New Zealand Deprivation Research Articles

DOES SOCIOECONOMIC DEPRIVATION INFLUENCE PATIENT OUTCOMES AFTER PERIACETABULAR OSTEOTOMY?

Higher levels of socioeconomic deprivation have been associated with worse health outcomes. The influence of socioeconomic deprivation on patients undergoing periacetabular osteotomy (PAO) has not previously been investigated.A total of 217 patients (171 female, 46 male; median age 23.4 years) who underwent PAO by a single surgeon were identified. Patients were categorised into three groups according to their New Zealand Deprivation (NZDep) Index: minimal deprivation (NZDep Index 1–3, n=89), moderate deprivation (NZDep Index 4-6, n=94), and maximal deprivation (NZDep Index 7-10, n=34). The three groups were compared with respect to baseline variables, surgical details, complications, and pre-operative and two-year post-operative functional scores (including International Hip Outcome Tool (iHOT-12), EQ-5D quality of life score, and University of California Los Angeles (UCLA) activity score). Multivariate regression was undertaken to assess for the effect of NZDep Index on patient outcomes.Patients in the maximal deprivation group were more likely to be Māori (p<0.001) and have surgery in a public rather than a private hospital (p=0.004), while the minimal deprivation group demonstrated a lower BMI (p=0.005). There were otherwise no other significant differences in baseline variables, surgical details, complications, nor pre-operative or two-year post-operative functional scores between the three groups (all p>0.05). Multivariate analysis identified a higher NZDep Index to be independently predictive of a lower pre-operative UCLA activity score (p=0.014) and a higher two-year iHOT-12 score (p<0.001).Our results demonstrate an inequality in access to PAO, with patients exposed to higher levels of socioeconomic deprivation under-represented in our study population. When provided access to PAO, these vulnerable patients achieve significant functional improvement at least as great as patients with less socioeconomic deprivation. Initiatives to improve access to hip preservation care in socioeconomically deprived populations appear warranted.

Health-Related Quality of Life across a Variety of Community Contexts

There is increasing interest in the socioeconomic determinants of health and well-being. Efforts to date have focused on the associations between measures of social position and objective measures of health. However, health can also be gauged using subjective measures such as health-related quality of life (HRQOL), while other social determinants, such as neighbourhood factors, appear largely neglected. The aim of this study was to estimate the relationship between HRQOL (as measured by the WHOQoL questionnaire) and both social position (as measured by the New Zealand Deprivation (NZDep) index) and participants’ perceptions about their home neighbourhood. A total of 746 participants living in areas with six different NZDep scores completed a survey probing HRQOL, problems in the neighbourhood, and perceptions of amenity. Results showed that people living in wealthier areas reported better HRQOL, and that amenity ratings mediated the relationship. The study’s findings have implications for researchers interested in the social determinants of health and the operationalisation of these social indicators and health in that health outcomes depended on perceived amenity rather than absolute wealth.

Potentially inappropriate medicine prescribing by nurse practitioners in New Zealand.

Nurse practitioners (NPs) in New Zealand (NZ) prescribe a broad range of medicines; little is known about their prescribing practice for older adults. Potentially inappropriate medicines (PIMs) can cause more harm than benefit. This study reports on the prescribing of PIMs to older adults (≥65 years) by NPs in NZ. A subset analysis using data from NZ Ministry of Health pharmaceutical collection from 2013 to 2015 was completed. Data included NP registration number, medicines dispensed, patient age, sex, and NZ Deprivation level. Those <65 years were excluded. Beers 2015 criteria were used to identify the PIMs. There were 106 NPs that prescribed medicines to 12,410 patients aged ≥65 years. One third of the patients were prescribed ≥1 PIMss. Most (68.4%) were prescribed one PIM; 21.9% two PIMs; 7.1% three PIMs; and 2.6% were prescribed ≥4 PIMs. NPs prescribed an average of 14.9% PIMs. Primary care NPs were more likely to prescribe PIMs, compared to those with a scope of older adults and long-term conditions (p ≤ 0.001). The most common Beers 2015 PIMs prescribed were proton pump inhibitors, non-steroidal anti-inflammatory drugs, alpha blockers, hypnotics, tricyclic antidepressants, and benzodiazepines. NPs prescribe lower rates of PIMs to older adults than other prescribers in NZ. However, prescribing practices can be improved and the findings indicate that a more specific educational focus on prescribing to older adults is required. The findings provide an important baseline internationally for NP PIM prescribing and can be used by NPs, and educationally to review and improve practices.

Who can afford a Mirena® for contraception?

