Ethnic disparities in infectious disease hospitalisations in the first year of life in New Zealand

Harti Hauora Tamariki: randomised controlled trial protocol for an opportunistic, holistic and family centred approach to improving outcomes for hospitalised children and their families in Aotearoa, New Zealand

Background

Health and wellbeing inequities between the Indigenous Māori and non-Māori populations in Aotearoa, New Zealand continue to be unresolved. Within this context, and of particular concern, hospitalisations for diseases of poverty are increasing for tamariki Māori (Māori children). To provide hospitalised tamariki Māori, and their whānau (families) comprehensive support, a wellbeing needs assessment; the Harti Hauora Tamariki Tool (The Harti tool) was developed. The purpose of this study is to determine how effective the Harti tool is at identifying wellbeing needs, ensuring the documentation of needs, enabling access to services and improving wellbeing outcomes for tamariki and their whānau.

Methods

The study uses a Kaupapa Māori methodology with qualitative and quantitative methods. Qualitative methods include in-depth interviews with whānau. This paper presents an overview of a randomised, two parallel, controlled, single blinded, superiority trial for quantitative evaluation of the Harti programme, and hospital satisfaction with care survey. Participants will be Māori and non-Māori tamariki/children aged 0-4 years admitted acutely to the paediatric medical wards at Waikato Hospital, Hamilton, Aotearoa New Zealand. They will be randomised electronically into the intervention or usual care group. The intervention group will receive usual care in addition to the Harti programme, which includes a 24-section health needs assessment delivered by trained Māori navigators to whānau during the time they are in hospital. The primary endpoint is the relative risk of an acute hospital readmission in the 30 days following discharge for the intervention group patients compared with control group patients. Secondary outcomes include access and utilisation of preventative health services including: oral health care, general practice enrolment, immunisation, healthy home initiatives, smoking cessation and the Well Child Tamariki Ora universal health checks available free of charge for children in Aotearoa New Zealand.

Discussion

Randomised controlled trials are a gold standard for measuring efficacy of complex multifaceted interventions and the results will provide high quality evidence for implementing the intervention nationwide. We expect that this study will provide valuable evidence for health services and policy makers who are considering how to improve the configuration of paediatric hospital services.

Trial registration

The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12618001079235.

State dependence in immunization and the role of discouragement

We investigate whether having a child immunized at a prior schedule genuinely increases the likelihood of vaccinating the child at the subsequent schedule. We use longitudinal data from the Growing Up in New Zealand study and apply a dynamic random-effects model that also controls for the initial immunization status. Prior to any covariate-adjusted estimations, our data shows that almost 96% of the children immunized at the previous schedule are also immunized at the subsequent schedule. In comparison, only 29% of children who were not immunized at the prior schedule receive immunization at the next milestone, thereby indicating an unadjusted state dependence in immunization of 67 percentage points (p.p.). Upon controlling for relevant covariates and unobserved heterogeneities, the genuine state dependence in immunization is, on average, estimated to be 20 p.p. Importantly, the magnitude of the state dependence is greater for Māori (by 5 p.p.) and also greater for mothers that report being discouraged from having their child immunized during the antenatal period (by 10 p.p.).

Pre-school wheeze hospital presentations: A demographic profile and review of clinical management

AIM

Pre-school wheeze is a common hospital presentation in Australasia. The aim of this study was to describe the regional hospital presentation and cost of pre-school wheeze.

METHODS

Audit of children diagnosed with pre-school wheeze at two hospitals in Auckland, New Zealand from October 2017 to September 2019. Guideline adherence was determined.

RESULTS

One hundred and ninety-two children made 247 pre-school wheeze hospital presentations. Pre-school wheeze accounted for a larger proportion of acute hospital presentations for Māori versus non-Māori children (rate ratio 1.76, 95% confidence intervals 1.32-2.31). Hospital representations with pre-school wheeze occurred in 38/192 (20%) children. The proportion with a pre-school wheeze representation was larger for Māori than non-Māori (30% vs. 16%, P = 0.02). Pre-school wheeze event median length of stay increased as household deprivation increased (P = 0.01). Clinical severity of 247 pre-school wheeze episodes was mild (n = 64, 26%), moderate (n = 153, 62%) and severe (n = 30, 12%). Of 244 episodes, inhaled bronchodilators only were given for 149 (61%), oxygen for 54 (22%) and intravenous treatment for 41 (17%). Hospital guideline use was evident in 164/247 (66%) episodes. Neither clinical severity nor treatment intensity varied with child sex, age or ethnicity or household deprivation. The estimated median (interquartile range) direct medical costs of each pre-school wheeze episode were NZ$1279 (NZ$774-2158).

