Ethnic Inequalities In Mortality Research Articles

Socioeconomic and Tobacco Mediation of Ethnic Inequalities in Mortality over Time: Repeated Census-mortality Cohort Studies, 1981 to 2011.

Racial/ethnic inequalities in mortality may be reducible by addressing socioeconomic factors and smoking. To our knowledge, this is the first study to estimate trends over multiple decades in (1) mediation of racial/ethnic inequalities in mortality (between Māori and Europeans in New Zealand) by socioeconomic factors, (2) additional mediation through smoking, and (3) inequalities had there never been smoking. We estimated natural (1 and 2 above) and controlled mediation effects (3 above) in census-mortality cohorts for 1981-1984 (1.1 million people), 1996-1999 (1.5 million), and 2006-2011 (1.5 million) for 25- to 74-year-olds in New Zealand, using a weighting of regression predicted outcomes. Socioeconomic factors explained 46% of male inequalities in all three cohorts and made an increasing contribution over time among females from 30.4% (95% confidence interval = 18.1%, 42.7%) in 1981-1984 to 41.9% (36.0%, 48.0%). Including smoking with socioeconomic factors only modestly altered the percentage mediated for males, but more substantially increased it for females, for example, 7.7% (5.5%, 10.0%) in 2006-2011. A counterfactual scenario of having eradicated tobacco in the past (but unchanged socioeconomic distribution) lowered mortality for all sex-by-ethnic groups and resulted in a 12.2% (2.9%, 20.8%) and 21.2% (11.6%, 31.0%) reduction in the absolute mortality gap between Māori and Europeans in 2006-2011, for males and females, respectively. Our study predicts that, in this high-income country, reducing socioeconomic disparities between ethnic groups would greatly reduce ethnic inequalities in mortality over the long run. Eradicating tobacco would notably reduce ethnic inequalities in absolute but not relative mortality.

Changing ethnic inequalities in mortality in New Zealand over 30\xa0years: linked cohort studies with 68.9 million person-years of follow-up

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.

Ethnic inequalities in mortality: the case of Arab-Americans.

BackgroundAlthough nearly 112 million residents of the United States belong to a non-white ethnic group, the literature about differences in health indicators across ethnic groups is limited almost exclusively to Hispanics. Features of the social experience of many ethnic groups including immigration, discrimination, and acculturation may plausibly influence mortality risk. We explored life expectancy and age-adjusted mortality risk of Arab-Americans (AAs), relative to non-Arab and non-Hispanic Whites in Michigan, the state with the largest per capita population of AAs in the US.Methodology/Principal FindingsData were collected about all deaths to AAs and non-Arab and non-Hispanic Whites in Michigan between 1990 and 2007, and year 2000 census data were collected for population denominators. We calculated life expectancy, age-adjusted all-cause, cause-specific, and age-specific mortality rates stratified by ethnicity and gender among AAs and non-Arab and non-Hispanic Whites. Among AAs, life expectancies among men and women were 2.0 and 1.4 years lower than among non-Arab and non-Hispanic White men and women, respectively. AA men had higher mortality than non-Arab and non-Hispanic White men due to infectious diseases, chronic diseases, and homicide. AA women had higher mortality than non-Arab and non-Hispanic White women due to chronic diseases.Conclusions/SignificanceDespite better education and higher income, AAs have higher age-adjusted mortality risk than non-Arab and non-Hispanic Whites, particularly due to chronic diseases. Features specific to AA culture may explain some of these findings.

O3-2.2 Linkage of census with mortality and cancer data in New Zealand. [part of symposium ref number 2353, "linkage of data in the study of ethnic inequalities ..."

<h3>Introduction</h3> Ethnicity is difficult to collect in a standard way between health and census datasets, meaning routinely calculated rates are prone to numerator-denominator bias. <h3>Methods</h3> Census and mortality data have been routinely linked in the New Zealand Census-Mortality Study, creating time series data from 1981. More recently, the Cancer trends study has linked cancer registrations. The proportion of eligible mortality / cancer records linked to a census record is now over 80%. Weighting is used to adjust for any linkage bias. <h3>Results</h3> Previously calculated mortality rates for Māori and Pacific people were shown to be underestimated by a quarter due to numerator-denominator bias. Corrected trends in mortality rates since 1981 demonstrate little if any improvement in Māori mortality rates during the 1980s–90s, concurrent with major reforms that impacted more on Māori than non-Māori (eg, unemployment rates among Māori reached 25% in 1992, compared with 7% among Europeans). Other analyses demonstrate that CVD is the major cause of death giving rise to ethnic inequalities in mortality, but as CVD rates fall for all ethnic groups inequalities in mortality are “relocating” to cancer. Inequalities in cancer incidence are less prominent than inequalities in cancer mortality, but nevertheless there are curious findings, such as: higher (and faster rising) breast cancer incidence among Māori, despite a more favourable risk factor profile; and particularly high endometrial and thyroid cancer incidence among Pacific women. There has also been a tremendous reduction in cervical cancer inequalities. <h3>Conclusion</h3> This linkage has allowed accurate research on trends that was hitherto impossible.