INTRODUCTION The Mirena®, a levonorgestrel-releasing intrauterine system (LNG-IUS), is an effective form of contraception that lasts for 5 years. In New Zealand, it is not subsidised for contraception and the device costs NZ$340 at Family Planning clinics. AIM To determine if there is a difference in the socioeconomic status and ethnicity of women who chose an LNG-IUS for contraception compared with women opting for a subsidised long-acting contraceptive (copper intrauterine device (IUD) or Jadelle® implant) or who qualified for a Special Authority Mirena® (funded by Pharmac, as treatment for heavy menstrual bleeding). METHODS All the Mirena®, Jaydess®, IUD and Jadelle® insertions that occurred at Family Planning clinics in 2015 in the Wellington region were identified. The deprivation quintile of current address and ethnicity were determined. RESULTS In the study period, 1410 devices were inserted. Of the self-funded LNG-IUSs inserted, 5% were for women with quintile 5 addresses (areas with the most deprived New Zealand Deprivation (NZDep) scores) and 28% for quintile 1 areas (least deprived NZDep scores). Of the Special Authority Mirenas® inserted, 24% were for women residing in quintile 5 areas and 19%, quintile 1 areas. Self-funded LNG-IUS were chosen by 2.5% of Māori women choosing contraception at study Family Planning clinics and no Pacific Peoples, whereas 21% of New Zealand European women chose LNG-IUS. Special Authority Mirenas® were chosen by 9.5% Māori and 9.6% Pacific Peoples compared to 4% New Zealand Europeans. DISCUSSION Māori, Pacific Peoples and women residing in quintile 5 areas chose self-funded LNG-IUSs less often than Special Authority Mirenas®. This was not the case for the other groups, who showed higher use of self-funded LNG-IUSs than Special Authority Mirenas®.

Modelled seasonal influenza mortality shows marked differences in risk by age, sex, ethnicity and socioeconomic position in New Zealand

Influenza is responsible for a large number of deaths which can only be estimated using modelling methods. Such methods have rarely been applied to describe the major socio-demographic characteristics of this disease burden. We used quasi Poisson regression models with weekly counts of deaths and isolates of influenza A, B and respiratory syncytial virus for the period 1994 to 2008. The estimated average mortality rate was 13.5 per 100,000 people which was 1.8% of all deaths in New Zealand. Influenza mortality differed markedly by age, sex, ethnicity and socioeconomic position. Relatively vulnerable groups were males aged 65-79 years (Rate ratio (RR)=1.9, 95% CI: 1.9, 1.9 compared with females), Māori (RR=3.6, 95% CI: 3.6, 3.7 compared with European/Others aged 65-79 years), Pacific (RR=2.4, 95% CI: 2.4, 2.4 compared with European/Others aged 65-79 years) and those living in the most deprived areas (RR=1.8, 95% CI: 1.3, 2.4) for New Zealand Deprivation (NZDep) 9&10 (the most deprived) compared with NZDep 1&2 (the least deprived). These results support targeting influenza vaccination and other interventions to the most vulnerable groups, in particular Māori and Pacific people and men aged 65-79 years and those living in the most deprived areas.

Do New Zealand children with non-cystic fibrosis bronchiectasis show disease progression?

There is minimal literature available on the long-term outcome of pediatric non-cystic fibrosis (CF) bronchiectasis. To document 5-year outcomes of children with chest computerized tomography (CT) scan diagnosed bronchiectasis from a tertiary New Zealand (NZ) respiratory clinic. Review of a clinical database identified 91 children. Demographics, clinical data, lung function, chest X-ray (CXR), sputum, presumed etiology, admission data, and the NZ deprivation index (NZDep) were collected. Univariate and multivariate regression were used to correlate clinical findings with lung function data and CXR scores using the Brasfield Scoring System. Of the 91 children, 53 (59%) were Pacific Island, 22 (24%) Maori, 14 (15%) European, and 2 (2%) Other. The median follow-up period was 6.7 years (range 5.0-15.3 years) and median age at diagnosis was 7.3 years (range 11 months-16 years). Lung function data (n = 64) showed a mean decline of -1.6% predicted/year. In 30 children lung function declined (mean FEV(1) -4.4% predicted/year, range 1-17%), remained stable in 13 and improved in 21 children (mean FEV(1) of +3% predicted/year, range 1-15%). Reduced lung function was associated with male gender, chronic Haemophilus influenzae infection, longevity of disease, and Maori and Pacific Island ethnicity. There was a significant correlation with FEV(1) and CXR score at beginning (n = 47, r = 0.45, P = 0.001) and end (n = 26, r = 0.59, P = 0.002) of the follow-up period. The only variable consistently related to CXR score was chronic Haemophilus influenzae infection occurring in 27 (30%) (r(2) = 0.52, P = <0.0001). Only four children were chronically infected with Pseudomonas species. Six children died. In our experience despite management in a tertiary multidisciplinary bronchiectasis clinic, progression of lung disease continues in a group of children and young adults.