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Sethi S, Ju X, Logan R, Hedges J, Garvey G, Jamieson L. Lip, oral and oropharyngeal cancer incidence among Aboriginal and Torres Strait Islander Peoples: First report from Australian population-based cancer registry, 1999-2018. Aust Dent J 2024; 69:182-188. [PMID: 38469883 DOI: 10.1111/adj.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The Australian Burden of Disease Study has shown that cancer is the single most important entity responsible for the greatest cause of health burden in Australia. Unfortunately, Aboriginal and Torres Strait Islander peoples experience a greater burden of this disease, with cancer of the lung, breast, bowel and prostrate being the most common. Lip, oral cavity and pharyngeal cancer incidence is rapidly rising globally and is now the sixth most common cancer in Australia. This paper aims to summarize, for the first time, the incidence and prevalence trends of lip, oral cavity and pharyngeal cancers in Aboriginal and Torres Strait Islander Australians. METHODS Data were obtained from the Australian Cancer Database (ACD), which is compiled at the Australian Institute of Health and Welfare (AIHW) from 1999 to 2018 to estimate the incidence and prevalence of certain head and neck cancers (ICD-10 codes C00-C10, C14). The other variables requested were age groups and sex. RESULTS Results were stratified by ICD-10 code, sex and age group at diagnosis and time period (i.e. grouped years of diagnosis). The total incidence of lip, oral cavity and pharyngeal cancers increased by 1.3 times from 1999 to 2008 (107/100 000) to 2009-2018 (135/100 000). The overall 5-year prevalence of lip, oral cavity and pharyngeal cancers was 0.17% (0.24% for men and 0.09% for women). CONCLUSIONS The significantly increased incidence of lip, oral cavity and pharyngeal cancers in Aboriginal and Torres Strait Islander peoples in Australia is concerning and should be explored. A targeted, comprehensive and culturally safe model of care for Aboriginal and Torres Strait Islander peoples with lip, oral cavity and pharyngeal cancers is imperative.
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Affiliation(s)
- S Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - X Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - R Logan
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - G Garvey
- Faculty of Medicine, School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - L Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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Costa ACDO, Ramos DDO, Sousa RPD. Indicators of social inequalities associated with cancer mortality in Brazilian adults: scoping review. CIENCIA & SAUDE COLETIVA 2024; 29:e19602022. [PMID: 39140553 DOI: 10.1590/1413-81232024298.19602022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/21/2023] [Indexed: 08/15/2024] Open
Abstract
The objective of this study was to identify indicators of social inequalities associated with mortality from neoplasms in the Brazilian adult population. A scoping review method was used, establishing the guiding question: What is the effect of social inequalities on mortality from neoplasms in the Brazilian adult population? A total of 567 papers were identified, 22 of which were considered eligible. A variety of indicators were identified, such as the Human Development Index and the Gini Index, which primarily assessed differences in income, schooling, human development and vulnerability. A single pattern of association between the indicators and the different neoplasms was not established, nor was a single indicator capable of explaining the effect of social inequality at all levels of territorial area and by deaths from all types of neoplasms identified. It is known that mortality is influenced by social inequalities and that the study of indicators provides an opportunity to define which best explains deaths. This review highlights important gaps regarding the use of non-modifiable social indicators, analysis of small geographical areas, and limited use of multidimensional indicators.
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Affiliation(s)
- Ana Cristina de Oliveira Costa
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fundação Oswaldo Cruz. R. Uberaba 780, sala 6, Barro Preto. 30180-080 Belo Horizonte MG Brasil.
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Bizuayehu HM, Belachew SA, Jahan S, Diaz A, Baxi S, Griffiths K, Garvey G. Utilisation of endocrine therapy for cancer in Indigenous peoples: a systematic review and meta-analysis. BMC Cancer 2024; 24:882. [PMID: 39039483 PMCID: PMC11264465 DOI: 10.1186/s12885-024-12627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Indigenous peoples worldwide experience inequitable cancer outcomes, and it is unclear if this is underpinned by differences in or inadequate use of endocrine treatment (ET), often used in conjunction with other cancer treatments. Previous studies examining ET use in Indigenous peoples have predominately focused on the sub-national level, often resulting in small sample sizes with limited statistical power. This systematic review aimed to collate the findings ofarticles on ET utilisation for Indigenous cancer patients and describe relevant factors that may influence ET use. METHODS We conducted a systematic review and meta-analysis of studies reporting ET use for cancer among Indigenous populations worldwide. PubMed, Scopus, CINAHL, Web of Science, and Embase were searched for relevant articles. A random-effect meta-analysis was used to pool proportions of ET use. We also performed a subgroup analysis (such as with sample sizes) and a meta-regression to explore the potential sources of heterogeneity. A socio-ecological model was used to present relevant factors that could impact ET use. RESULTS Thirteen articles reported ET utilisation among Indigenous populations, yielding a pooled estimate of 67% (95% CI:54 - 80), which is comparable to that of Indigenous populations 67% (95% CI: 53 - 81). However, among studies with sufficiently sized study sample/cohorts (≥ 500), Indigenous populations had a 14% (62%; 95% CI:43 - 82) lower ET utilisation than non-Indigenous populations (76%; 95% CI: 60 - 92). The ET rate in Indigenous peoples of the USA (e.g., American Indian) and New Zealand (e.g., Māori) was 72% (95% CI:56-88) and 60% (95% CI:49-71), respectively. Compared to non-Indigenous populations, a higher proportion of Indigenous populations were diagnosed with advanced cancer, at younger age, had limited access to health services, lower socio-economic status, and a higher prevalence of comorbidities. CONCLUSIONS Indigenous cancer patients have lower ET utilisation than non-Indigenous cancer patients, despite the higher rate of advanced cancer at diagnosis. While reasons for these disparities are unclear, they are likely reflecting, at least to some degree, inequitable access to cancer treatment services. Strengthening the provision of and access to culturally appropriate cancer care and treatment services may enhance ET utilisation in Indigenous population. This study protocol was registered on Prospero (CRD42023403562).
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Affiliation(s)
- Habtamu Mellie Bizuayehu
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Sewunet Admasu Belachew
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Shafkat Jahan
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Abbey Diaz
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia
- Menzies School of Health Research, Darwin, Australia
| | - Siddhartha Baxi
- GenesisCare Australia, Griffith University, Gold Coast, Australia
| | - Kalinda Griffiths
- Poche SA+NT, Flinders University, Darwin, Australia
- Menzies School of Health Research, Darwin, Australia
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - Gail Garvey
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Brisbane, Australia
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Teng A, Stanley J, Jackson C, Koea J, Lao C, Lawrenson R, Meredith I, Sika-Paotonu D, Gurney J. The growing cancer burden: Age-period-cohort projections in Aotearoa New Zealand 2020-2044. Cancer Epidemiol 2024; 89:102535. [PMID: 38280359 DOI: 10.1016/j.canep.2024.102535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Cancer is a major cause of premature death and inequity, and global case numbers are rapidly expanding. This study projects future cancer numbers and incidence rates in Aotearoa New Zealand. METHODS Age-period-cohort modelling was applied to 25-years of national data to project cancer cases and incidence trends from 2020 to 2044. Nationally mandated cancer registry data and official historical and projected population estimates were used, with sub-groups by age, sex, and ethnicity. RESULTS Cancer diagnoses were projected to increase from 25,700 per year in 2015-2019 to 45,100 a year by 2040-44, a 76% increase (2.3% per annum). Across the same period, age-standardised cancer incidence increased by 9% (0.3% per annum) from 348 to 378 cancers per 100,000 person years, with greater increases for males (11%) than females (6%). Projected incidence trends varied substantially by cancer type, with several projected to change faster or in the opposite direction compared to projections from other countries. CONCLUSIONS Increasing cancer numbers reinforces the critical need for both cancer prevention and treatment service planning activities. Investment in developing new ways of working and increasing the workforce are required for the health system to be able to afford and manage the future burden of cancer.
