Ethnic disparities in the incidence and outcome from out-of-hospital cardiac arrest: A New Zealand observational study.

BACKGROUND: New Zealand (NZ) has an ethnically diverse population. International studies have demonstrated significant differences in health equity by ethnicity; however, there is limited evidence in the context of out-of-hospital cardiac arrest in NZ. We investigated whether heath disparities in incidence and outcome of out-of-hospital cardiac arrest exist between NZ ethnic groups. METHOD: A retrospective observational study was conducted using NZ cardiac arrest registry data for a 2-year period. Ethnic cohorts investigated were the indigenous Maori population, Pacific Peoples and European/Others. Incidence rates, population characteristics and outcomes (Return of Spontaneous Circulation sustained to hospital handover and thirty-day survival) were compared. RESULTS: Age-adjusted incidence rates per 100,000 person-years were higher in Maori (144.4) and Pacific Peoples (113.5) compared to European/Others (93.8). Return of spontaneous circulation sustained to hospital handover was significantly lower in Maori (adjusted OR 0.74, 95% CI 0.64-0.87, p < 0.001). Survival to thirty-days was lower for both Maori (adjusted OR 0.61, 95% CI 0.48-0.78, p < 0.001) and Pacific Peoples (adjusted OR 0.52, 95% CI 0.37-0.72, p < 0.001). A higher proportion of events occurred in all age groups below 65 years old in Maori and Pacific Peoples (p < 0.001), and a higher proportion of events occurred among women in Maori and Pacific Peoples (p < 0.001). CONCLUSIONS: There are significant differences in health equity by ethnicity. Both Maori and Pacific Peoples have higher incidence of out-of-hospital cardiac arrest and at a younger age. Maori and Pacific Peoples have lower rates of survival to thirty-days. Our results provide impetus for targeted health strategies for at-risk ethnic populations.

NHS and charitable funding for children and young people with cancer in England and Wales.

In 2005 the National Institute for Health and Clinical Excellence Guidance on Cancer Services: Improving Outcomes in Children and Young People with Cancer, identified the need to quantify the substantial contribution made by charities to NHS provision to this group of patients. This article quantifies the contribution in England and Wales. It identifies 51 charities established specifically to assist this patient group, estimates that 340 charities made some financial contribution and 28 organizations administered charitable funds for hospices. The financial contribution to services by charities was estimated to be between pound25 million and pound38 million in 2003, representing between one-third and a half of the total resources directed to the treatment and support of children and young people with cancer in specialist centres across England and Wales. Reliance on the substantial charitable funding of health care in England and Wales raises concerns over government responsibility, and the potential misalignment between NHS priorities and those of the charities.