New Zealand Population Research Articles

Understanding protective plasma levels of penicillin and monitoring antibody responses for the prevention of GAS infection in a paediatric population in New Zealand

Abstract Acute Rheumatic Fever (ARF) is an autoimmune condition resulting from untreated Group A Streptococcal (GAS) infection of the upper respiratory tract and possibly skin. Repeated untreated and severe episodes of ARF can cause permanent cardiac damage known as Rheumatic Heart Disease (RHD). Rates of ARF in New Zealand and Australia are among the highest in the world, particularly amongst Māori and Pacific and Indigenous Aboriginal children. Monthly injections of Benzathine Penicillin G (BPG) are given intramuscularly to prevent GAS infections that can lead to ARF and cause RHD. Early studies exploring the Pharmacokinetics (PK) properties of BPG were conducted in healthy, fit, young military recruits without ARF/RHD. BPG bioavailability, metabolism may differ in paediatric populations groups with ARF who have comorbidities and vary in Body Mass Index. This project seeks to determine the PK characteristics in a paediatric population currently receiving monthly injections of BPG while at the same time monitoring antibody immune responses to possible GAS infections. This is a prospective cohort study in a paediatric population of Wellington based children and teens (aged 5–21 years of predominantly Pasifika and Māori heritage) with a previous diagnosis of ARF and are receiving monthly BPG injections via community services. Participants will contribute finger prick blood samples over time for Dried Blood Spot assays designed to quantify penicillin G levels in the blood and measure streptococcal serology. Routine throat swab samples will also be collected with ASOT antibody levels monitored for GAS breakthrough infections. This is the first population PK study exploring use of BPG in Māori and Pacific children previously diagnosed with ARF.

Identification, risk assessment, and management of patients with atrial fibrillation in a large primary care cohort

BackgroundAtrial fibrillation (AF) is associated with increased risk of cardiovascular disease (CVD) complications including stroke. We investigated the assessment and management of cardiovascular risk among patients with AF aged 35–74years, by ethnic group, in a large cohort of people receiving a CVD risk assessment in primary care (PREDICT). MethodsPREDICT was linked to national dispensing, hospitalisation and mortality records. AF was present if recorded in PREDICT or during a prior hospitalisation; medications were those dispensed ≤6months before or after a PREDICT assessment; the CHA2DS2-VASc score and a New Zealand (NZ) adjusted Framingham CVD risk were calculated. Data were linked to outcomes of stroke or major adverse cardiovascular event (MACE). Results12,739 (2.8%) of 447,020 people aged 35–74years had AF. Māori, the indigenous population of NZ, had the highest proportion of AF, which by age group, was similar to that among Europeans 10years older. 77% were at high stroke risk, of whom 42% received anticoagulation; 54% were at high CVD risk, of whom 67% received both lipid- and blood pressure-lowering medication. Per category of predicted risk, stroke risk was overestimated and risk of MACE was underestimated. ConclusionsThe burden of AF and risk factors differed by ethnic group thus recommendations to screen for AF above a universal age threshold may introduce inequity in the detection and management of associated risk. The high burden of comorbidities at younger ages among many ethnic groups contributes to the poor performance of available risk assessment tools, further compounding potential inequity.

Development and validation of a new population-based simulation model of osteoarthritis in New Zealand

To describe the construction and preliminary validation of a new population-based microsimulation model developed to analyse the health and economic burden and cost-effectiveness of treatments for knee osteoarthritis (OA) in New Zealand (NZ). We developed the New Zealand Management of Osteoarthritis (NZ-MOA) model, a discrete-time state-transition microsimulation model of the natural history of radiographic knee OA. In this article, we report on the model structure, derivation of input data, validation of baseline model parameters against external data sources, and validation of model outputs by comparison of the predicted population health loss with previous estimates. The NZ-MOA model simulates both the structural progression of radiographic knee OA and the stochastic development of multiple disease symptoms. Input parameters were sourced from NZ population-based data where possible, and from international sources where NZ-specific data were not available. The predicted distributions of structural OA severity and health utility detriments associated with OA were externally validated against other sources of evidence, and uncertainty resulting from key input parameters was quantified. The resulting lifetime and current population health-loss burden was consistent with estimates of previous studies. The new NZ-MOA model provides reliable estimates of the health loss associated with knee OA in the NZ population. The model structure is suitable for analysis of the effects of a range of potential treatments, and will be used in future work to evaluate the cost-effectiveness of recommended interventions within the NZ healthcare system.