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Affiliation(s)
- Andrea Teng
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand.
| | - James Stanley
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand
| | - Christopher Jackson
- Department of Medicine (Dunedin), University of Otago, PO Box 56, Dunedin, New Zealand
| | - Jonathan Koea
- General Surgery, Waitakere Hospital, Private Bag 92019, Auckland, New Zealand; Medical Surgery, The University of Auckland, Auckland, New Zealand
| | - Chunhuan Lao
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, New Zealand; Commissioning, Te Whatu Ora, Hamilton, Waikato, New Zealand
| | - Ineke Meredith
- General Surgery, Wakefield Hospital, 30 Florence Street, Wellington, New Zealand
| | - Dianne Sika-Paotonu
- Dean's Department UOW & Division of Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand
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Gustafson P, Lambert M, Bartholomew K, Ratima M, Aziz YA, Kremer L, Fusheini A, Carswell P, Brown R, Priest P, Crengle S. Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context. Int J Equity Health 2024; 23:15. [PMID: 38280997 PMCID: PMC10822165 DOI: 10.1186/s12939-023-02087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/20/2023] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Health intervention implementation in Aotearoa New Zealand (NZ), as in many countries globally, usually varies by ethnicity. Māori (the Indigenous peoples of Aotearoa) and Pacific peoples are less likely to receive interventions than other ethnic groups, despite experiencing persistent health inequities. This study aimed to develop an equity-focused implementation framework, appropriate for the Aotearoa NZ context, to support the planning and delivery of equitable implementation pathways for health interventions, with the intention of achieving equitable outcomes for Māori, as well as people originating from the Pacific Islands. METHODS A scoping review of the literature to identify existing equity-focused implementation theories, models and frameworks was undertaken. One of these, the Equity-based framework for Implementation Research (EquIR), was selected for adaptation. The adaptation process was undertaken in collaboration with the project's Māori and consumer advisory groups and informed by the expertise of local health equity researchers and stakeholders, as well as the international implementation science literature. RESULTS The adapted framework's foundation is the principles of Te Tiriti o Waitangi (the written agreement between Māori rangatira (chiefs) and the British Crown), and its focus is whānau (extended family)-centred implementation that meets the health and wellbeing aspirations, priorities and needs of whānau. The implementation pathway comprises four main steps: implementation planning, pathway design, monitoring, and outcomes and evaluation, all with an equity focus. The pathway is underpinned by the core constructs of equitable implementation in Aotearoa NZ: collaborative design, anti-racism, Māori and priority population expertise, cultural safety and values-based. Additionally, the contextual factors impacting implementation, i.e. the social, economic, commercial and political determinants of health, are included. CONCLUSIONS The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services.
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Affiliation(s)
- Papillon Gustafson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Karen Bartholomew
- Te Whatu Ora Waitematā and Te Toka Tumai Auckland, Auckland, Aotearoa, New Zealand
| | - Mihi Ratima
- Taumata Associates, Hāwera, Aotearoa, New Zealand
| | - Yasmin Abdul Aziz
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Lisa Kremer
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054
| | - Adam Fusheini
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | | | - Rachel Brown
- National Hauora Coalition, Auckland, Aotearoa, New Zealand
| | - Patricia Priest
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, PO Box 56, Dunedin, Aotearoa, New Zealand, 9054.
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Gustafson P, Abdul Aziz Y, Lambert M, Bartholomew K, Rankin N, Fusheini A, Brown R, Carswell P, Ratima M, Priest P, Crengle S. A scoping review of equity-focused implementation theories, models and frameworks in healthcare and their application in addressing ethnicity-related health inequities. Implement Sci 2023; 18:51. [PMID: 37845686 PMCID: PMC10578009 DOI: 10.1186/s13012-023-01304-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Inequities in implementation contribute to the unequal benefit of health interventions between groups of people with differing levels of advantage in society. Implementation science theories, models and frameworks (TMFs) provide a theoretical basis for understanding the multi-level factors that influence implementation outcomes and are used to guide implementation processes. This study aimed to identify and analyse TMFs that have an equity focus or have been used to implement interventions in populations who experience ethnicity or 'race'-related health inequities. METHODS A scoping review was conducted to identify the relevant literature published from January 2011 to April 2022 by searching electronic databases (MEDLINE and CINAHL), the Dissemination and Implementation model database, hand-searching key journals and searching the reference lists and citations of studies that met the inclusion criteria. Titles, abstracts and full-text articles were screened independently by at least two researchers. Data were extracted from studies meeting the inclusion criteria, including the study characteristics, TMF description and operationalisation. TMFs were categorised as determinant frameworks, classic theories, implementation theories, process models and evaluation frameworks according to their overarching aim and described with respect to how equity and system-level factors influencing implementation were incorporated. RESULTS Database searches yielded 610 results, 70 of which were eligible for full-text review, and 18 met the inclusion criteria. A further eight publications were identified from additional sources. In total, 26 papers describing 15 TMFs and their operationalisation were included. Categorisation resulted in four determinant frameworks, one implementation theory, six process models and three evaluation frameworks. One framework included elements of determinant, process and evaluation TMFs and was therefore classified as a 'hybrid' framework. TMFs varied in their equity and systems focus. Twelve TMFs had an equity focus and three were established TMFs applied in an equity context. All TMFs at least partially considered systems-level factors, with five fully considering macro-, meso- and micro-level influences on equity and implementation. CONCLUSIONS This scoping review identifies and summarises the implementation science TMFs available to support equity-focused implementation. This review may be used as a resource to guide TMF selection and illustrate how TMFs have been utilised in equity-focused implementation activities.
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Affiliation(s)
- Papillon Gustafson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand
| | - Yasmin Abdul Aziz
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand
| | - Karen Bartholomew
- Te Whatu Ora Waitematā and Te Toka Tumai Auckland, Auckland, Aotearoa, New Zealand
| | - Nicole Rankin
- Evaluation and Implementation Science Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Adam Fusheini
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Rachel Brown
- National Hauora Coalition, Auckland, Aotearoa, New Zealand
| | | | - Mihi Ratima
- Taumata Associates, Hāwera, Aotearoa, New Zealand
| | - Patricia Priest
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand.
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Lao C, Gurney J, Stanley J, Krebs J, Meredith I, Campbell I, Teng A, Sika-Paotonu D, Koea J, Lawrenson R. Association of diabetes and breast cancer characteristics at diagnosis. Cancer Causes Control 2023; 34:103-111. [PMID: 36409455 DOI: 10.1007/s10552-022-01654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE This study aims to examine the association of diabetes and breast cancer characteristics at diagnosis in Aotearoa/New Zealand. METHODS Patients diagnosed with invasive breast cancer between 2005 and 2020 were identified from the National Breast Cancer Register. Logistic regression modeling was used to estimate the adjusted odds ratio (OR) of having stage III-IV cancer and the OR of having stage IV cancer for women with diabetes compared to those without diabetes. The adjusted OR of having screen-detected breast cancers for patients aged 45-69 years with diabetes compared to patients without diabetes was estimated. RESULTS 26,968 women were diagnosed with breast cancer, with 3,137 (11.6%) patients having diabetes at the time of cancer diagnosis. The probability of co-occurrence of diabetes and breast cancer increased with time. Māori, Pacific and Asian women were more likely to have diabetes than European/Others. The probability of having diabetes also increased with age. For patients with diabetes, the probability of being diagnosed with stage III-IV cancer and stage IV cancer was higher than for patients without diabetes (OR 1.14, 95% CI 1.03-1.27; and 1.17, 95% CI 1.00-1.38). Women aged 45-69 years with diabetes were more likely to have screen-detected cancer than those without diabetes (OR 1.13, 95% CI 1.02-1.26). CONCLUSIONS The co-occurrence of diabetes and breast cancer is becoming more common. Overall there is a small but significant adverse impact of having advanced disease for women with diabetes that is found at the time of breast cancer diagnosis, and this may contribute to other inequities that occur in the treatment pathway that may impact on patient outcomes.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jeremy Krebs
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Ineke Meredith
- General Surgery, Wakefield Hospital, Wellington, New Zealand
| | - Ian Campbell
- General Surgery, Wakefield Hospital, Wellington, New Zealand
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Andrea Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Dianne Sika-Paotonu
- Department of Pathology & Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- General Surgery, Wakefield Hospital, Wellington, New Zealand
- Medical Surgery, The University of Auckland, Auckland, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
- Strategy and Funding, Waikato Hospital, Hamilton, New Zealand
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Nghiem N, Teng A, Cleghorn C, McKerchar C, Wilson N. Using household economic survey data to assess food expenditure patterns and trends in a high-income country with notable health inequities. Sci Rep 2022; 12:21703. [PMID: 36522384 PMCID: PMC9753885 DOI: 10.1038/s41598-022-26301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
This study aimed to identify dietary trends in Aotearoa New Zealand (NZ) and whether inequities in dietary patterns are changing. We extracted data from the Household Economic Survey (HES), which was designed to provide information on impacts of policy-making in NZ, and performed descriptive analyses on food expenditures. Overall, total household food expenditure per capita increased by 0.38% annually over this period. Low-income households spent around three quarters of what high-income households spent on food per capita. High-income households experienced a greater increase in expenditure on nuts and seeds and a greater reduction in expenditure on processed meat. There was increased expenditure over time on fruit and vegetables nuts and seeds, and healthy foods in Māori (Indigenous) households with little variations in non-Māori households. But there was little change in processed meat expenditure for Māori households and expenditure on less healthy foods also increased over time. Routinely collected HES data were useful and cost-effective for understanding trends in food expenditure patterns to inform public health interventions, in the absence of nutrition survey data. Potentially positive expenditure trends for Māori were identified, however, food expenditure inequities in processed meat and less healthy foods by ethnicity and income continue to be substantial.