CONCLUSIONS

In Auckland, pre-school wheeze accounts for a larger proportion of acute hospital presentations for Māori compared with non-Māori and Māori children have increased odds of pre-school wheeze readmissions. Length of hospital stay for pre-school wheeze episodes increased with household deprivation. In this audit pre-school wheeze guideline adherence was poor.

Determinants of ethnic differences in the uptake of child healthcare services in New Zealand: a decomposition analysis

BACKGROUND

There are persistent ethnic gaps in uptake of child healthcare services in New Zealand (NZ), despite increasing policy to promote equitable access. We examined ethnic differences in the uptake of immunisation and primary healthcare services at different ages and quantified the contribution of relevant explanatory factors, in order to identify potential points of intervention.

METHODS

We used data from the Growing Up in New Zealand birth cohort study, including children born between 2009 and 2010. Econometric approaches were used to explore underlying mechanisms behind ethnic differences in service uptake. Multivariable regression was used to adjust for mother, child, household, socioeconomic, mobility, and social factors. Decomposition analysis was used to assess the proportion of each ethnic gap that could be explained, as well as the main drivers behind the explained component. These analyses were repeated for four data time-points.

RESULTS

Six thousand eight hundred twenty-two mothers were enrolled during the antenatal survey, and children were followed up at 9-months, 2-years and 4-years. In univariable models, there were ethnic gaps in uptake of immunisation and primary care services. After adjusting for covariates in multivariable models, compared to NZ Europeans, Asian and Pacific children had higher timeliness and completeness of immunisation at all time-points, while indigenous Māori had lower timeliness of first-year vaccines despite high intentions to immunise. Asian and Pacific mothers were less likely to have their first-choice lead maternity caregiver (LMC) than NZ Europeans mothers, and Māori and Asian mothers were less likely to be satisfied with their general practitioner (GP) at 2-years. Healthcare utilisation was strongly influenced by socio-economic, mobility and social factors including ethnic discrimination. In decomposition models comparing Māori to NZ Europeans, the strongest drivers for timely first-year immunisations and GP satisfaction (2-years) were household composition and household income. Gaps between Pacific and NZ Europeans in timely first-year immunisations and choice of maternity carer were largely unexplained by factors included in the models.

CONCLUSIONS

Ethnic gaps in uptake of child healthcare services vary by ethnicity, service, and time-point, and are driven by different factors. Addressing healthcare disparities will require interventions tailored to specific ethnic groups, as well as addressing underlying social determinants and structural racism. Gaps that remain unexplained by our models require further investigation.

Understanding barriers to immunisation against vaccine-preventable diseases in Pacific people in New Zealand, Aotearoa: an integrative review

Introduction Pacific people have an increased risk of hospitalisation if barriers to immunisation against vaccine-preventable diseases are not reduced. This research sought to determine what is known about the barriers to immunisations in Pacific people living in New Zealand and identify ways to reduce these barriers and inform health care. Aim To identify the barriers to immunisation for Pasifika and to identify ways to reduce these barriers and inform health care. Methods An integrative review was undertaken with databases searched for articles published between February 2021 and May 2021. The review follows the five-stage process of problem formulation; literature search; evaluation of data; data analysis and interpretation; and presentation of the results through discussion. Results Twelve studies were included. Three themes were identified: Deprivation, Health Literacy (which covered understanding the importance of immunisation programmes, attitudes and beliefs and communication), and access to health care (including communication accessibility to health professionals and physical access). Discussion This review has identified that barriers such as level of deprivation strongly influences immunisation uptake in Pacific people. The significance of government-led initiatives was shown to improve the rates of immunisation of Pacific children. Pacific people's awareness of immunisation programmes and government campaigns are encouraged to incorporate ethnic-specific strategies in addressing barriers, such as bringing vaccinations to where Pacific people frequent, including churches, community hubs, and venues that parents can easily access.