Climate change, internal migration, and the future spatial distribution of population: a case study of New Zealand

This paper evaluates the impact of climate change on the spatial distribution of population in New Zealand, focusing on the effects of climate on internal migration dynamics. Specifically, a gravity modelling framework is first used to identify climate variables that have statistically significant associations with internal migration. The gravity model is then embedded within a population projection model to evaluate the effect of climate scenarios on regional populations. Of the climate variables, only surface radiation in the origin exhibits a significant association with internal migration. Including this variable in the population projection model makes a small difference to the regional population distribution, and the difference between different climate scenarios is negligible. Overall, the results suggest that, while statistically significant, climate change in the form of changes in the distribution of the weather will have a negligible effect on the population distribution of New Zealand at the regional level. These null results probably reflect the high capacity for adaptation to climate change available to a developed country.

Are we using the appropriate reference samples to develop juvenile age estimation methods based on bone size? An exploration of growth differences between average children and those who become victims of homicide

The population on which forensic juvenile skeletal age estimation methods are applied has not been critically considered. Previous research suggests that child victims of homicide tend to be from socioeconomically disadvantaged contexts, and that these contexts impair linear growth. This study investigates whether juvenile skeletal remains examined by forensic anthropologists are short for age compared to their normal healthy peers. Cadaver lengths were obtained from records of autopsies of 1256 individuals, aged birth to eighteen years at death, conducted between 2000 and 2015 in Australia, New Zealand, and the U.S. Growth status of the forensic population, represented by homicide victims, and general population, represented by accident victims, were compared using height for age Z-scores and independent sample t-tests. Cadaver lengths of the accident victims were compared to growth references using one sample t-tests to evaluate whether accident victims reflect the general population. Homicide victims are shorter for age than accident victims in samples from the U.S., but not in Australia and New Zealand. Accident victims are more representative of the general population in Australia and New Zealand. Different results in Australia and New Zealand as opposed to the U.S. may be linked to socioeconomic inequality. These results suggest that physical anthropologists should critically select reference samples when devising forensic juvenile skeletal age estimation methods. Children examined in forensic investigations may be short for age, and thus methods developed on normal healthy children may yield inaccurate results. A healthy reference population may not necessarily constitute an appropriate growth comparison for the forensic anthropology population.

Risk of lower limb amputation in a national prevalent cohort of patients with diabetes.

Lower limb amputation is a serious complication of diabetes mellitus. Understanding how amputation risk differs by population subgroups is crucial in terms of directing preventive strategies. In this study, we describe those factors that impact amputation risk in the entire prevalent diabetic population of New Zealand. A national prevalent cohort of 217,207 individuals with diabetes in 2010 were followed up until the end of 2013 for lower limb amputations, and 2014 for mortality. Inpatient hospitalisation data were used to define lower limb amputation using ICD-10 codes. Cox proportional hazards models were used to describe relative hazard of amputation over the follow-up period. A total of 784 individuals (3.6 cases/1000 individuals) underwent a major (above-ankle) lower limb amputation during follow-up, while 1217 (5.6/1000) underwent a minor (below ankle) amputation. The risk of major and minor amputation was 39% and 77% greater for men than women, respectively (adjusted HR: major amputation 1.39, 95% CI 1.20, 1.61; minor amputation 1.77, 95% CI 1.56, 2.00). Indigenous Māori were at 65% greater risk of above-knee amputation compared with the European/Other diabetic population (HR 1.65, 95% CI 1.37, 1.97). Amputation risk increased with increasing comorbidity burden, and peripheral vascular disease conferred the greatest independent risk of all comorbid conditions. Prior minor amputation increased the risk of subsequent major amputation by tenfold (HR 10.04, 95% CI 7.83, 12.87), and increased the risk of another minor amputation by 20-fold (HR 21.39, 95% CI 17.89, 25.57). Death was common among the total cohort, but particularly among those who underwent amputation, with more than half of those who underwent a major amputation dying within 3years of their procedure (57%). Using a large, well-defined, national prevalent cohort of people with diabetes, we found that being male, indigenous Māori, living in deprivation, having a high comorbidity burden and/or having a previous amputation were strongly associated with subsequent risk of lower limb amputation. The use of this prevalent cohort strengthens the value of our estimates in terms of applicability to the general population, and highlights the subgroups at greatest risk of lower limb amputation.