Determinants of inequalities in cervical cancer stage at diagnosis and survival in New Zealand

The aim of this study is to assess whether ethnic inequalities in cervical cancer mortality are due to differences in survival independent of stage and age at diagnosis, and to assess the contribution of screening to stage at diagnosis. Demographic data and cervical screening history were collected for 402 women with histologically proven primary invasive cervical cancer, diagnosed in New Zealand between 1 January 2000 and 30 September 2002. Date of death was available for women who died up to 30 September 2004. A Cox proportional hazard model showed that, after adjusting for age, the Māori mortality rate was 1.80 times (95% CI 1.07-3.04) that of non-Māori. This reduced to 1.25 (95% CI 0.74-2.11) when stage at diagnosis was also adjusted for. Among determinants of late stage at diagnosis, older age and being Māori significantly increased the risk, while screening was protective. These results indicate that later stage at diagnosis is the main determinant of Māori women's higher mortality from cervical cancer. Improving cervical screening among Māori women would reduce stage at diagnosis and therefore ethnic inequalities in mortality.

Ethnic inequalities in mortality among the elderly in New Zealand

To explore the contributions of socio-economic and demographic factors to ethnic disparity among older adult (65+) all cause and cause-specific mortality differentials among Māori, Pacific, Asians and non-Māori, non-Pacific non-Asian (nMnPnA) in New Zealand. We used univariate and multivariable Poisson regression models on linked New Zealand census and mortality data for older adults (65 years and above) (2001 to 2004, 1.3 million person years) with a comprehensive set of socio-economic indicators (education, income, car access, housing tenure, neighourhood deprivation). After controlling for the differences in age structure, Māori and Pacific males had a higher relative risk of dying than nMnPnA (RR=1.88 (95% Cl: 1.74, 2.04) and RR=1.75 (95% Cl: 1.54, 1.99) respectively) while Asian males had lower risk of dying (RR=0.66, 95% Cl: 0.57, 0.76). For females, the pattern was similar. The mortality gap between ethnic groups was mediated in part by socio-economic factors. The five socio-economic factors appear to account for greater than 40% of the excess mortality for Māori and Pacific men and about 34% for Māori females and 48% for Pacific females compared to nMnPnA men and nMnPnA women respectively. However, for Asian people, adjusting for socio-economic factors actually increases the relative gaps in mortality compared to nMnPnA by 18% for male and 71% for females. The results demonstrate that clear ethnic mortality gradients persist into old age and the mortality level of most groups was influenced by varying distribution of socio-economic factors. To reduce ethnic differences in old age mortality, inequalities as a result of socio-economic position should be reduced.

What is the contribution of smoking and socioeconomic position to ethnic inequalities in mortality in New Zealand?

Mortality rates for Māori are twice those for non-Māori in New Zealand. We have assessed the contribution of tobacco smoking and socioeconomic position to these inequalities in 45-74-year-old census respondents during 1981-84 and 1996-99 (2.3 and 2.7 million person-years, respectively). We used linked census and mortality cohort datasets with measures of socioeconomic position (household income, highest educational qualification, car access, labour-force status, and neighbourhood deprivation) and smoking (never, ex, current). We used direct standardisation to adjust for smoking and Poisson regression to adjust for socioeconomic position. The apparent contribution of smoking to mortality differences between Māori and non-Māori non-Pacific people was greatest for women in 1996-99 (8% reduction in standardised rate difference); it had increased from 3% in 1981-84. The corresponding reductions in men were 5% in 1996-99 and -1% in 1981-84. The apparent contribution of socioeconomic factors to mortality differences between Māori and non-Māori non-Pacific was greatest for men (39% in 1981-84 and 37% in 1996-99) and increased over time for women (from 23% in 1981-84 to 32% in 1996-99). Although small, the contribution of smoking to ethnic inequalities in mortality increased over time and might grow more during the next two decades if differences in smoking between ethnic groups continue to increase. Better measurement of socioeconomic position (eg, lifecourse measures, asset wealth) might increase the proportion of ethnic inequalities attributable to socioeconomic position, perhaps to about half. Action to redress socioeconomic gaps and control of tobacco use will both be important in reducing ethnic inequalities in health.

Ethnic inequalities in age- and cause-specific mortality in The Netherlands.

By describing ethnic differences in age- and cause-specific mortality in The Netherlands we aim to identify factors that determine whether ethnic minority groups have higher or lower mortality than the native population of the host country. We used data for 1995-2000 from the municipal population registers and cause of death registry. All inhabitants of The Netherlands were included in the study. The mortality of people who themselves or whose parent(s) were born in Turkey, Morocco, Surinam, or the Dutch Antilles/Aruba was compared with that of the native Dutch population. Mortality differences were estimated by Poisson regression analyses and by directly standardized mortality rates. Compared with native Dutch men, mortality was higher among Turkish (relative risk [RR] = 1.21, 95% CI: 1.16, 1.26), Surinamese (RR = 1.24, 95% CI: 1.19, 1.29), and Antillean/Aruban (RR = 1.25, 95% CI: 1.15, 1.36) males, and lower among Moroccan males (RR = 0.85, 95% CI: 0.81, 0.90). Among females, inequalities in mortality were small. In general, mortality differences were influenced by socio-economic and marital status. Most minority groups had a high mortality at young ages and low mortality at older ages, a high mortality from ill-defined conditions (which is related to mortality abroad) and external causes, and a low mortality from neoplasms. Cardiovascular disease mortality was low among Moroccan males (RR = 0.51, 95% CI: 0.44, 0.59) and high among Surinamese males (RR = 1.13, 95% CI: 1.05, 1.21) and females (RR = 1.14, 95% CI: 1.06, 1.23). Homicide mortality was elevated in all groups. Socio-economic factors and marital status were important determinants of ethnic inequalities in mortality in The Netherlands. Mortality from cardiovascular diseases, homicide, and mortality abroad were of particular importance for shifting the balance from high towards low all-cause mortality.