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Affiliation(s)
- Nhung Nghiem
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Andrea Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Christine Cleghorn
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Christina McKerchar
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
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Health promoting and demoting consumption: What accounts for budget share differentials by ethnicity in New Zealand. SSM Popul Health 2022; 19:101204. [PMID: 36033347 PMCID: PMC9403558 DOI: 10.1016/j.ssmph.2022.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/27/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background Health demoting consumption of alcohol and tobacco are some of the most important risk factors for health loss worldwide, however there is limited information on these consumption risk factors in New Zealand (NZ) and whether inequities in the risk factors are ethnically patterned. Methods We used three nationally representative Household Economic Survey waves (2006/07, 2009/10, 2012/13) (n = 9030) in NZ to examine household expenditure for key health risk-related components of consumption by ethnicity, and its contributors to the differences using non-parametric, parametric and decomposition methods. Results Māori households (NZ indigenous population) were significantly poorer (25% less) than non-Māori households in terms of household per capita expenditure. However, our various econometric estimations suggested that, in relative terms, Māori spent more on tobacco and alcohol, and less on healthcare. The gaps become larger at upper quantiles of the budget share distributions; the composition effect (the gap due to differences in individual and household characteristics between Māori and non-Māori) explains most of the tobacco and alcohol budget share gap between the two groups, and less for healthcare. The structure effect (the gap due to returns to/or effect of individual and household characteristics) contributes very little to the budget share gap for tobacco and drink, but increasingly and predominantly when moving along the distribution of healthcare budget share. The differences between Māori and non-Māori in household ownership, education, and income negatively affect budget share on these health demoting consumption (tobacco and alcohol). The household head's age, education, and employment contributed most to the structure effect. Conclusions Our study suggested ethnic inequities in the health risk consumption behaviour are evidenced in NZ. Interventions targeting education and employment that significantly affect household budget shares on risk factors (i.e., harmful consumption) for health loss may help narrow the gaps. Alcohol and tobacco are important risk factors for health loss worldwide. National Household Economic Survey data were analysed by ethnicity for New Zealand. Māori households spent more on tobacco and alcoholic drinks, and less on healthcare. The gap due to differences in household characteristics explains most of the budget share gap. Interventions targeting education and employment may help narrow the gaps.
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Smith S, Brand M, Harden S, Briggs L, Leigh L, Brims F, Brooke M, Brunelli VN, Chia C, Dawkins P, Lawrenson R, Duffy M, Evans S, Leong T, Marshall H, Patel D, Pavlakis N, Philip J, Rankin N, Singhal N, Stone E, Tay R, Vinod S, Windsor M, Wright GM, Leong D, Zalcberg J, Stirling RG. Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry: a protocol paper. BMJ Open 2022; 12:e060907. [PMID: 36038161 PMCID: PMC9438055 DOI: 10.1136/bmjopen-2022-060907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer mortality, comprising the largest national cancer disease burden in Australia and New Zealand. Regional reports identify substantial evidence-practice gaps, unwarranted variation from best practice, and variation in processes and outcomes of care between treating centres. The Australia and New Zealand Lung Cancer Registry (ANZLCR) will be developed as a Clinical Quality Registry to monitor the safety, quality and effectiveness of lung cancer care in Australia and New Zealand. METHODS AND ANALYSIS Patient participants will include all adults >18 years of age with a new diagnosis of non-small-cell lung cancer (NSCLC), SCLC, thymoma or mesothelioma. The ANZLCR will register confirmed diagnoses using opt-out consent. Data will address key patient, disease, management processes and outcomes reported as clinical quality indicators. Electronic data collection facilitated by local data collectors and local, state and federal data linkage will enhance completeness and accuracy. Data will be stored and maintained in a secure web-based data platform overseen by registry management. Central governance with binational representation from consumers, patients and carers, governance, administration, health department, health policy bodies, university research and healthcare workers will provide project oversight. ETHICS AND DISSEMINATION The ANZLCR has received national ethics approval under the National Mutual Acceptance scheme. Data will be routinely reported to participating sites describing performance against measures of agreed best practice and nationally to stakeholders including federal, state and territory departments of health. Local, regional and (bi)national benchmarks, augmented with online dashboard indicator reporting will enable local targeting of quality improvement efforts.
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Affiliation(s)
- Shantelle Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Margaret Brand
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Susan Harden
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lisa Briggs
- Victorian Lung Cancer Registry, Monash University, Clayton, Victoria, Australia
| | - Lillian Leigh
- Victorian Lung Cancer Registry, Monash University, Clayton, Victoria, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Mark Brooke
- Lung Foundation Australia, Milton, Queensland, Australia
| | - Vanessa N Brunelli
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Collin Chia
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Paul Dawkins
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand
- Strategy and Funding, Waikato District Health Board, Hamilton, New Zealand
| | - Mary Duffy
- Lung Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sue Evans
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Tracy Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Dainik Patel
- Department of Medical Oncology, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Nick Pavlakis
- Medical Oncology, Genesis Care and University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Philip
- Department of Medicine, Univ Melbourne, Fitzroy, Victoria, Australia
| | - Nicole Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nimit Singhal
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Stone
- School of Clinical Medicine, University NSW, Sydney, Victoria, Australia
| | - Rebecca Tay
- Department of Medical Oncology, The Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Morgan Windsor
- Department of Thoracic Surgery, Prince Charles and Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Gavin M Wright
- Department of Surgery, Cardiothoracic Surgery Unit, St Vincent, Victoria, Australia
| | - David Leong
- Department of Medical Oncology, John James Medical Centre Deakin, Canberra, Australian Capital Territory, Australia
| | - John Zalcberg
- Cancer Research Program, Monash University, Melbourne, Victoria, Australia
| | - Rob G Stirling
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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11
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Yu D, Wang Z, Cai Y, McBride K, Osuagwu UL, Pickering K, Baker J, Cutfield R, Orr-Walker BJ, Sundborn G, Jameson MB, Zhao Z, Simmons D. Ethnic Differences in Cancer Rates Among Adults With Type 2 Diabetes in New Zealand From 1994 to 2018. JAMA Netw Open 2022; 5:e2147171. [PMID: 35129595 PMCID: PMC8822383 DOI: 10.1001/jamanetworkopen.2021.47171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE People with type 2 diabetes have greater risk for some site-specific cancers, and risks of cancers differ among racial and ethnic groups in the general population of Aotearoa New Zealand. The extent of ethnic disparities in cancer risks among people with type 2 diabetes in New Zealand is unclear. OBJECTIVE To compare the risks of 21 common adult cancers among Māori, Pasifika, and New Zealand European individuals with type 2 diabetes in New Zealand from 1994 to 2018. DESIGN, SETTING, AND PARTICIPANTS This population-based, matched cohort study used data from the primary care audit program in Auckland, New Zealand, linked with national cancer, death, and hospitalization registration databases, collected from January 1, 1994, to July 31, 2018, with follow-up data obtained through December 31, 2019. Using a tapered matching method to balance potential confounders (sociodemographic characteristics, lifestyle, anthropometric and clinical measurements, treatments [antidiabetes, antihypertensive, lipid-lowering, and anticoagulant], period effects, and recorded duration of diabetes), comparative cohorts were formed between New Zealand European and Māori and New Zealand European and Pasifika individuals aged 18 years or older with type 2 diabetes. Sex-specific matched cohorts were formed for sex-specific cancers. EXPOSURES Māori, Pasifika, and New Zealand European (reference group) ethnicity. MAIN OUTCOMES AND MEASURES The incidence rates of 21 common cancers recorded in nationally