Abstract
As with many Indigenous populations internationally, Māori in New Zealand suffer health inequity. We aimed to assess the rate of fall injuries at home with and without home modifications in houses with Māori occupants. We did a single-blind randomised controlled trial in the Wellington and Taranaki regions of New Zealand and enrolled owner-occupied households with at least one Māori occupant. Only households who stated they intended to live at that address for the subsequent 3 years were eligible for participation. We randomly assigned (1:1) households to either the intervention group, who received home modifications (handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, repairs to window catches, high-visibility and slip-resistant edging for outside steps, fixing of lifted edges of carpets and mats, non-slip bath mats, and slip-resistant surfacing for outside areas such as decks) immediately, or the control group, who received the modifications 3 years later. Data on home injuries were obtained from the Accident Compensation Corporation and coded by study team members, who were masked to study group allocation. The primary outcome was the rate of medically treated fall injuries at home per household per year, analysed according to intention to treat. This Māori Home Injury Prevention Intervention (MHIPI) trial is now completed, and is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000148774. Between Sept 3, 2013, and Oct 1, 2014, 824 households were assessed for eligibility and 254 were enrolled, of which 126 (50%) were assigned to the intervention group and 128 (50%) were assigned to the control group. After adjustment for previous falls and geographical region, there was an estimated 31% reduction in the rate of fall injuries at home per year exposed to the intervention compared with households in the control group (adjusted relative rate 0·69 [95% CI 0·47-1·00]). Low-cost home modifications and repairs can be an effective means to reduce injury disparities. The high prevalence of modifiable safety issues in Māori homes merits considerable policy and community effort. Health Research Council of New Zealand.
Highlights
Fall injuries globally were responsible for 1·4% of disability-adjusted life-years (DALYs) due to disease and injury in 2017
Added value of this study Our study shows the potential for home modification to address inequities in injury rates for Māori, New Zealand’s Indigenous population, who are more likely than non-Māori to live in rented accommodation and in older homes
Past year refers to the 365 days before the intervention date; the intervention date was the date the modifications were made for the intervention group, and the median date interventions were made in intervention group households in that region for the control group
Summary
Fall injuries globally were responsible for 1·4% of disability-adjusted life-years (DALYs) due to disease and injury in 2017. In terms of age-standardised DALYs in 2017, falls as a cause of health loss were ranked as the 18th most common cause globally, higher than chronic kidney disease, Alzheimer’s disease and other dementias, and asthma.[1] Compared with other injury types, falls were ranked third, following road injury and self-harm.[2] High-income countries, which commonly have growing proportions of older people (age >65 years), can expect corresponding increases in fall injuries, which already place considerable burden on hospitals and society generally.[3]. Over the period 2014–18, there were more than 24 000 hospital discharges per year for unintentional fall injuries[5] and for the period 2011–18, there were an average of 658 000 falls per year requiring some form of medical treatment, more than half of which occurred at home (if the setting was defined).[6]
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