Time trends and seasonal patterns of asthma deaths and hospitalisations among Maori and non-Maori.

AIM: To examine the time trends and seasonal patterns in asthma mortality and hospitalisations in Maori and non-Maori. METHODS: We studied asthma deaths in Maori and non-Maori during 1962-1998 and asthma hospitalisations during 1976-1998 in the 5-34 and 35-74 year age-groups. Average monthly mortality and hospital discharge rates were calculated for 1978-1998 to observe the seasonal patterns. RESULTS: The two asthma mortality epidemics of the 1960s and 1970s affected Maori disproportionately, with the peak rates in 1979 being twice that of non-Maori (7.4 vs 3.7 per 100 000) although the rates are now similar. Hospitalisation rates for Maori were consistently higher than non-Maori with the rates remaining elevated until 1987. The most recent hospitalisation figures show a fall of 61.2% from the 1987 rate. For Maori in the 5-34 year age-group, deaths were highest in spring while hospitalisations peaked in the winter month of May. CONCLUSION: Although asthma mortality and hospitalisation rates for Maori have declined over the period under study, Maori continue to experience more severe asthma and have a higher number of hospital admissions for asthma than non-Maori.

Characteristics of ovarian cancer in women residing in Aotearoa, New Zealand: 1993-2004.

BACKGROUND: Few studies have compared ovarian cancer rates between different ethnic groups in the same country. The aim of this study was to describe ethnic patterns in the incidence and mortality of ovarian cancer in New Zealand, and to investigate ethnic and socioeconomic differences in the grade and stage of ovarian cancer. METHODS: Data on all women registered with ovarian cancer on the New Zealand Cancer Registry (1993-2004) were analysed. Population data were taken from the 1996 and 2001 census. Logistic regression was used to estimate associations between ethnicity, deprivation and tumour characteristics. RESULTS: Age-standardised incidence rates were highest in Pacific women, intermediate in Maori women, and lowest in non-Maori, non-Pacific women. Age-standardised mortality rates showed the same pattern. Ovarian cancer subtypes differed by ethnic group. There was no significant association between socioeconomic deprivation and tumour grade or stage. Age-adjusted models showed that Maori women were more likely to have well-differentiated tumours and less likely to present at a later stage compared to non-Maori, non-Pacific women. These patterns were partly explained by socioeconomic deprivation, and were not apparent for Pacific women. CONCLUSIONS: Pacific and Maori women experience higher incidence of ovarian cancer and mortality, compared to non-Maori, non-Pacific women. Maori women seemed to have better prognostic factors (local stage and well-differentiated tumours) than non-Maori, non-Pacific women. More work is needed to improve current cancer prevention strategies, particularly in Pacific women.

Socioeconomic status, asthma and chronic bronchitis in a large community-based study.

The present study investigated the relationship between socioeconomic status, using measures of occupational class and education level, and the prevalence and incidence of asthma (with and without atopy) and chronic bronchitis using data from the European Community Respiratory Health Survey (ECRHS). Asthma and chronic bronchitis were studied prospectively within the ECRHS (n = 9,023). Incidence analyses comprised subjects with no history of asthma or bronchitis at baseline. Asthma symptoms were also assessed as a continuous score. Bronchitis risk was associated with low educational level (prevalence odds ratio (POR) 1.9; 95% confidence interval (CI) 1.4-2.8) and occupational class (1.8; 1.2-2.7). Incident bronchitis also increased with low educational level (risk ratio (RR) 2.8; 95%CI 1.5-5.4). Prevalent and incident asthma with no atopy were associated with low educational level. Subjects in the low occupational class (incident risk ratio (IRR) 1.4; 95%CI 1.2-1.7) and education group (IRR 1.3; 95% CI 1.1-1.6) had higher mean asthma scores than those in higher socioeconomic groups. Lower educational level was associated with increased risk of prevalent and incident chronic bronchitis and asthma with no atopy. Lower socioeconomic groups tended to have a higher prevalence and incidence of asthma, particularly higher mean asthma scores. Adjustment for variables associated with asthma and bronchitis explained little of the observed health differences by socioeconomic status.

He Mate Huango: an update on Maori asthma.

In 1990, a Ministerial Review to consider asthma among Maori people was undertaken following concern over disproportionate mortality and morbidity rates from asthma in Maori compared with non-Maori. Findings from the Maori Asthma Review included: a need for a reduction in cost of health care; increased patient education; use of asthma management plans; and greater Maori participation in the planning and delivery of asthma services and asthma education. Alongside this, a significant and complex situation was highlighted regarding Maori not accessing asthma services and asthma resources, the result of which was reflected in more severe asthma and higher hospital admission rates and death rates. The Review made a number of recommendations focussed on a need for substantial improvements in asthma management and asthma education, with the significant involvement of Maori people. This paper reviews the work and conclusions of the Maori Asthma Review and considers what developments have been made in research and policy since the Review's publication in 1991. A literature review was undertaken examining asthma prevalence studies and asthma mortality and morbidity data among Maori since the Maori Asthma Review was completed. Health policies and relevant government health initiatives were examined to assess the policy outcomes resulting from the findings and recommendations of the Review. The findings indicate that asthma prevalence remains similar between Maori and non-Maori children but asthma severity is greater in Maori children. Both prevalence and severity of asthma are greater in Maori than in non-Maori adults. Funding of health services in New Zealand have undergone dramatic changes since the introduction of the health reforms in 1993. These changes have affected the development and implementation of asthma services to Maori at both local and national levels. Effective planning and development of asthma services will continue to be hindered by a lack of dedicated and ongoing funding which is necessary to ensure long term planning and implementation of asthma services to Maori can take place.