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