Barriers to and facilitators and perceptions of nut consumption among the general population in New Zealand.

Despite considerable evidence supporting the health benefits of regular nut consumption, nut intakes remain lower than recommended among many populations. Understanding how the general population perceives nuts could inform strategies to promote regular nut consumption and increase intakes among the general public. Cross-sectional study. Participants were invited to complete a questionnaire which included information on nut consumption and knowledge and perceptions of nuts. The study was set in New Zealand (NZ). Participants (n 1600), aged 18 years or over, were randomly selected from the NZ electoral roll. A total of 710 participants completed the questionnaire (response rate 44 %). More than half of the respondents believed that nuts are healthy, filling, high in protein and high in fat. The most common reason cited by consumers for eating nuts was taste (86 % for nuts, 85 % for nut butters), while dental issues was the most frequent reason for avoidance. About 40 % of respondents were not aware of the effects of nut consumption on lowering blood cholesterol and CVD risk. Despite overall basic knowledge of the nutritional value of nuts, a substantial proportion of the general population was unaware of the cardioprotective effects of nuts. The present study identified common motivations for eating and avoiding nuts, as well as perceptions of nuts which could affect intake. These should guide the content and direction of public health messages to increase regular nut consumption. The public's knowledge gaps should also be addressed.

PP-33 Codeine and tramadol use in a paediatric population in new zealand

Background There are concerns regarding codeine in the Methods All NZ community dispensing data for codeine phosphate, tramadol and morphine were extracted from national administrative databases (National Pharmaceu-tical Collection and National Minimum Dataset) for the period 01 January 2010 to 31 December 2015. The data were summarised for each calendar year by age group: Results In the Conclusion These data suggest that prescribers have adopted recommendations with regard to codeine but there may be substitution of codeine with tramadol.

Māori men, relationships, and everyday practices: towards broadening domestic violence research

Relationships are central to the health and wellbeing of Māori (indigenous people of New Zealand). Through processes of colonisation, cultural ways of relatedness embedded within Māori social struc...

Deaths from Opioid Overdosing: Implications of Coroners' Inquest Reports 2008-2012 and Annual Rise in Opioid Prescription Rates: A Population-Based Cohort Study.

IntroductionIn the late 1990s multiple physicians and advocacy organizations promoted increased use of opioids for the treatment of acute, chronic and cancer pain. There has been an exponential growth in opioid prescribing in the last 20 years in the United States of America, in Australia, and in other developed Western countries. There are negative consequences associated with the liberal use of opioids. The primary aim of this population-based cohort study is to investigate the opioid-related death rate in New Zealand between 1 January 2008 and 31 December 2012. The secondary aims of this cohort study are: (1) to compare the opioid-related death rate per population in New Zealand in 2001/2002 with that between 2011/2012; (2) to investigate the number of opioid prescriptions in New Zealand between 2001 and 2012; (3) to compare the opioid-related death rate per population in New Zealand between 2001 and 2012 with the number of opioid prescriptions in New Zealand between 2001 and 2012.MethodsPermission to access records from the Coronial Services Office in Wellington for 2008–2012 was acquired. Permission to access records for prescriptions containing opioids (dose and formulation) was obtained from the Pharmaceutical Collection.ResultsThe rate of opioid-related deaths in New Zealand has increased by 33% from 2001 to 2012. More than half of the opioid-related deaths between 2008 and 2012 were unintentional opioid overdoses. Opioid analgesic deaths were most likely due to methadone, morphine and codeine prescribed by healthcare professionals. That 179 of these opioid-related deaths between 2008 and 2012 were unintentional opioid overdoses, and thus could have been avoided, is tragic. This study shows that there was a steady annual increases in opioid prescriptions in New Zealand from 2001 to 2012. This rise in opioid analgesic deaths was associated with the increases in the numbers of opioid prescriptions.ConclusionA multifaceted national public health approach is needed to bring together the various stakeholders involved with pain management, opioid dependence, opioid availability and opioid diversion. There needs to be a targeted approach to educate current and future medical practitioners regarding the appropriate use of opioid prescriptions for the management of pain, as well as a strengthening of primary, secondary and tertiary resources to support medical practitioners managing their patients who suffer with pain.

