2DM) disproportionately affects Māori and Pacific peoples in Aotearoa (New Zealand). Despite this, the lived experiences of T2DM and its management by Māori and Pacific peoples are scarcely acknowledged in health literature. The present study examines the lived experiences of T2DM by Māori and Pacific participants in the Mana Tū diabetes programme. Mana Tū is a Māori-led diabetes support programme co-designed by the National Hauora Coalition (NHC) alongside patients with diabetes, clinicians, health service planners and whānau ora providers.

                METHOD: The study used qualitative methods underpinned by Kaupapa Māori (Māori approaches) approaches. Twenty-two semi-structured interviews were conducted with participants of the Mana Tū diabetes programme and their whānau (thirteen Māori, 9 Pacific) from Tāmaki Makaurau (Auckland) and Te Tai Tokerau (Northland).

                RESULTS: The study identified barriers, facilitators and motivators for participants to live well with T2DM. Four key themes were constituted: (1) whānau experience of T2DM, (2) cultural safety in healthcare interactions, (3) whānau ora (collective family wellbeing) and (4) Kaupapa Māori approaches to health interventions. Themes were consistent across Māori and Pacific participants.

                CONCLUSION: Findings suggest that Māori-led health interventions can better support Māori and Pacific people living with T2DM and are needed to ensure these communities receive appropriate, responsive and equitable healthcare.

                • BibTex Key
                • Authors A.Peihopa | D.Nicholls | J.Murray | K.Hawkins | M. Harwood | N.Rice | T.Tane | V. Selak | V.Lata
                • Tags Diabetes | Māori health | Pacific health
                • Publisher The New Zealand Medical Journal (Online)
                • Edition 134(1543), pp.79-6.

                  2020 The importance of considering both primary and secondary diagnostic codes when using administrative health data to study acute coronary syndrome epidemiology (ANZACS-QI 47)

                  Journal Article

                  Abstract

                  Aims

                  Routinely collected health administrative data have become an important data source for investigators assessing disease epidemiology. Our aim was to investigate the implications of identifying acute coronary syndrome (ACS) events in New Zealand (NZ) national hospitalization data using either the first (primary) or subsequent (secondary) codes.

                  Methods and results

                  Using national health datasets, we identified all NZ hospitalizations (2014–16) for patients ≥20 years with a primary or secondary International Classification of Diseases 10th Revision, Australian Modification (ICD10-AM) ACS code. Outcomes included 1-year all-cause and cause-specific mortality, hospitalized non-fatal myocardial infarction, heart failure, stroke, or major bleeding, and a composite comprising these outcomes. Of 35 646 ACS hospitalizations, 78.5% were primary and 21.5% secondary diagnoses. Compared to primary coding, patients with a secondary diagnosis were older (mean 77 vs. 69 years), more likely to be females (48% vs. 36%), had more comorbidity, and were less likely to receive coronary angiography or revascularization. Higher adverse event rates were observed for the secondary diagnosis group including a three-fold higher 1-year mortality (40% vs. 13%) and two-fold higher composite adverse outcome (54% vs. 26%). The use of primary codes alone, rather than combined primary and secondary codes, resulted in overestimation of coronary angiography and revascularization rates, and underestimation of the 1-year case fatality (13.1% vs. 19.0%) and composite adverse event rate (26% vs. 32%).

                  Conclusion

                  Patient characteristics and outcomes of ACS events recorded as primary vs. secondary codes are very different. These findings have important implications for designing studies utilizing ICD10-AM codes.

                  • BibTex Key
                  • Authors A. Kerr | C. Grey | K. Poppe | S. Wells | T. Wang | Y.Jiang
                  • Tags Acute coronary syndrome | ANZACS
                  • DOI Number 10.1093/ehjqcco/qcaa056
                  • Publisher European Heart Journal-Quality of Care and Clinical Outcomes
                  • Edition Volume 7, Issue 6

                    2021 mRNA and Māori Health

                    Presentation

                    Webinar hosted by Healthier Lives on 17 November 2021: Pathways between research, policy and practice for equitable evidence-informed health and wellbeing in Aotearoa’s new health system

                    • BibTex Key
                    • Authors M. Harwood
                    • Tags implementation science | Māori health

                      2021 Cardiovascular disease and its management among Pacific people: a systematic review by ethnicity and place of birth

                      Journal Article

                      Abstract

                      Background:

                      Pacific people experience a disproportionate burden of cardiovascular disease (CVD), whether they remain in their country of origin or migrate to higher‑income countries, such as Australia, Aotearoa New Zealand or the United States of America. We sought to determine whether the CVD health needs of Pacific people vary according to their ethnicity or place of birth.

                      Methods:

                      We conducted a systematic review of medical research databases and grey literature to identify relevant data published up to 2020. Texts were included if they contained original data stratified by Pacific‑specific ethnicity or place of birth on the burden or management of CVD, and were assessed as having good quality using a National Heart, Lung, and Blood Institute quality assessment tool. The protocol for this review was registered with the Open Science Forum (https:// doi. org/ 10. 17605/ OSF. IO/ X7NR6).

                      Results:

                      Of 3679 texts identified, 310 full texts were reviewed and the quality of 23 of these assessed, using the pre‑defined search strategy. Six items (four reports, one article, one webpage) of good quality met the review eligibility criteria. All included texts provided data on epidemiology but only one reported on the management of CVD. Four texts were of Pacific populations in Pacific Island countries and two were of Pacific diaspora in other countries. Data from the Global Burden of Disease study, which provided estimates for the greatest number of Pacific countries, showed substantial differences in mortality rates between Pacific countries for every CVD type. For example, the mortality rate per 100,000 for ischemic heart disease (IHD) ranged from 103.41 in the Cook Islands to 430.35 in the Solomon Islands. A New Zealand‑based report showed differences in CVD rates by Pacific ethnicity (e.g. the age‑standardised prevalence of IHD per 1,000 population in Auckland ranged from 107.8 (Niuean) to 138 among Cook Islands Māori (p < 0.001)).