Complex differences in infection rates between ethnic groups in Scotland: a retrospective, national census-linked cohort study of 1.65 million cases

BACKGROUND

Ethnicity can influence susceptibility to infection, as COVID-19 has shown. Few countries have systematically investigated ethnic variations in infection.

METHODS

We linked the Scotland 2001 Census, including ethnic group, to national databases of hospitalizations/deaths and serological diagnoses of bloodborne viruses for 2001-2013. We calculated age-adjusted rate ratios (RRs) in 12 ethnic groups for all infections combined, 15 infection categories, and human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses.

RESULTS

We analysed over 1.65 million infection-related hospitalisations/deaths. Compared with White Scottish, RRs for all infections combined were 0.8 or lower for Other White British, Other White and Chinese males and females, and 1.2-1.4 for Pakistani and African males and females. Adjustment for socioeconomic status or birthplace had little effect. RRs for specific infection categories followed similar patterns with striking exceptions. For HIV, RRs were 136 in African females and 14 in males; for HBV, 125 in Chinese females and 59 in males, 55 in African females and 24 in males; and for HCV, 2.3-3.1 in Pakistanis and Africans.

CONCLUSIONS

Ethnic differences were found in overall rates and many infection categories, suggesting multiple causative pathways. We recommend census linkage as a powerful method for studying the disproportionate impact of COVID-19.

Consequences of barriers to primary health care for children in Aotearoa New Zealand

Inequities in the provision of accessible primary health care contribute to poor health outcomes and health inequity. This study evaluated inequities in the prevalence and consequences of barriers that children face in seeing a general practitioner (GP) in Aotearoa New Zealand. We analysed data on 5,947 children from the Growing Up in New Zealand longitudinal study cohort on barriers to seeing a GP in the previous year, reported by mothers when their children were aged 24 months and 54 months (in 2011/12 and 2013/14 respectively); and maternal-reported hospitalisations in the year prior to age 54 months. We used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CIs) for consequences of these barriers.

Overall, 4.7% (n = 279) of children experienced barriers to seeing a GP in the year to 24 months and 5.5% (n = 325) in the year to 54 months. At each age, and for each specific barrier studied, barriers were more prevalent among Māori (the indigenous people of Aotearoa New Zealand), and among Pacific, compared to New Zealand European, children. Children facing barriers in the year to age 24 months were twice as likely to be hospitalised in the year to 54 months (OR 2.18, 95%CI: 1.38 to 3.44). When this relationship was analysed by ethnicity, the association was strongest for Māori (OR: 2.92, 95%CI: 1.60 to 5.30), less strong for Pacific (OR 2.01, 95%CI: 0.92 to 4.37) and not present for New Zealand European (OR 1.27, 95%CI 0.39 to 4.12) families.

Barriers that children face to seeing a GP have social and cost implications for families and the health system. Changes to the health system, and future health policy, must align with the New Zealand government’s obligations under Te Tiriti o [The Treaty of] Waitangi, to ensure that health equity becomes a reality for Māori.

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Overall, 5% of children in Aotearoa New Zealand experienced barriers to seeing a GP at age 12–24 months.

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Barriers were more prevalent among Māori children, and among Pacific children, compared to New Zealand European children.

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Children who faced barriers were twice as likely to be hospitalised as those who did not.

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When analysed by ethnicity, the association was strongest for Māori and not present for New Zealand European families.

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Future health policy must ensure that health equity becomes a reality for Māori.

Vitamin D status at birth and acute respiratory infection hospitalisation during infancy

BACKGROUND

Hospital admission for acute respiratory infections (ARIs) during early childhood is a global public health concern. Vitamin D deficiency is prevalent during pregnancy and infancy. Evidence indicates that vitamin D supplementation prevents ARIs.

OBJECTIVES

To determine whether vitamin D deficiency at birth is associated with ARI hospitalisations during infancy.

METHODS

We performed a nested case-control study in children aged 0-12 months. Cases had ≥1 ARI hospitalisation and 4 controls were individually matched to each case. Newborn 25(OH)D concentration was measured on dried blood spots using two-dimensional liquid chromatography-tandem mass spectrometry. Hospital admissions were measured using health care records. Median serum 25(OH)D concentration in cases and controls was compared, and covariates of ARI hospitalisation during infancy were assessed using conditional logistic regression analysis.