Colorectal Cancer Screening: How Health Gains and Cost-Effectiveness Vary by Ethnic Group, the Impact on Health Inequalities, and the Optimal Age Range to Screen

Background: Screening programs consistently underserve indigenous populations despite a higher overall burden of cancer. In this study, we explore the likely health gains and cost-effectiveness of a national colorectal cancer screening program for the indigenous Māori population of New Zealand (NZ).Methods: A Markov model estimated: health benefits (quality-adjusted life-year; QALY), costs, and cost-effectiveness of biennial immunochemical fecal occult blood testing (FOBTi) of 50- to 74-year-olds from 2011. Input parameters came from literature reviews, the NZ Bowel Screening Programme Pilot, and NZ linked health datasets. Equity analyses substituted non-Māori values for Māori values of background (noncolorectal cancer) morbidity and mortality, colorectal cancer survival and incidence, screening coverage, and stage-specific survival. We measured the change in "quality-adjusted life expectancy" (QALE) as a result of the intervention.Results: Based upon a threshold of GDP per capita (NZ$45,000), colorectal cancer screening in NZ using FOBTi is cost-effective: NZ$2,930 (US$1,970) per QALY gained [95% uncertainty interval: cost saving to $6,850 (US$4,610)]. Modeled health gains per capita for Māori were less than for non-Māori: half for 50- to 54-year-olds (0.031 QALYs per person for Māori vs. 0.058 for non-Māori), and a fifth (0.003 c.f. 0.016) for 70- to 74-year-olds and ethnic inequalities in QALE increased with colorectal cancer screening.Conclusions: Colorectal cancer screening in NZ using FOBTi is likely to be cost-effective but risks increasing inequalities in health for Māori.Impact: To avoid or mitigate the generation of further health inequalities, attention should be given to underserved population groups when planning and implementing screening programs. Cancer Epidemiol Biomarkers Prev; 26(9); 1391-400. ©2017 AACR.

Frequency of a FAS ligand gene variant associated with inherited feline autoimmune lymphoproliferative syndrome in British shorthair cats in New Zealand

AIMSTo determine the frequency of the FAS-ligand gene (FASLG) variant associated with feline autoimmune lymphoproliferative syndrome (FALPS) and the proportion of carriers of the variant in three British shorthair (BSH) breeding catteries in New Zealand.METHODSBuccal swabs were collected from all cats in two BSH breeding catteries from the South Island and one from the North Island of New Zealand. DNA was extracted and was tested for the presence of the FASLG variant using PCR. Cats with the FASLG variant were identified and the frequency of the FASLG variant allele calculated. Pedigree analysis was performed and inbreeding coefficients were calculated for cats with the FASLG variant.RESULTSOf 32 BSH cats successfully tested for the presence of the FASLG variant, one kitten (3%) was homozygous (FALPS-affected), and seven (22%) cats were heterozygous (carriers) for the FASLG variant allele, and 24 (75%) cats were homozygous for the wild type allele. The overall frequency of the FASLG variant allele in these 32 cats was 0.14. Cats carrying the FASLG variant were from all three breeding catteries sampled, including two catteries that had not previously reported cases of FALPS. Pedigree analysis revealed common ancestry of FALPS-affected and carrier cats within six generations, as well as frequent inbreeding, with inbreeding coefficients >0.12 for five cats with the FASLG variant.CONCLUSIONS AND CLINICAL RELEVANCEThere was a high frequency of the FASLG variant allele (0.14) in this small sample of BSH cats, with 22% of healthy cats identified as carriers of the FASLG variant. For an inherited disease, lethal at a young age, in a small population in which inbreeding is common, these results are significant. To prevent future cases of disease and stop further spread of the FASLG variant allele within the BSH population in New Zealand, it is recommended that all BSH and BSH-cross cats be tested for the presence of the FASLG variant before mating. Cats identified as carriers of the variant allele should be desexed and not used for breeding. Results support the need for further investigations of the true frequency of the FASLG variant allele and occurrence of FALPS in the wider population of BSH cats in New Zealand.

Women in Prison With Traumatic Brain Injury: Prevalence, Mechanism, and Impact on Mental Health.