linked databases between 1994 and 2018 were the main outcomes. Weighted Cox proportional hazards regression was used to assess ethnic differences in risk of each cancer. RESULTS A total of 33 524 adults were included: 15 469 New Zealand European (mean [SD] age, 61.6 [13.2] years; 8522 [55.1%] male), 6656 Māori (mean [SD] age, 51.2 [12.4] years; 3345 [50.3%] female), and 11 399 Pasifika (mean [SD] age, 52.8 [12.7] years; 5994 [52.6%] female) individuals. In the matched New Zealand European and Māori cohort (New Zealand European: 8361 individuals; mean [SD] age, 58.9 [12.9] years; 4595 [55.0%] male; Māori: 5039 individuals; mean [SD] age, 51.4 [12.3] years; 2542 [50.5%] male), significant differences between New Zealand European and Māori individuals were identified in the risk for 7 cancers. Compared with New Zealand European individuals, the hazard ratios (HRs) among Māori individuals were 15.36 (95% CI, 4.50-52.34) for thyroid cancer, 7.94 (95% CI, 1.57-40.24) for gallbladder cancer, 4.81 (95% CI, 1.08-21.42) for cervical cancer (females only), 1.97 (95% CI, 1.30-2.99) for lung cancer, 1.81 (95% CI, 1.08-3.03) for liver cancer, 0.56 (95% CI, 0.35-0.90) for colon cancer, and 0.11 (95% CI, 0.04-0.27) for malignant melanoma. In the matched New Zealand European and Pasifika cohort (New Zealand European: 9340 individuals; mean [SD] age, 60.6 [13.1] years; 4885 [52.3%] male; Pasifika: 8828 individuals; mean [SD] age, 53.1 [12.6] years; 4612 [52.2%] female), significant differences between New Zealand European and Pasifika individuals were identified for 6 cancers. Compared with New Zealand European individuals, HRs among Pasifika individuals were 25.10 (95% CI, 3.14-200.63) for gallbladder cancer, 4.47 (95% CI, 1.25-16.03) for thyroid cancer, 0.48 (95% CI, 0.30-0.78) for colon cancer, 0.21 (95% CI, 0.09-0.48) for rectal cancer, 0.21 (95% CI, 0.07-0.65) for malignant melanoma, and 0.01 (95% CI, 0.01-0.10) for bladder cancer. CONCLUSIONS AND RELEVANCE In this cohort study, differences in the risk of 21 common cancers were found between New Zealand European, Māori, and Pasifika groups of adults with type 2 diabetes in New Zealand from 1994 to 2018. Research into the mechanisms underlying these differences as well as additional screening strategies (eg, for thyroid and gallbladder cancers) appear to be warranted.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom
| | - Zheng Wang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Kate McBride
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | - Uchechukwu Levi Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Brandon J. Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Michael B. Jameson
- Oncology Department, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - David Simmons
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
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12
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Hawkins M. Were warriors once low carb? Commentary on New Zealand Māori nutrition and anthropometrics over the last 150 years. J Prim Health Care 2021; 13:106-111. [PMID: 34620290 DOI: 10.1071/hc20129] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
Obesity is a scourge on modern society and an epidemic has exploded in the developed world over the last half century, resulting in sicker populations and economically unsustainable health expenditure. The Pacific region became colonised by Europeans from the early nineteenth century onwards and, as a consequence, 'European' foodstuffs were introduced to New Zealand Māori. This has intensified over the last 150 years; so much so, that obesity is now common among New Zealand Māori, who suffer disproportionately from the chronic diseases arising from obesity.
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Affiliation(s)
- Marcus Hawkins
- Botany Doctor Medical Practice, Botany Town Centre, 588 Chapel Road, Botany, Auckland, New Zealand.
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13
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Varghese C, Liu VY, Immanuel T, Chien N, Green T, Chan G, Theakston E, Kalev-Zylinska M. Ethnic differences in acute promyelocytic leukaemia between New Zealand Polynesian and European patients. ACTA ACUST UNITED AC 2021; 26:215-224. [PMID: 33594940 DOI: 10.1080/16078454.2021.1882146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ethnic differences in haematologic malignancies remain poorly elucidated, hence research in this area is important. This was a retrospective study into potential ethnic disparity in the presentation and outcomes of acute promyelocytic leukaemia (APL) between New Zealand (NZ) Polynesian and European patients. Data were analysed for patients treated at Auckland City Hospital (ACH; n = 55) and recorded in the New Zealand Cancer Registry (NZCR; n = 173), both for the period 2000-2017. We found that Polynesian patients treated at ACH presented at a younger age than European (P = 0.005), showed higher blast counts (P = 0.033), and a marginally higher prothrombin ratio (P = 0.02). Treatment with all-trans retinoic acid (ATRA) was started faster in Polynesian patients than European (P = 0.021), suggesting Polynesians were sicker at presentation but were managed accordingly. There were no differences in bleeding events, transfusion requirements and early deaths during the first month of treatment. Long-term survival was also similar. Data extracted from the NZCR confirmed NZ Polynesian patients with APL were younger than European (P < 0.001), but long-term survival was similar (P = 0.920). In summary, this study indicates a discrepancy in the presentation and severity of APL between NZ Polynesian and European patients but treatment initiation was rapid with no difference in outcomes. The distinctive features of APL in NZ Polynesians raise the possibility of a predisposing genetic factor or a different risk factor profile, elucidation of which is important for all patients with APL.
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Affiliation(s)
- Chris Varghese
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | | | - Tracey Immanuel
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Nicole Chien
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Taryn Green
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - George Chan
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Department of Haematology, Auckland City Hospital, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Edward Theakston
- Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Maggie Kalev-Zylinska
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
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14
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Gall A, Butler TL, Lawler S, Garvey G. Traditional, complementary and integrative medicine use among Indigenous peoples with diabetes in Australia, Canada, New Zealand and the United States. Aust N Z J Public Health 2021; 45:664-671. [PMID: 34028943 DOI: 10.1111/1753-6405.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This systematic review aimed to describe traditional, complementary and integrative medicine (TCIM) use among Indigenous peoples with diabetes from Australia, Canada, New Zealand and the United States (US). METHODS A systematic search following the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) statement guidelines was conducted. Data were analysed using meta-aggregation. RESULTS Thirteen journal articles from 12 studies across Australia, Canada and the US were included in the review (no articles from New Zealand were identified). Indigenous peoples used various types of TCIM alongside conventional treatment for diabetes, particularly when conventional treatment did not meet Indigenous peoples' holistic understandings of wellness. TCIM provided opportunities to practice important cultural and spiritual activities. While TCIM was often viewed as an effective treatment through bringing balance to the body, definitions of treatments that comprise safe and effective TCIM use were lacking in the articles. CONCLUSIONS The concurrent use of TCIM and conventional treatments is common among Indigenous peoples with diabetes, but clear definitions of safe and effective TCIM use are lacking. Implications for public health: Healthcare providers should support Indigenous peoples to safely and effectively treat diabetes with TCIM alongside conventional treatment.
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Affiliation(s)
- Alana Gall
- Menzies School of Health Research, Charles Darwin University, Queensland
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Queensland
| | - Sheleigh Lawler
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Queensland
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15
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Kidd J, Cassim S, Rolleston A, Chepulis L, Hokowhitu B, Keenan R, Wong J, Firth M, Middleton K, Aitken D, Lawrenson R. Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities. BMC Cancer 2021; 21:121. [PMID: 33541294 PMCID: PMC7863263 DOI: 10.1186/s12885-021-07862-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities. Methods This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whānau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. Results Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whānau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whānau journey focused on agency and the impact on whānau. Conclusions The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whānau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whānau as carers to foster health literacy in future generations. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07862-0.