RESULTS

Six per cent of the cohort (n = 384) had an ARI hospitalisation during infancy, and 1536 controls were matched to cases. Median DBS [25(OH)D] was lower among ARI cases than controls (46 nmol/l vs. 61 nmol/L). Median 25(OH)D levels were lower for those hospitalised ≥2 times (47, IQR 36, 58) vs. those hospitalised once (52, IQR 42, 62) vs. the controls and also lower for those who stayed in the hospital for ≥3 days (45, IQR 36, 54) vs 1-2 days (48, IQR 38, 59) compared to the controls. After adjustment for season of birth and covariates describing demographic, antenatal, perinatal, and infant characteristics, DBS 25(OH)D concentration (<50 nmol/L) at birth was associated with increased odds of ARI hospitalisation during infancy (odds ratio 2.20, 95% confidence interval 1.48, 2.91).

CONCLUSIONS

Vitamin D deficiency at birth is associated with increased odds of ARI hospitalisations in infants. The findings have implications for a developed country like New Zealand where vitamin D supplementation is not routinely recommended and the burden of ARI hospitalisation in young children is high.

Surveillance of pediatric parapneumonic effusion/empyema in New Zealand

AIM

The incidence of childhood empyema has been increasing in some developed countries despite the introduction of pneumococcal vaccination. This study aimed to document the incidence, bacterial pathogens, and morbidity/mortality of parapneumonic effusion/empyema in New Zealand.

METHODS

A prospective study of 102 children <15 years of age requiring hospitalization with parapneumonic effusion/empyema between May 1, 2014 and May 31, 2016 notified via the New Zealand Paediatric Surveillance Unit. Parapneumonic effusion/empyema was defined as pneumonia and pleural effusion persisting ≥7 days, and/or any pneumonia, and pleural effusion necessitating drainage. Notifying pediatricians completed standardized questionnaires.

RESULTS

Annual pediatric parapneumonic effusion/empyema incidence was 5.6/100,000 (95% confidence interval [CI]: 4.7-6.9). Most children (80%) required surgical intervention and 31% required intensive care. A causative organism was identified in 71/102 (70%) cases. Although Staphylococcus aureus (25%) and Streptococcus pneumoniae (25%) infection rates were equal, prolonged hospitalization and intensive care admission were more common in children with S. aureus PPE/E. Māori and Pasifika children were over-represented at 2.2 and 3.5 times, their representation in the New Zealand pediatric population. Pneumococcal vaccination was incomplete, with only 61% fully immunized and 30% unimmunized. Haemophilus influenzae type b vaccine uptake was near complete at 89/94 (95%), with influenza immunization only 3/78 (4%).

CONCLUSIONS

New Zealand has a high incidence of pediatric complicated parapneumonic effusion/empyema with significant morbidity. S. aureus was a significant cause of severe empyema in New Zealand, particularly for Māori and Pasifika children. Improvements in vaccine coverage are needed along with strategies to reduce S. aureus disease morbidity.

Respiratory syncytial virus hospitalisations among young children: a data linkage study

We aimed to provide comprehensive estimates of laboratory-confirmed respiratory syncytial virus (RSV)-associated hospitalisations. Between 2012 and 2015, active surveillance of acute respiratory infection (ARI) hospitalisations during winter seasons was used to estimate the seasonal incidence of laboratory-confirmed RSV hospitalisations in children aged <5 years in Auckland, New Zealand (NZ). Incidence rates were estimated by fine age group, ethnicity and socio-economic status (SES) strata. Additionally, RSV disease estimates determined through active surveillance were compared to rates estimated from hospital discharge codes. There were 5309 ARI hospitalisations among children during the study period, of which 3923 (73.9%) were tested for RSV and 1597 (40.7%) were RSV-positive. The seasonal incidence of RSV-associated ARI hospitalisations, once corrected for non-testing, was 6.1 (95% confidence intervals 5.8–6.4) per 1000 children <5 years old. The highest incidence was among children aged <3 months. Being of indigenous Māori or Pacific ethnicity or living in a neighbourhood with low SES independently increased the risk of an RSV-associated hospitalisation. RSV hospital discharge codes had a sensitivity of 71% for identifying laboratory-confirmed RSV cases. RSV infection is a leading cause of hospitalisation among children in NZ, with significant disparities by ethnicity and SES. Our findings highlight the need for effective RSV vaccines and therapies.