Relatively little is known about the characteristics of female offenders. Here, we studied the prevalence of traumatic brain injury (TBI) and mental health issues in an exclusively female prison population in New Zealand. Participants ( N = 38) were recruited from all security levels at Christchurch Women's Prison. Measures for depression, anxiety, and stress, sleep, and a history of TBI were administered; 94.7% (36/38) of participants presented with a history of TBI. Younger age at first injury was associated with an increased risk of mental health problems. The study concludes that TBI is highly prevalent among female offenders and may be linked to increased mental health problems. TBI should be considered as an important factor in offender pathways and treatment programs.

Cost-benefit analyses of supplementary measles immunisation in the highly immunized population of New Zealand.

As endemic measles is eliminated from countries through increased immunisation, the economic benefits of enhanced immunisation programs may come into question. New Zealand has suffered from outbreaks after measles introductions from abroad and we use it as a model system to understand the benefits of catch up immunisation in highly immunised populations. We provide cost-benefit analyses for measles supplementary immunisation in New Zealand. We model outbreaks based on estimates of the basic reproduction number in the vaccinated population (Rv, the number of secondary infections in a partially immunised population), based on the number of immunologically-naïve people at district and national levels, considering both pre- and post-catch up vaccination scenarios. Our analyses suggest that measles Rv often includes or exceeds one (0.18-3.92) despite high levels of population immunity. We calculate the cost of the first 187 confirmed and probable measles cases in 2014 to be over NZ$1 million (∼US$864,200) due to earnings lost, case management and hospitalization costs. The benefit-cost ratio analyses suggest additional vaccination beyond routine childhood immunisation is economically efficient. Supplemental vaccination-related costs are required to exceed approximately US$66 to US$1877 per person, depending on different scenarios, before supplemental vaccination is economically inefficient. Thus, our analysis suggests additional immunisation beyond childhood programs to target naïve individuals is economically beneficial even when childhood immunisation rates are high.

Prevalence of Traumatic Brain Injury in a Male Adult Prison Population and Its Association with the Offence Type

Background: The prevalence of traumatic brain injury (TBI) in prison populations has been found to vary considerably. This study aimed to determine the prevalence of TBI in a prison population in New Zealand and to identify whether age, ethnicity, offence type, security classification and sentence length were linked to TBI prevalence. Methods: All offenders admitted to a new Corrections Facility over a 6-month period (May-November 2015) were screened to understand their history of TBI. Data was merged with demographic information, details of the offence type, sentence length and security classification from the prison database. Binary logistic regression was used to identify the contribution of predictors on TBI history. Results: Of the 1,061 eligible male prisoners, 1,054 (99.3%) completed a TBI history screen. Out of the 672 (63.7%) who had sustained at least one TBI in their lifetime, 343 (32.5%) had experienced multiple injuries. One in 5 participants experienced their first TBI injury before the age of 15 years. A regression model was able to correctly classify 66.9% of cases and revealed that belonging to Māori ethnicity or being imprisoned for violent, sexual or burglary offences were independently predictive of TBI (χ² = 9.86, p = 0.28). Conclusions: The high prevalence of TBI within male prisoners and a high proportion of injuries sustained in childhood suggest the need for routine screening for TBI to identify prisoners at risk of persistent difficulties. Interventions to support those experiencing persistent difficulties post-TBI are needed to optimise functioning and prevent reoffending.

Mortality causes and outcomes in Indigenous populations of Canada, the United States, and Australia with rheumatic disease: A systematic review.