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Affiliation(s)
- Jacquie Kidd
- School of Clinical Sciences, Faculty of Environmental and Health Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Shemana Cassim
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Anna Rolleston
- The Centre for Health, PO Box 13068, Tauranga, 3141, New Zealand
| | - Lynne Chepulis
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Brendan Hokowhitu
- Te Pua Wananga ki te Ao Faculty of Māori and Indigenous Studies, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Rawiri Keenan
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Janice Wong
- Waikato District Health Board, Waikato Hospital, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Melissa Firth
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Karen Middleton
- Waikato District Health Board, Waikato Hospital, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Denise Aitken
- Lakes District Health Board, Rotorua Hospital, Private Bag 3023, Rotorua Mail Centre, Rotorua, 3046, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
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16
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Cassim S, Kidd J, Rolleston A, Keenan R, Aitken D, Firth M, Middleton K, Chepulis L, Wong J, Hokowhitu B, Lawrenson R. Hā Ora: Barriers and enablers to early diagnosis of lung cancer in primary healthcare for Māori communities. Eur J Cancer Care (Engl) 2020; 30:e13380. [PMID: 33280179 DOI: 10.1111/ecc.13380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/29/2020] [Accepted: 11/18/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this research was to document the barriers to early presentation and diagnosis of lung cancer within primary healthcare, identified by Māori whānau (families) and primary healthcare providers in the Midland region of Aotearoa New Zealand. METHODS This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Each community hui included cancer patients, whānau, and other community members. Each healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. RESULTS Barriers and enablers to early diagnosis of lung cancer were categorised into three key themes: GP relationship and position in the community, health literacy and pathways to diagnosis. CONCLUSION This study demonstrates that culturally responsive, patient-centred healthcare, and positive GP-patient relationships are significant factors for Māori patients and whānau serving as barriers and enablers to early diagnosis of lung cancer.
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Affiliation(s)
- Shemana Cassim
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Jacquie Kidd
- School of Nursing, Auckland University of Technology, Auckland, New Zealand
| | | | - Rawiri Keenan
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | | | - Melissa Firth
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | | | - Lynne Chepulis
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Janice Wong
- Waikato District Health Board, Hamilton, New Zealand
| | - Brendan Hokowhitu
- Te Pua Wananga ki te Ao Faculty of Māori and Indigenous Studies, The University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
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17
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McLeod M, Sandiford P, Kvizhinadze G, Bartholomew K, Crengle S. Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis. BMJ Open 2020; 10:e037145. [PMID: 32973060 PMCID: PMC7517554 DOI: 10.1136/bmjopen-2020-037145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE There are large inequities in the lung cancer burden for the Indigenous Māori population of New Zealand. We model the potential lifetime health gains, equity impacts and cost-effectiveness of a national low-dose CT (LDCT) screening programme for lung cancer in smokers aged 55-74 years with a 30 pack-year history, and for formers smokers who have quit within the last 15 years. DESIGN A Markov macrosimulation model estimated: health benefits (health-adjusted life-years (HALYs)), costs and cost-effectiveness of biennial LDCT screening. Input parameters came from literature and NZ-linked health datasets. SETTING New Zealand. PARTICIPANTS Population aged 55-74 years in 2011. INTERVENTIONS Biennial LDCT screening for lung cancer compared with usual care. OUTCOME MEASURES Incremental cost-effectiveness ratios were calculated using the average difference in costs and HALYs between the screened and the unscreened populations. Equity analyses included substituting non-Māori values for Māori values of background morbidity, mortality and stage-specific survival. Changes in inequities in lung cancer survival and 'health-adjusted life expectancy' (HALE) were measured. RESULTS LDCT screening in NZ is likely to be cost-effective for the total population: NZ$34 400 per HALY gained (95% uncertainty interval NZ$27 500 to NZ$42 900) and for Māori separately (using a threshold of gross domestic product per capita NZ$45 000). Health gains per capita for Māori females were twice that for non-Māori females and 25% greater for Māori males compared with non-Māori males. LDCT screening will narrow absolute inequities in HALE and lung cancer mortality for Māori, but will slightly increase relative inequities in mortality from lung cancer (compared with non-Māori) due to differential stage-specific survival. CONCLUSION A national biennial LDCT lung cancer screening programme in New Zealand is likely to be cost-effective, will improve total population health and reduce health inequities for Māori. Attention must be paid to addressing ethnic inequities in stage-specific lung cancer survival.
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Affiliation(s)
- Melissa McLeod
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Peter Sandiford
- Waitemata District Health Board, Takapuna, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | | | | | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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18
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Weinkove R, McQuilten ZK, Adler J, Agar MR, Blyth E, Cheng AC, Conyers R, Haeusler GM, Hardie C, Jackson C, Lane SW, Middlemiss T, Mollee P, Mulligan SP, Ritchie D, Ruka M, Solomon B, Szer J, Thursky KA, Wood EM, Worth LJ, Yong MK, Slavin MA, Teh BW. Managing haematology and oncology patients during the COVID-19 pandemic: interim consensus guidance. Med J Aust 2020; 212:481-489. [PMID: 32401360 PMCID: PMC7273031 DOI: 10.5694/mja2.50607] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction A pandemic coronavirus, SARS‐CoV‐2, causes COVID‐19, a potentially life‐threatening respiratory disease. Patients with cancer may have compromised immunity due to their malignancy and/or treatment, and may be at elevated risk of severe COVID‐19. Community transmission of COVID‐19 could overwhelm health care services, compromising delivery of cancer care. This interim consensus guidance provides advice for clinicians managing patients with cancer during the pandemic. Main recommendations During the COVID‐19 pandemic: In patients with cancer with fever and/or respiratory symptoms, consider causes in addition to COVID‐19, including other infections and therapy‐related pneumonitis. For suspected or confirmed COVID‐19, discuss temporary cessation of cancer therapy with a relevant specialist. Provide information on COVID‐19 for patients and carers. Adopt measures within cancer centres to reduce risk of nosocomial SARS‐CoV‐2 acquisition; support population‐wide social distancing; reduce demand on acute services; ensure adequate staffing; and provide culturally safe care. Measures should be equitable, transparent and proportionate to the COVID‐19 threat. Consider the risks and benefits of modifying cancer therapies due to COVID‐19. Communicate treatment modifications, and review once health service capacity allows. Consider potential impacts of COVID‐19 on the blood supply and availability of stem cell donors. Discuss and document goals of care, and involve palliative care services in contingency planning.
Changes in management as a result of this statement This interim consensus guidance provides a framework for clinicians managing patients with cancer during the COVID‐19 pandemic. In view of the rapidly changing situation, clinicians must also monitor national, state, local and institutional policies, which will take precedence. Endorsed by Australasian Leukaemia and Lymphoma Group; Australasian Lung Cancer Trials Group; Australian and New Zealand Children's Haematology/Oncology Group; Australia and New Zealand Society of Palliative Medicine; Australasian Society for Infectious Diseases; Bone Marrow Transplantation Society of Australia and New Zealand; Cancer Council Australia; Cancer Nurses Society of Australia; Cancer Society of New Zealand; Clinical Oncology Society of Australia; Haematology Society of Australia and New Zealand; National Centre for Infections in Cancer; New Zealand Cancer Control Agency; New Zealand Society for Oncology; and Palliative Care Australia.