Hospital admissions in the first year of life: inequalities over three decades in a southern Brazilian city

BACKGROUND

Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas.

METHODS

We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour.

RESULTS

In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers.

CONCLUSIONS

Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain.

Respiratory health inequality starts early: The impact of social determinants on the aetiology and severity of bronchiolitis in infancy

AIM

To define the impact of demographics on the incidence, aetiology and clinical course of viral bronchiolitis in infants younger than 2 years of age.

METHODS

Retrospective case review of all viral bronchiolitis admissions for patients aged younger than 2 years old from January 1 2014 to 31 December 2015 at Wellington Regional Hospital, New Zealand. Demographic data, second-hand smoke exposure (SHSE) and presence of predisposing conditions were collected, along with outcome data including use of respiratory support and intensive care unit (ICU) admission. This was compared to background rates calculated from regional census data.

RESULTS

There were 556 admissions included (11% of paediatric medical admissions); 49% tested positive for respiratory syncytial virus (RSV) (84% tested), and 40% of admissions received positive pressure respiratory support and 10% ICU admission. Admission rates ranged from 9.6 to 77 per 1000/year, with higher rates seen in those from areas of high deprivation. Admission rates by deprivation varied according to aetiology. RSV-positive admission rates increased from 9.7 per 1000/year to 24.6 per 1000/year in the least to most deprived areas, whereas non-RSV admissions showed even greater disparity, increasing from 10.1 per 1000/year to 37.5 per 1000/year (both P < 0.0001).

CONCLUSIONS

This study further reinforces that material deprivation contributes significantly to poor health outcomes that are apparent in infancy. SHSE is a potent risk factor for adverse respiratory outcomes in this patient population. Ongoing efforts to eradicate smoking and reduce material inequality need to continue.

How differing methods of ascribing ethnicity and socio-economic status affect risk estimates for hospitalisation with infectious disease

Significant ethnic and socio-economic disparities exist in infectious diseases (IDs) rates in New Zealand, so accurate measures of these characteristics are required. This study compared methods of ascribing ethnicity and socio-economic status. Children in the Growing Up in New Zealand longitudinal cohort were ascribed to self-prioritised, total response and single-combined ethnic groups. Socio-economic status was measured using household income, and both census-derived and survey-derived deprivation indices. Rates of ID hospitalisation were compared using linked administrative data. Self-prioritised ethnicity was simplest to use. Total response accounted for mixed ethnicity and allowed overlap between groups. Single-combined ethnicity required aggregation of small groups to maintain power but offered greater detail. Regardless of the method used, Māori and Pacific children, and children in the most socio-economically deprived households had a greater risk of ID hospitalisation. Risk differences between self-prioritised and total response methods were not significant for Māori and Pacific children but single-combined ethnicity revealed a diversity of risk within these groups. Household income was affected by non-random missing data. The census-derived deprivation index offered a high level of completeness with some risk of multicollinearity and concerns regarding the ecological fallacy. The survey-derived index required extra questions but was acceptable to participants and provided individualised data. Based on these results, the use of single-combined ethnicity and an individualised survey-derived index of deprivation are recommended where sample size and data structure allow it.

Caregiver experiences of racism and child healthcare utilisation: cross-sectional analysis from New Zealand

OBJECTIVES

Children's exposure to racism via caregiver experience (vicarious racism) is associated with poorer health and development. However, the relationship with child healthcare utilisation is unknown. We aimed to investigate (1) the prevalence of vicarious racism by child ethnicity; (2) the association between caregiver experiences of racism and child healthcare utilisation; and (3) the contribution of caregiver socioeconomic position and psychological distress to this association.

DESIGN

Cross-sectional analysis of two instances of the New Zealand Health Survey (2006/2007: n=4535 child-primary caregiver dyads; 2011/2012: n=4420 dyads).