Indigenous populations of Canada, America, Australia, and New Zealand have increased rates and severity of rheumatic disease. Our objective was to summarize mortality outcomes and explore disease and social factors related to mortality. A systematic search was performed in medical (Medline, EMBASE, and CINAHL), Indigenous and conference abstract databases (to June 2015) combining search terms for Indigenous populations and rheumatic diseases. Studies were included if they reported measures of mortality (crude frequency, mortality rate, survival, and potential years of life lost (PYLL)) in Indigenous populations from the four countries. Of 5269 titles and abstracts identified, 504 underwent full-text review and 12 were included. No studies from New Zealand were found. In five Canadian studies of systemic lupus erythematosus (SLE) patients, First Nations ethnicity was associated with lower survival after adjusting for disease and social factors, and an increased frequency of death from lupus and its complications compared to Caucasians was found. All-cause mortality was higher in Native Americans (n = 2 studies) relative to Whites with SLE after adjusting for disease and social factors, but not in those with lupus nephritis alone. Australian Aborigines with SLE frequently developed infection and lupus complications leading to death (n = 3 studies). Mortality rates were increased in Pima Indians in the United States with rheumatoid arthritis (RA) compared to those without RA. One study in Native Americans with scleroderma found nearly all deaths were related to progressive disease. Canadian and American Indigenous populations with SLE have increased mortality rates compared to Caucasian populations. Mortality in Canadian and Australian Indigenous populations with SLE, and in Native American populations with RA and scleroderma, is frequently attributed to disease progression or complications. The proportional attribution of rheumatic disease severity and social factors to mortality and complications leading to death between Indigenous and non-Indigenous populations has not been fully evaluated.

Prevalence and risk factors for cats testing positive for feline immunodeficiency virus and feline leukaemia virus infection in cats entering an animal shelter in New Zealand

AIMSTo estimate the prevalence of cats testing positive for antibodies to feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) antigens in domestic cats entering a New Zealand animal shelter, based on a commercial point-of-care ELISA, to identify risk factors associated with cats testing positive, and to compare the results obtained from the ELISA with those obtained using PCR-based testing.METHODA cross-sectional study was performed on 388 cats entering the Royal New Zealand Society for the Prevention of Cruelty to Animals animal shelter in Auckland, New Zealand between 7 February 2014 and 30 May 2014. Whole blood samples were collected from each cat and tested for FIV antibody and FeLV antigen using a commercial point-of-care ELISA. Information on the signalment and health status of the cat at the time of entry was also recorded. Blood and saliva samples from a subset of cats were tested for FIV and FeLV proviral DNA using a real-time PCR assay.RESULTSOf the 388 cats in the study sample, 146 (37.6%) had been relinquished by owners, 237 (62.4%) were strays, and 5 (1.3%) were of unknown origin. Overall, 53/388 (13.7%) cats tested positive for FIV antibodies and 4/388 (1.0%) were positive for FeLV antigen. Stray cats had a higher FIV seroprevalence than relinquished cats (42/237 (17.8%) vs. 11/146 (7.5%); p=0.008). Of 53 cats that were FIV-seropositive, 51 (96%) tested positive for FIV proviral DNA using PCR testing of blood. Of these 51 cats, 28 (55%) were positive by PCR testing of saliva. Of the four cats that were FeLV antigen-positive by ELISA, two (50%) were positive for FeLV proviral DNA by PCR testing of blood. The odds of a cat being seropositive for FIV were greater for intact compared to desexed cats (OR=3.3; 95% CI=1.6–7.4) and for male compared to female cats (OR=6.5; 95% CI=3.2–14.0).CONCLUSIONS AND CLINICAL RELEVANCEThe seroprevalence for FIV was 14% among cats entering an animal shelter in Auckland, whereas the prevalence of FeLV antigen-positive cats was only 1%. These findings suggest differences in the transmission dynamics of each virus in free-roaming cat populations in New Zealand. Our study also highlights the potential role of desexing cats in reducing transmission of FIV. However, further data from first-opinion veterinary practices are required to confirm that these findings may be generalised to the wider domestic cat population in New Zealand.

Commercial equine production in New Zealand. 3. The racing and sport industries

The present review examines the commercial production of racing and sport horses in New Zealand, describing the size and scope of the industries, the management and feeding, and the training and wastage of race (Thoroughbred and Standardbred) and sport horses. The number of horses per head of population in New Zealand (30/1000 people) is high by international standards and the main equine industries generate ~2% of national gross domestic product. In New Zealand the Thoroughbred breeding and racing industry dominates organised equestrian activity (economically and numerically). Furthermore, this Thoroughbred bias has an influence on equestrian culture and may explain, in part, the high proportion of Thoroughbred sport horses registered for eventing in New Zealand, which is in contrast to other international sport-horse populations. An understanding of the production, management and structure of the racing and sport industries in New Zealand is paramount to ensure the health and welfare of the equine athlete and the continuing success of the industries.

