Abstract
Abstract Background Type 2 Diabetes (T2DM) affects different populations disproportionately including in New Zealand (NZ), where long-term temporal trends in cause-specific clinical outcomes between Māori, European and Pacific people remain unclear. Methods Data from patients with T2DM, aged 35-84 years enrolled 1994-2018 in a NZ primary care audit programme (the Diabetes Care Support Service) were linked with national death registration, hospitalisation, pharmaceutical claims and primary care databases. Cause-specific death and hospitalisation rates were adjusted for gender, age, smoking, obesity, social-economic status and time periods by age-period-cohort models. Results Overall, 79,912 (50.6% female, mean-age 56±15 years, median follow-up 9.7 years) patients with T2DM were enrolled. For Europeans vs Māori, adjusted incidence rates ratio (IRR) and absolute risk difference /1000 person-years were 1.96 (95% CI: 1.80- 2.14) and 22.85 (19.93-25.77) for all-cause mortality, 1.93 (1.63-2.29) and 6.97 (5.14-8.80) for cardiovascular (CVD) mortality, 1.64 (1.40-1.93) and 3.08 (2.25-3.92) for cancer mortality, 1.26 (1.25-1.28) and 42.70 (41.32-44.08) for CVD hospitalisation, 1.31 (1.28-1.34) and 44.76 (42.37-47.15) for cancer hospitalisation, 2.05 (1.96-2.14) and 31.44 (29.67-33.21) for end-stage renal disease (ESRD) hospitalisation. Pacific rates were significantly less than Māori, but higher than Europeans for ESRD (IRR:1.59 (1.52-1.67)) and CVD (1.09 (1.07-1.10)) hospitalisation. Conclusions Poorer health outcomes have persisted among Māori and Pacific people with T2DM for >20 years. New policies supporting more intensive management of T2DM are urgently needed. Differences in outcomes between Māori and Pacific people warrant further research. Key messages Outcome disparities have persisted among Māori and Pacific people with T2DM for >20 years.
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