MAIN OUTCOME MEASURES

Children's unmet need for healthcare, reporting no usual medical centre and caregiver-reported dissatisfaction with their child's medical centre.

RESULTS

The prevalence of reporting 'any' experience of racism was higher among caregivers of indigenous Māori and Asian children (30.0% for both groups in 2006/2007) compared with European/Other children (14.4% in 2006/2007). Vicarious racism was independently associated with unmet need for child's healthcare (OR=2.30, 95% CI 1.65 to 3.20) and dissatisfaction with their child's medical centre (OR=2.00, 95% CI 1.26 to 3.16). Importantly, there was a dose-response relationship between the number of reported experiences of racism and child healthcare utilisation (eg, unmet need: 1 report of racism, OR=1.89, 95% CI 1.34 to 2.67; 2+ reports of racism, OR=3.06, 95% CI 1.27 to 7.37). Adjustment for caregiver psychological distress attenuated the association between caregiver experiences of racism and child healthcare utilisation.

CONCLUSIONS

Vicarious racism is a serious health problem in New Zealand disproportionately affecting Māori and Asian children and significantly impacting children's healthcare utilisation. Tackling racism may be an important means of improving inequities in child healthcare utilisation.

The role of neonatal pulmonary morbidity in the longitudinal patterns of hospitalisation for respiratory infection during the first year of life

Respiratory infections among infants constitute a major burden to health care systems in developed nations, yet the course and risk factors leading to these conditions are poorly understood. We examine the longitudinal patterns of respiratory infection hospitalisation (RIH) and how these patterns are influenced by neonatal pulmonary morbidities. We included all live births (n = 429 058) occurring in the Australian state of Queensland between January 2009 and December 2015. Data were structured so that each participant had a record (present/absent) of RIH for each month from birth to 12 months. Initially, latent class growth analysis was used to identify the trajectories of RIH adjusted for spatial-temporal factors; using the identified trajectories of RIH as outcomes, we built a multinomial logistic regression model to identify neonatal predictors of RIH trajectories. Our results indicated that a four-class solution was the best fit to the data, comprising a 'no-risk' trajectory, a 'low-risk' trajectory, an 'early-risk' trajectory and a 'chronic-risk' trajectory. Compared with the no-risk trajectory, membership in the other trajectories was predicted by a range of neonatal pulmonary morbidities, with transient tachypnoea of newborn showing a specific relationship with the early-risk group and sleep apnoea showing a specific and strong risk with the chronic-risk group. Our findings suggest the possibility of identifying neonates at risk of recurrent RIH and implementing effective intervention strategies prior to neonatal discharge.

Racism and health in New Zealand: Prevalence over time and associations between recent experience of racism and health and wellbeing measures using national survey data

OBJECTIVES

Racism is an important health determinant that contributes to ethnic health inequities. This study sought to describe New Zealand adults' reported recent experiences of racism over a 10 year period. It also sought to examine the association between recent experience of racism and a range of negative health and wellbeing measures.

METHODS

The study utilised previously collected data from multiple cross-sectional national surveys (New Zealand Health Surveys 2002/03, 2006/07, 2011/12; and General Social Surveys 2008, 2010, 2012) to provide prevalence estimates of reported experience of racism (in the last 12 months) by major ethnic groupings in New Zealand. Meta-analytical techniques were used to provide improved estimates of the association between recent experience of racism and negative health from multivariable models, for the total cohorts and stratified by ethnicity.

RESULTS

Reported recent experience of racism was highest among Asian participants followed by Māori and Pacific peoples, with Europeans reporting the lowest experience of racism. Among Asian participants, reported experience of racism was higher for those born overseas compared to those born in New Zealand. Recent experience of racism appeared to be declining for most groups over the time period examined. Experience of racism in the last 12 months was consistently associated with negative measures of health and wellbeing (SF-12 physical and mental health component scores, self-rated health, overall life satisfaction). While exposure to racism was more common in the non-European ethnic groups, the impact of recent exposure to racism on health was similar across ethnic groups, with the exception of SF-12 physical health.

CONCLUSIONS

The higher experience of racism among non-European groups remains an issue in New Zealand and its potential effects on health may contribute to ethnic health inequities. Ongoing focus and monitoring of racism as a determinant of health is required to inform and improve interventions.