Abstract
BackgroundInternationally, 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.MethodsCohort 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.ResultsAll-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.ConclusionsWe 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.
Highlights
Ethnic inequalities in mortality within countries are increasingly recognized as a public health concern
We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous] and Pacific compared to the benchmark, European/Other) in mortality for a country with high-quality ethnicity data, using both standard methods and novel visualization methods
Pacific males showed an overall similar pattern to Māori in all-cause rates – a period of no significant reduction in mortality followed by a downward trend, in this case the final three followup periods (Fig. 1)
Summary
Ethnic inequalities in mortality within countries are increasingly recognized as a public health concern. 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. Ethnic and indigenous inequalities in mortality within countries are increasingly recognized as a public health concern [1,2,3,4]. We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous] and Pacific compared to the benchmark, European/Other) in mortality for a country with high-quality ethnicity data, using both standard methods and novel visualization methods. Ethnic inequalities in mortality in New Zealand are well-documented [6]. Understanding what causes these inequalities in the past, and how they are changing over time, with qualitative (at least) projections into the future, highlight where future mortality reduction gains could be made by ethnic group and inequalities reduced [3]
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