                      Conclusions:

                      This review of published studies reveals that the epidemiology of CVD among Pacific people varies by specific ethnic groups, place of birth, and country of residence. There is a critical need for high‑quality contemporary ethnic‑specific Pacific data to respond to the diverse CVD health needs in these underrepresented groups.

                      Open access: https://rdcu.be/cz2T5

                       

                      • BibTex Key
                      • Authors C. Grey | J. Winter-Smith | M. Harwood | S. Amertunga | V. Selak
                      • Tags Atherosclerosis | Cardiovascular disease | Epidemiology | Equity | Management | Migrant | Pacific
                      • DOI Number https://doi.org/10.1186/s12872‑021‑02313‑x
                      • Publisher BMC Cardiovascular disorders

                        2021 AUS-ROC Early Career Researchers Meeting: The Future is Shocking

                        Proceeding

                        Rochelle Newport will be presenting at the Australian Resuscitation Outcomes Consortium 2021 meeting: ww.ausroc.org.au

                        • BibTex Key
                        • Authors R. Newport
                        • Tags Ambulance | Pre-hospital

                          2020 Ethnic differences in cardiovascular risk profiles among 475,241 adults in primary care in Aotearoa, New Zealand.

                          Journal Article

                          AIM: In Aotearoa, New Zealand, cardiovascular disease (CVD) burden is greatest among Indigenous Māori, Pacific and Indian people. The aim of this study was to describe CVD risk profiles by ethnicity. METHODS: We conducted a cross-sectional analysis of a cohort of people aged 35-74 years who had a CVD risk assessment in primary care between 2004 and 2016. Primary care data were supplemented with linked data from regional/national databases. Comparisons between ethnic groups were made using age-adjusted summaries of continuous or categorical data. RESULTS: 475,241 people (43% women) were included. Fourteen percent were Māori, 13% Pacific, 8% Indian, 10% Other Asian and 55% European. Māori and Pacific people had a much higher prevalence of smoking, obesity, heart failure, atrial fibrillation and prior CVD compared with other ethnic groups. Pacific and Indian peoples, and to a lesser extent Māori and Other Asian people, had markedly elevated diabetes prevalence compared with Europeans. Indian men had the highest prevalence of prior coronary heart disease. CONCLUSIONS: Māori and Pacific people experience the most significant inequities in exposure to CVD risk factors compared with other ethnic groups. Indians have a high prevalence of diabetes and coronary heart disease. Strong political commitment and cross-sectoral action to implement effective interventions are urgently needed.

                           

                          • BibTex Key selak2020ethnic
                          • Authors A. Kerr | C. Grey | D. Exeter | J. Winter-Smith | K. Poppe | M. Harwood | R. Jackson | S. Mehta | S. Wells | T. Riddell | V. Selak
                          • Tags CVD risk assessment
                          • ISBN/ISSN 0028-8446

                            2021 Heart Health Equity Hui Report

                            Technical Report

                            Heart health researchers, clinicians, providers and funders focused on achieving equitable heart health outcomes for Māori and Pacific people gathered at a National Hui on 8 July, 2021. Click here to read the report.

                            • BibTex Key
                            • Authors C. Grey | J. Paynter | J. Winter-Smith | K. Brewer | M. Harwood | R. Newport | S. Amertunga | S. Hanchard | V. Selak
                            • Tags
                            • ISBN/ISSN 978-0-473-58843-4

                              2021 Should Pacific people be homogenized when considering their need for CVD health services? A systematic review of the epidemiology and management of CVD among Pacific people

                              Proceeding

                              Moderated poster session at Cardiac Society New Zealand Annual Scientific Meeting

                              • BibTex Key
                              • Authors J. Winter-Smith
                              • Tags Pacific people

                                2021 ANZACS IHD

                                Proceeding

                                ANZACS IHD session at Cardiac Society New Zealand Annual Scientific Meeting

                                • BibTex Key
                                • Authors V. Selak
                                • Tags ANZACS

                                  2021 Aspirin in primary prevention

                                  Proceeding

                                  Chest pain session at Cardiac Society New Zealand Annual Scientific Meeting

                                  • BibTex Key
                                  • Authors V. Selak
                                  • Tags Primary prevention

                                    2021 Manawataki Fatu Fatu for ACCESS (Māori and Pacific hearts in unison for Achieving Cardiovascular Care for Equity StudieS)

                                    Proceeding

                                    Equity session at Cardiac Society New Zealand Annual Scientific Meeting

                                    • BibTex Key
                                    • Authors C. Grey | M. Harwood
                                    • Tags

                                      2021 Manawataki Fatu Fatu for ACCESS (Māori and Pacific hearts in unison for Achieving Cardiovascular Care for Equity StudieS)

                                      Proceeding

                                      Heart Health Research Fellows Forum by Heart Foundation

                                      • BibTex Key
                                      • Authors C. Grey | J. Paynter | J. Winter-Smith | K. Brewer | M. Harwood | R. Newport | S. Amertunga | S. Hanchard | V. Selak
                                      • Tags Heart health equity

                                        2020 Achieving equity in cardiovascular outcomes for Pacific people

                                        Presentation

                                        Dr Corina Grey presented a review of evidence about health equity for Pacific peoples in New Zealand at the Pan Pasifika Fono, hosted by The Heart Foundation, and held on 4 and 5 November, 2020 at the Ellerslie Event Centre in Auckland. Click here to view her presentation.

                                        • BibTex Key
                                        • Authors C. Grey
                                        • Tags Equity | Pacific people