The population prevalence of undetected abdominal aortic aneurysm in New Zealand Maori.

BACKGROUND: The prevalence of abdominal aortic aneurysm (AAA) in Polynesian populations such as the New Zealand Maori has not been characterized. We measured this in a large population-based sample. METHODS: A cross-sectional population-based prevalence study was conducted as part of an AAA screening pilot; 2467 Maori men aged 54 to 74 years and 1526 women aged 65 to 74 years registered with a primary care practice in Auckland (New Zealand) were invited to be screened by abdominal ultrasound between June 2016 and March 2018. Patients with pre-existing AAA disease and those with terminal conditions or circumstances that would make them unlikely to benefit from screening were excluded. The prevalence rate of AAA in Maori women was calculated with a cutoff definition of 27 mm as well as with the normal 30-mm definition (used in men). A log-binomial regression model estimated the prevalence rate at exactly 65 years for the purpose of comparison with screened populations in the United Kingdom. RESULTS: The crude prevalence rate of undiagnosed AAA in Maori men aged 60 to 74 years was 3.6%. In women, it was 1.7% at the 30-mm threshold and 2.3% at 27 mm. The prevalence rate at exactly 65 years of age was calculated from the log-binomial regression model to be 2.7% (confidence interval [CI], 2.0%-3.8%) in men, 0.9% (CI, 0.4%-2.2%) in women at the 30-mm threshold, and 1.5% (CI, 0.7%-3.0%) in women at the 27-mm threshold. Among smokers, the crude prevalence rates were 7.5% (CI, 4.9%-11.5%) in men and 6.9% (CI, 4.1%-11.5%) in women (30 mm+). CONCLUSIONS: The prevalence of undiagnosed AAA in New Zealand Maori men is considerably higher than in screened populations of equivalent age in the United Kingdom and Sweden. Prevalence rates in New Zealand Maori women are close to those of screened British men. New Zealand should consider implementing a population-based screening program for Maori men and conduct further research into the health impact of screening Maori women.

External quality assurance for cervical cytology in developing countries. Experience in Peru and Nicaragua.

Given interest from the professionals concerned, an external quality assurance scheme for cervical cytology can successfully be introduced in developing countries. This is a very important precondition if screening programs are to be expanded and decreases in mortality from cervical cancer are to occur in developing countries. Nicaragua and Peru have been experimenting with an external quality assurance system adapted from the Scottish and Northern Ireland scheme. It has been received with enthusiasm and acceptance and has helped cytology laboratories in these countries focusing on quality issues. Nevertheless, a successful quality control scheme that is to result in improvements in the quality of professionals' diagnostic skills needs to be accompanied by a remedial program for subperformers.

Measuring unexplained variation in acute hospital use by patients enrolled with northern New Zealand general practices.

INTRODUCTION: There is increasing concern worldwide at the steady growth in acute inpatient admissions and emergency department (ED) attendances. AIM: To develop measures of variation in acute hospital use between populations enrolled at different general practices that are independent of the sociodemographic characteristics of those populations. METHODS: Two consecutive years of hospital discharge and ED attendance data were combined with primary health organisation (PHO) registers from 385 practices of over 1.5 million people to develop and test two measures of unplanned hospital use: the standardised acute hospital admission ratio (SAAR) and the standardised ED attendance ratio (SEAR). Disease-specific measures were also produced for inpatient events. RESULTS: The enrolled populations of a high proportion of practices had significantly higher or lower than expected acute use of hospitals and this was consistent over both years studied. Practices whose population made unexpectedly high use of acute hospital care for one condition tended to do so for others. Differences in health needs between practice populations as measured by clinical complexity, comorbidities and length of stay did not explain a significant portion of the overall variation in hospital admissions. The enrolled population's average travelling time to a 24-hour ED accounted for some of the practice variation in unplanned utilisation of hospital services. DISCUSSION: This study confirms that there is considerable unexplained practice variation in acute hospital use. Further development of the SAAR and SEAR measures may be possible to use these to identify modifiable practice-level factors associated with high unplanned hospital use.

The effect of Maori ethnicity misclassification on cervical screening coverage.

AIM: There is a large difference in the cervical screening coverage rate between Maori and European women in New Zealand. This paper examines the extent to which this difference is due to misclassification of ethnicity. METHODS: Data from Waitemata District Health Board's two Primary Health Organisations (PHOs) was used to identify the population of Waitemata domiciled women aged 25-69 years eligible for cervical screening. Their cervical screening status was obtained from the National Cervical Screening Programme register (NCPS-R). Data from Auckland and Waitemata DHBs was used to determine the women's ethnicity in the National Health Index (NHI). Women who had withdrawn from the NCSP-R, women who were deceased and women for whom an NHI ethnicity code could not be obtained were excluded from the analysis. Ethnicity codes from the three sources (PHO registers, NCSP-R and NHI) were compared to identify women classified as non-Maori in the NCSP-R but Maori in either of the other two data sources. The effect on Maori cervical screening coverage rates of not counting these women was assessed. RESULTS: Within the study population there was a total of 6718 women identified as Maori on the NCSP of whom 5242 had been screened within the last 3 years and 1476 who had not. In addition to these, there were 2075 women identified as Maori in either the PHO or NHI databases but not in the NCSP-R who had been screened within the preceding 3 years, and a further 2094 who had not been screened. There were also 797 women identified as Maori in the NHI or PHO datasets who were not on the NCSP-R (and therefore were not screened). If all screened women classified as Maori from any source were counted, Waitemata DHB's Maori screening coverage rate would rise from 49.3% to 68.8% (or to 61.0% and 63.2% respective if just PHO and NHI Maori were counted). CONCLUSION: Misclassification of ethnicity could explain (in absolute terms) up to 19.5% of the 35.0% difference in cervical screening coverage rate between Maori and non-Maori , non-Pacific, non-Asian coverage in Waitemata District. Misclassification is likely to have similar effects on coverage estimates throughout New Zealand. Without improving the accuracy of ethnicity data in the NCSP-R it will be impossible for the country to achieve the target coverage rate of 80% among Maori.