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Affiliation(s)
- Robert Weinkove
- Wellington Blood and Cancer Centre, Capital and Coast District Health Board, Wellington, NZ.,Malaghan Institute of Medical Research, Wellington, NZ
| | - Zoe K McQuilten
- Monash University, Melbourne, VIC.,Monash Health, Melbourne, VIC
| | - Jonathan Adler
- Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, NZ
| | - Meera R Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology, Sydney, NSW
| | - Emily Blyth
- Westmead Hospital, Sydney, NSW.,Westmead Institute for Medical Research, Sydney, NSW
| | | | - Rachel Conyers
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
| | - Gabrielle M Haeusler
- Peter MacCallum Cancer Centre, Melbourne, VIC.,Royal Children's Hospital, Melbourne, VIC
| | - Claire Hardie
- MidCentral District Health Board, Palmerston North, NZ
| | - Christopher Jackson
- Cancer Society of New Zealand, Wellington, NZ.,University of Otago, Dunedin, NZ
| | | | | | - Peter Mollee
- Princess Alexandra Hospital, Brisbane, QLD.,University of Queensland, Brisbane, QLD
| | | | | | - Myra Ruka
- Waikato District Health Board, Hamilton, NZ.,University of Auckland, Auckland, NZ
| | | | - Jeffrey Szer
- Peter MacCallum Cancer Centre, Melbourne, VIC.,Royal Melbourne Hospital, Melbourne, VIC
| | - Karin A Thursky
- Peter MacCallum Cancer Centre, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Erica M Wood
- Monash University, Melbourne, VIC.,Monash Health, Melbourne, VIC
| | - Leon J Worth
- Peter MacCallum Cancer Centre, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Michelle K Yong
- Peter MacCallum Cancer Centre, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Monica A Slavin
- Peter MacCallum Cancer Centre, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Benjamin W Teh
- Peter MacCallum Cancer Centre, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
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Cost-effectiveness of a low-dose computed tomography screening programme for lung cancer in New Zealand. Lung Cancer 2020; 144:99-106. [PMID: 32317183 DOI: 10.1016/j.lungcan.2020.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The cost-effectiveness of low-dose computed tomography (LDCT) screening for lung cancer is uncertain. This study estimated the health gains, costs (net health system, and including 'unrelated') and cost-effectiveness of biennial LDCT screening among 55-74 years olds with a smoking history of at least 30 pack years, and (if a former smoker) having quit within last 15 years, in New Zealand. METHODS We used a macrosimulation stage shift model with New Zealand-specific lung cancer incidence rates and intervention parameters from the National Lung Screening Trial, a health system perspective, and a lifetime horizon for quality-adjusted life-years (QALYs) and costs discounted at 3% per annum. We also examined heterogeneity by gender, ethnicity (Māori (indigenous population) versus non-Māori), age and smoking status. RESULTS AND CONCLUSION We estimated 0.067 QALYs gained (95 % uncertainty interval (UI) 0.044 to 0.095) per eligible participant, at a cost of US$2843 ($2067-3797; 2011 $US). The overall incremental cost effectiveness ratio (ICER) was US$44,000 per QALY gained (95 % UI US$27,000 to US$70,000). The ICER was substantially lower for Māori, at US$26,000 per QALY gained (95 % UI US$17,000 to US$39,000). The cost-effectiveness varied by socio-demographics, from US$21,000 for 70-74 year old Māori females to US$60,000 for 55-59 year old non-Māori males. The two scenarios that lowered the ICER the most were halving the screening costs (ICER = US$33,000 per QALY), and improving the sensitivity (from 93.8% to 98%) and specificity (from 73.4% to 95%) of the screening test (ICER = US$23,000 per QALY). Based on a threshold of GDP per capita per QALY gained (i.e. US$30,000), LDCT screening for lung cancer is unlikely to be cost-effective in New Zealand for the proposed target population under our modelling assumptions. However, it is likely to be cost-effective for Māori, a population group which carries a disproportionately high disease burden from lung cancer.
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Context of cancer control in New Zealand. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gurney JK, Sarfati D, Lawrence B, Jackson C, Findlay M, McPherson K. Cancer research in the New Zealand context: Challenges and advantages. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The state of cancer prevention in Aotearoa New Zealand: Slow progress requires political leadership and investment for health and equity. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Diaz A, Soerjomataram I, Moore S, Whop LJ, Bray F, Hoberg H, Garvey G. Collection and Reporting of Indigenous Status Information in Cancer Registries Around the World. JCO Glob Oncol 2020; 6:133-142. [PMID: 32031453 PMCID: PMC6998012 DOI: 10.1200/jgo.19.00119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Worldwide, Indigenous people often have disproportionally worse health and lower life expectancy than their non-Indigenous counterparts. Despite the impact of cancer on life expectancy, little is known about the burden of cancer for Indigenous people primarily because of the paucity of data. We investigated the collection and reporting of Indigenous status information among a global sample of population-based cancer registries (PBCRs). PARTICIPANTS AND METHODS An online survey was e-mailed to eligible registries using set inclusion criteria. Respondents were asked questions on the collection, reporting, and quality assessment of Indigenous status in their registers. RESULTS Eighty-three PBCRs from 25 countries were included. Of these, 66% reported that their registry collected Indigenous status data, although the quality of this variable had been assessed in less than half in terms of completeness (38%) and accuracy (47%). Two thirds of PBCRs who collected Indigenous status data (67%), from nine of 25 countries responded that cancer statistics for Indigenous people were reported using registry data. Key barriers to the collection of Indigenous status information included the lack of data collection at the point of care (79%), lack of transfer of Indigenous status to the cancer registry (46%), inadequate information systems (43%), and legislative limitations (32%). Important variations existed among world regions, although the lack of Indigenous status data collection at the point of care was commonly reported across all regions. CONCLUSION High-quality data collection is lacking for Indigenous peoples in many countries. To ensure the design and implementation of cancer control activities required to reduce disparities for Indigenous populations, health information systems, including cancer registries, need to be strengthened, and this must be done in dialogue with Indigenous leaders.
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Affiliation(s)
- Abbey Diaz
- Charles Darwin University, Casuarina, NT, Australia
| | | | | | - Lisa J. Whop
- Charles Darwin University, Casuarina, NT, Australia
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Hana Hoberg
- Charles Darwin University, Casuarina, NT, Australia
| | - Gail Garvey
- Charles Darwin University, Casuarina, NT, Australia
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Kim DH, Chepulis L, Keenan R, Lao C, Hodgson F, Bullen C, Lawrenson R. Prevalence of invasive cancer in a large general practice patient population in New Zealand. J Prim Health Care 2020; 12:215-224. [DOI: 10.1071/hc19113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONThe prevalence of cancer in the community is likely to be increasing due to an ageing population, implementation of cancer screening programmes and advances in cancer treatment.
AIMTo determine the prevalence of primary invasive cancers in a large general practice patient population in New Zealand and to characterise the health-care status of these cancer patients.
METHODSData were sourced from the patient management system of a large general practice (n=11,374 patients) in a medium-sized Waikato town and from the New Zealand Cancer Registry dataset to identify patients diagnosed with cancer between January 2009 and December 2018.
RESULTSThere were 206 cancer diagnoses in 201 patients; 35 cancers were diagnosed in 1887 Māori patients (1.9%) and 171 in 9487 non-Māori patients (1.8%). The age-standardised prevalence was 3092/100,000 in Māori patients and 1971/100,000 in non-Māori patients. The most prevalent cancers were breast, male genital organ, digestive organ and skin cancers. In May 2019, 81 of 201 (40.8%) patients with cancer were receiving only usual care from their general practitioner, whereas 66 (32.8%) were having their cancer managed in secondary care. Comorbidities were common, including hypertension (38.8%), gastrointestinal disorders (29.9%) and mood disorders (24.4%).
DISCUSSIONResults suggest that there may be disparities in cancer prevalence between Māori and non-Māori patients, although this needs to be confirmed in other general practices. Furthermore, primary care appears to be responsible for most of the care in this patient cohort and workloads should be planned accordingly, particularly with the high incidence of comorbidities.