Mortality trends in Australian Aboriginal peoples and New Zealand M\u0101ori

BackgroundThe health status of Indigenous populations of Australia and New Zealand (NZ) Māori manifests as life expectancies substantially lower than the total population. Accurate assessment of time trends in mortality and life expectancy allows evaluation of progress in reduction of health inequalities compared to the national or non-Indigenous population.MethodsAge-specific mortality and life expectancy (at birth) (LE) for Indigenous populations (Australia from 1990 and NZ from 1950); and all Australia and non-Māori NZ (from 1890), males (M) and females (F), were obtained from published sources and national statistical agency reports. Period trends were assessed for credible estimates of Indigenous LE, and the LE gap compared to the total population for Australia, and non-Māori for NZ. Period trends in premature adult mortality, as cumulative probability of dying over 15–59 years, were assessed similarly. The relative contribution of differences in age-specific mortality to the LE gap between Indigenous and the all-Australia population, and the non-Māori NZ, was estimated for each country by sex for the most recent period: 2010–2012 for Australia, 2012–2014 for NZ.ResultsLE increased for all populations, although LE gaps between Indigenous and all Australia showed little change over time. LE gaps between NZ Māori and non-Māori increased significantly from the early 1980s to the mid-1990s, and since then have fallen again. Recent LE gaps in Australia (M 12.5; F 12.0 years in 2010–2012) were larger than in NZ (M 7.3; F 6.8 years in 2012–2014). Premature adult mortality (15–59 years) improved for all populations, but mortality ratios show little change since 2000, with Indigenous at 3½-4 times that of all Australians, and Māori 2–3 times that of non-Māori. Using decomposition analysis, the age interval contributing most strongly to differences in LE between Indigenous and all Australia was 35–59 years, but between Māori and non-Māori it was 60–74 years.ConclusionIn Australia and NZ, Indigenous LE and adult mortality are improving in absolute terms, but not relative to the entire or non-Indigenous populations, causing gaps in life expectancy to persist.

Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40–70 Years

BackgroundSexual function declines with age and erectile dysfunction (ED) is a common condition worldwide; however, prevalence rates vary markedly between populations and reliable data specific to New Zealand (NZ) are lacking. AimTo assess the prevalence of ED in NZ men using a population-based cross-sectional survey. MethodsPostal questionnaires were sent, according to a modified Dillman method, to a randomly selected age-stratified population-based sample of 2,000 men 40 to 70 years old obtained from the electoral roll. Self-reported erectile function was assessed using the five-item International Index of Erectile Function (IIEF-5) and the single-question self-assessment tool. OutcomesThe prevalence of ED is presented as crude, age-adjusted to the distribution of the NZ population, and standardized to the World Health Organization World Standard Population (WSP). Associations between sexual function and age were analyzed using χ2 test. ResultsThe response rate was 30% (599) and 28% (562) were complete for analysis. The crude prevalence of ED was 42% (22% mild, 10% mild to moderate, 6% moderate, and 4% severe), the age-adjusted prevalence was 38%, and the WSP-adjusted prevalence was 37%. Among men reporting ED, 16% were medically diagnosed and 22% were treated. ED affected 24% of men in their 40s, 38% in their 50s, and 60% in their 60s (P < .001). Age was associated with a significant increase in diagnosed ED (P = .001), treated ED (P = .006), dissatisfaction with current sexual function (P < .001), associated anxiety or depression (P = .023), and a decrease in sexual activity (P < .001). Clinical TranslationApproximately one in three NZ men 40 to 70 years old might have ED. Although comparable to overseas populations, this prevalence is high. Strengths and LimitationsThis study provides the most reliable, comprehensive, and current information on ED and its risk factors in NZ men. Strengths include the large sample, the use of random selection from a population-based sampling frame, established effective survey methods, and the validated IIEF-5. Limitations include the inability of cross-sectional data to determine causation, non-sampling errors associated with the population-based sampling frame, the low response rate, the inability to assess non-respondents, the possibility of men with ED who were sexually inactive not responding or not completing the IIEF-5, and the inherent inability to rule out recall bias. ConclusionED is a marker of subclinical cardiovascular disease. The high prevalence and low levels of diagnosis and treatment indicate a lost opportunity for timely intervention to delay or prevent the progression toward clinical disease.Quilter M, Hodges L, von Hurst P, et al. Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40–70 Years. J Sex Med 2017;14:928–936.