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Signal V, Gurney J, Inns S, McLeod M, Sika-Paotonu D, Sowerbutts S, Teng A, Sarfati D. Helicobacter pylori, stomach cancer and its prevention in New Zealand. J R Soc N Z 2019. [DOI: 10.1080/03036758.2019.1650081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Virginia Signal
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jason Gurney
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Stephen Inns
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Melissa McLeod
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Dianne Sika-Paotonu
- Department of Pathology & Molecular Medicine, University of Otago, Wellington, New Zealand
- Dean’s Department, University of Otago, Wellington, New Zealand
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Sam Sowerbutts
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Andrea Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
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Hakkaart C, Ellison-Loschmann L, Day R, Sporle A, Koea J, Harawira P, Cheng S, Gray M, Whaanga T, Pearce N, Guilford P. Germline CDH1 mutations are a significant contributor to the high frequency of early-onset diffuse gastric cancer cases in New Zealand Māori. Fam Cancer 2019; 18:83-90. [PMID: 29589180 PMCID: PMC6323075 DOI: 10.1007/s10689-018-0080-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
New Zealand Māori have a considerably higher incidence of gastric cancer compared to non-Māori, and are one of the few populations worldwide with a higher prevalence of diffuse-type disease. Pathogenic germline CDH1 mutations are causative of hereditary diffuse gastric cancer, a cancer predisposition syndrome primarily characterised by an extreme lifetime risk of developing diffuse gastric cancer. Pathogenic CDH1 mutations are well described in Māori families in New Zealand. However, the contribution of these mutations to the high incidence of gastric cancer is unknown. We have used next-generation sequencing, Sanger sequencing, and Multiplex Ligation-dependent Probe Amplification to examine germline CDH1 in an unselected series of 94 Māori gastric cancer patients and 200 healthy matched controls. Overall, 18% of all cases, 34% of cases diagnosed with diffuse-type gastric cancer, and 67% of cases diagnosed aged less than 45 years carried pathogenic CDH1 mutations. After adjusting for the effect of screening known HDGC families, we estimate that 6% of all advanced gastric cancers and 13% of all advanced diffuse-type gastric cancers would carry germline CDH1 mutations. Our results demonstrate that germline CDH1 mutations are a significant contributor to the high frequency of diffuse gastric cancer in New Zealand Māori.
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Affiliation(s)
- Christopher Hakkaart
- Cancer Genetics Laboratory, Centre for Translational Cancer Research, University of Otago, P. O. Box 56, Dunedin, 9054, New Zealand
| | | | - Robert Day
- Cancer Genetics Laboratory, Centre for Translational Cancer Research, University of Otago, P. O. Box 56, Dunedin, 9054, New Zealand
| | - Andrew Sporle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Jonathan Koea
- Waitemata District Health Board, Auckland, New Zealand
| | | | - Soo Cheng
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Michelle Gray
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Tracey Whaanga
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Parry Guilford
- Cancer Genetics Laboratory, Centre for Translational Cancer Research, University of Otago, P. O. Box 56, Dunedin, 9054, New Zealand.
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Cassim S, Chepulis L, Keenan R, Kidd J, Firth M, Lawrenson R. Patient and carer perceived barriers to early presentation and diagnosis of lung cancer: a systematic review. BMC Cancer 2019; 19:25. [PMID: 30621616 PMCID: PMC6323678 DOI: 10.1186/s12885-018-5169-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/02/2018] [Indexed: 01/17/2023] Open
Abstract
Background Lung cancer is typically diagnosed at a late stage. Early presentation and detection of lung cancer symptoms is critical to improving survival but can be clinically complicated and as yet a robust screening method for diagnosis is not available in routine practice. Accordingly, the barriers to help-seeking behaviour and diagnosis need to be considered. This review aimed to document the barriers to early presentation and diagnosis of lung cancer, based on patient and carer perspectives. Methods A systematic review of databases was performed for original, English language articles discussing qualitative research on patient perceived barriers to early presentation and diagnosis of lung cancer. Three major databases were searched: Scopus, PubMed and EBSCOhost. References cited in the selected studies were searched for further relevant articles. Results Fourteen studies met inclusion criteria for review. Barriers were grouped into three categories: healthcare provider and system factors, patient factors and disease factors. Conclusions Studies showed that the most frequently reported barriers to early presentation and diagnosis of lung cancer reported by patients and carers related to poor relationships between GPs and patients, a lack of access to services and care for patients, and a lack of awareness of lung cancer symptoms and treatment. Addressing these barriers offers opportunities by which rates of early diagnosis of lung cancer may be improved.
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Affiliation(s)
- Shemana Cassim
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand.
| | - Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand
| | - Rawiri Keenan
- School of Nursing, University of Auckland, Auckland, 1023, New Zealand
| | - Jacquie Kidd
- School of Nursing, University of Auckland, Auckland, 1023, New Zealand
| | - Melissa Firth
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand.,Waikato Medical Research Centre, Waikato DHB Campus, Waikato Hospital, Hamilton, 3240, New Zealand
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Smith MA, Hall M, Lew JB, Canfell K. Potential for HPV vaccination and primary HPV screening to reduce cervical cancer disparities: Example from New Zealand. Vaccine 2018; 36:6314-6324. [DOI: 10.1016/j.vaccine.2018.08.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 12/19/2022]
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Cost-effectiveness of a low-dose computed tomography screening programme for lung cancer in New Zealand. Lung Cancer 2018; 124:233-240. [PMID: 30268467 DOI: 10.1016/j.lungcan.2018.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The cost-effectiveness of low-dose computed tomography (LDCT) screening for lung cancer is uncertain. This study estimated the health gains, costs (net health system, and including 'unrelated') and cost-effectiveness of biennial LDCT screening among 55-74 years olds with a smoking history of at least 30 pack years, and (if a former smoker) having quit within last 15 years, in New Zealand. METHODS We used a macrosimulation stage shift model with New Zealand-specific lung cancer incidence rates and intervention parameters from the National Lung Screening Trial, a health system perspective, and a lifetime horizon for quality-adjusted life-years (QALYs) and costs discounted at 3% per annum. We also examined heterogeneity by gender, ethnicity (Māori (indigenous population) versus non-Māori), age and current versus ex-smoking status. RESULTS AND CONCLUSION We estimated 0.037 QALYs gained (95% uncertainty interval (UI) 0.024-0.053) per eligible participant, at a cost of US$3606 ($2689-4681). The overall incremental cost effectiveness ratio (ICER) was US$104,000 per QALY gained (95% UI US$59,000-US$175,000). The cost-effectiveness varied moderately by socio-demographics, with the 'best' ICER being US$52,000 for 70-74 year old Māori females and the 'worst' ICER being US$142,000 for 55-59 year old non-Māori females. The ICER varied little by current smoking status, due to higher competing mortality risk limiting QALY gains for current smokers. The two scenarios that lowered the ICER the most were increasing the screening uptake to 100% (ICER = US$50,000 per QALY), and improving the sensitivity (from 93.8%-98%) and specificity (from 73.4%-95%) of the screening test (ICER = US$42,000 per QALY). Based on a threshold of GDP per capita per QALY gained (i.e. US$30,000), LDCT screening for lung cancer is unlikely to be cost-effective in New Zealand for any sociodemographic group.
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Gall A, Leske S, Adams J, Matthews V, Anderson K, Lawler S, Garvey G. Traditional and Complementary Medicine Use Among Indigenous Cancer Patients in Australia, Canada, New Zealand, and the United States: A Systematic Review. Integr Cancer Ther 2018; 17:568-581. [PMID: 29779402 PMCID: PMC6142081 DOI: 10.1177/1534735418775821] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cancer 'patients' are increasingly using traditional indigenous and complementary medicines (T&CM) alongside conventional medical treatments to both cure and cope with their cancer diagnoses. To date T&CM use among Indigenous cancer patients from Australia, Canada, New Zealand, and the United States has not been systematically reviewed. METHODS We systematically searched bibliographic databases to identify original research published between January 2000 and October 2017 regarding T&CM use by Indigenous cancer patients in Australia, Canada, New Zealand, and the United States. Data from records meeting eligibility criteria were extracted and appraised for quality by 2 independent reviewers. RESULTS Twenty-one journal articles from 18 studies across all 4 countries met our inclusion criteria. T&CM use ranged from 19% to 57.7% (differing across countries). T&CM was mostly used concurrently with conventional cancer treatments to meet their spiritual, emotional, social, and cultural needs; however, bush, traditional, and herbal medicines were used in a minority of cases as an alternative. CONCLUSIONS Our findings highlight the importance of T&CM use to Indigenous cancer patients across these 4 countries; we identified multiple perceived spiritual, emotional and cultural benefits to its use. The patient's perception of their health professional's attitudes toward T&CM in some cases hindered or encouraged the patient's disclosure. Additional research is required to further explore the use and disclosure of T&CM among Indigenous cancer patients to help inform and ensure effective, safe, coordinated care for Indigenous cancer patients that relies on shared open decision making and communication across patients, communities, and providers.
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Affiliation(s)
- Alana Gall
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| | - Stuart Leske
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| | - Jon Adams
- 2 University of Technology Sydney, Sydney, New South Wales, Australia
| | - Veronica Matthews
- 3 University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Kate Anderson
- 1 Charles Darwin University, Brisbane, Queensland, Australia
| | | | - Gail Garvey
- 1 Charles Darwin University, Brisbane, Queensland, Australia
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Wilson N, Clement C, Boyd M, Teng A, Woodward A, Blakely T. The long history of health inequality in New Zealand: occupational class and lifespan in the late 1800s and early 1900s. Aust N Z J Public Health 2018; 42:175-179. [PMID: 29442408 DOI: 10.1111/1753-6405.12765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/01/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE As relatively little is known about how socioeconomic position might have affected health prior to the Second World War, we aimed to study lifespan by occupational class in two cohorts in New Zealand. METHODS The first study included men on the electoral rolls in Dunedin in the period 1893 to 1902. The second study used an established cohort of male military personnel who were recruited for the First World War. Linear regression was used to estimate lifespan by occupational class. RESULTS The first study of 259 men on the electoral rolls found no substantive lifespan differences between the high and low occupational class groups. But the second study of 2,406 military personnel found that men in the three highest occupational classes lived 3.5 years longer (95%CI: 0.3-6.8 years) than the three lowest classes (in the multivariable analysis adjusting for age in 1918 and rurality of occupation). CONCLUSIONS We found no significant lifespan differences in one cohort, but a second cohort is the earliest demonstration to our knowledge of substantial differences in mortality by socioeconomic position in this country prior to the 1960s. Implications for public health: This study provides historical context to the long-term efforts to address health inequalities in society.
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Affiliation(s)
- Nick Wilson
- Department of Public Health, University of Otago, New Zealand
| | | | | | - Andrea Teng
- Department of Public Health, University of Otago, New Zealand
| | | | - Tony Blakely
- Department of Public Health, University of Otago, New Zealand
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Teng A, Atkinson J, Disney G, Wilson N, Blakely T. Changing smoking-mortality association over time and across social groups: National census-mortality cohort studies from 1981 to 2011. Sci Rep 2017; 7:11465. [PMID: 28904367 PMCID: PMC5597615 DOI: 10.1038/s41598-017-11785-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/29/2017] [Indexed: 02/04/2023] Open
Abstract
The difference in mortality between current and never-smokers varies over time, affecting future projections of health gains from tobacco control. We examine this heterogeneity by sex, ethnicity and cause of death on absolute and relative scales using New Zealand census data. These data included smoking status, and were linked to subsequent mortality records in 1981-84, 1996-99 and 2006-11 for 25-74 year olds (16.1 million person-years of follow-up). Age-standardised mortality rates and rate differences (SRDs) were calculated comparing current to never-smokers, and Poisson regression was used to adjust for multiple socioeconomic factors and household smoking. We found that mortality declined over time in never-smokers; however, mortality trends in current-smokers varied by sex, ethnicity and cause of death. SRDs were stable over time in European/Other men, moderately widened in European/Other women and markedly increased in Māori men and women (Indigenous population). Poisson smoking-mortality rate ratios (RRs) increased from 1981-84 to 1996-99 with a moderate increase from 1996-99 to 2006-11 (RRs 1.48, 1.77, 1.79 in men and 1.51, 1.80, 1.90 in women). Socioeconomic confounding increased over time. In summary, this marked heterogeneity in smoking-mortality RRs over time has implications for estimating the future health and inequality impacts of tobacco control interventions.
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Affiliation(s)
- Andrea Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - June Atkinson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - George Disney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Tony Blakely
- Department of Public Health, University of Otago, Wellington, New Zealand
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Ellison-Loschmann L, Sporle A, Corbin M, Cheng S, Harawira P, Gray M, Whaanga T, Guilford P, Koea J, Pearce N. Risk of stomach cancer in Aotearoa/New Zealand: A Māori population based case-control study. PLoS One 2017; 12:e0181581. [PMID: 28732086 PMCID: PMC5521812 DOI: 10.1371/journal.pone.0181581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/03/2017] [Indexed: 12/31/2022] Open
Abstract
Māori, the indigenous people of New Zealand, experience disproportionate rates of stomach cancer, compared to non-Māori. The overall aim of the study was to better understand the reasons for the considerable excess of stomach cancer in Māori and to identify priorities for prevention. Māori stomach cancer cases from the New Zealand Cancer Registry between 1 February 2009 and 31 October 2013 and Māori controls, randomly selected from the New Zealand electoral roll were matched by 5-year age bands to cases. Logistic regression was used to estimate odd ratios (OR) and 95% confidence intervals (CI) between exposures and stomach cancer risk. Post-stratification weighting of controls was used to account for differential non-response by deprivation category. The study comprised 165 cases and 480 controls. Nearly half (47.9%) of cases were of the diffuse subtype. There were differences in the distribution of risk factors between cases and controls. Of interest were the strong relationships seen with increased stomach risk and having >2 people sharing a bedroom in childhood (OR 3.30, 95%CI 1.95–5.59), testing for H pylori (OR 12.17, 95%CI 6.15–24.08), being an ex-smoker (OR 2.26, 95%CI 1.44–3.54) and exposure to environmental tobacco smoke in adulthood (OR 3.29, 95%CI 1.94–5.59). Some results were attenuated following post-stratification weighting. This is the first national study of stomach cancer in any indigenous population and the first Māori-only population-based study of stomach cancer undertaken in New Zealand. We emphasize caution in interpreting the findings given the possibility of selection bias. Population-level strategies to reduce the incidence of stomach cancer in Māori include expanding measures to screen and treat those infected with H pylori and a continued policy focus on reducing tobacco consumption and uptake.
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Affiliation(s)
- Lis Ellison-Loschmann
- Centre for Public Health Research, Massey University, Wellington, New Zealand
- * E-mail:
| | - Andrew Sporle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Marine Corbin
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Soo Cheng
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | | | - Michelle Gray
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Tracey Whaanga
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Parry Guilford
- Centre for Translational Research, University of Otago, Dunedin, New Zealand
| | - Jonathan Koea
- Waitemata District Health Board, Auckland, New Zealand
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, England
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Disney G, Teng A, Atkinson J, Wilson N, Blakely T. Changing ethnic inequalities in mortality in New Zealand over 30 years: linked cohort studies with 68.9 million person-years of follow-up. Popul Health Metr 2017; 15:15. [PMID: 28446238 PMCID: PMC5406924 DOI: 10.1186/s12963-017-0132-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 04/12/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Internationally, ethnic inequalities in mortality within countries are increasingly recognized as a public health concern. But few countries have data to monitor such inequalities. We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous], Pacific, and European/Other) in mortality for a country with high quality ethnicity data, using both standard and novel visualization methods. METHODS Cohort studies of the entire New Zealand population were conducted, using probabilistically-linked Census and mortality data from 1981 to 2011 (68.9 million person years). Absolute (standardized rate difference) and relative (standardized rate ratio) inequalities were calculated, in 1-74-year-olds, for Māori and Pacific peoples in comparison to European/Other. RESULTS All-cause mortality rates were highest for Māori, followed by Pacific peoples then European/Other, and declined in all three ethnic groups over time. Pacific peoples experienced the slowest annual percentage fall in mortality rates, then Māori, with European/Other having the highest percentage falls - resulting in widening relative inequalities. Absolute inequalities, however, for both Māori and Pacific males compared to European/Other have been falling since 1996. But for females, only Māori absolute inequalities (compared with European/Other) have been falling. Regarding cause of death, cancer is becoming a more important contributor than cardiovascular disease (CVD) to absolute inequalities, especially for Māori females. CONCLUSIONS We found declines in all-cause mortality rates, over time, for each ethnic group of interest. Ethnic mortality inequalities are generally stable or even falling in absolute terms, but have increased on a relative scale. The drivers of these inequalities in mortality are transitioning over time, away from CVD to cancer and diabetes; such transitions are likely in other countries, and warrant further research. To address these inequalities, policymakers need to enhance prevention activities and health care delivery, but also support wider improvements in educational achievement and socioeconomic position for highest need populations.
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Affiliation(s)
- George Disney
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Andrea Teng
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - June Atkinson
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Nick Wilson
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Tony Blakely
- University of Otago, 23a Mein Street, Wellington, New Zealand
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