Zealand Residents Research Articles

Development and validation of alternative cardiovascular risk prediction equations for population health planning: a routine health data linkage study of 1.7 million New Zealanders.

Cardiovascular disease (CVD) risk prediction equations are primarily used in clinical settings to inform individual risk management decisions. We sought to develop and validate alternative equations derived solely from linked routinely collected national health data that could be applied countrywide to inform population health planning. Individual-level linkage of eight administrative health datasets identified all New Zealand residents aged 30-74 years in contact with publicly funded health services during 2006 with no previous hospitalizations for CVD or heart failure, and with complete data on eight pre-specified predictors. The linked health datasets encompassed demographic characteristics, hospitalizations, outpatient visits, primary care enrolment, primary care reimbursement, community laboratory requests, community pharmaceutical dispensing and mortality. Sex-specific Cox models were developed to estimate the risk of CVD death or hospitalization within 5 years and included sex, age, ethnicity, level of deprivation, diabetes, previous hospitalization for atrial fibrillation and baseline preventive pharmacotherapy (blood-pressure-lowering, lipid-lowering and antiplatelet/anticoagulant medications) as predictors. Calibration and discrimination were assessed in the whole cohort, in 15-year age bands, in different ethnic groups, in quintiles of deprivation, according to baseline dispensing of pharmacotherapy, and in regional sub-populations. First CVD events occurred in 62031 of the 1746695 people during 8526024 person-years of follow-up (mean = 4.8 years). Median 5-year CVD risk was 1.1% in women and 2.6% in men. In both sexes, the risk equations were well calibrated throughout the risk range and had good risk discrimination in the national, regional and ethnic populations, within 15-year age bands, in deprivation quintiles and according to baseline medication dispensing. Robust policy-focused CVD risk equations can be developed solely from administrative health data to inform population health planning, and will complement CVD primary prevention at the individual level using clinical risk tools. Similar policy-focused equations could be replicated in countries and regions with linked administrative health datasets.

Comparing Event Attendees and Their Telecast Audiences: A Case Study of a Commemorative Event

Attendees who are physically present at events are not the only consumers of events. Indeed, in many cases, the number of people who watch an event via its telecast far exceeds the number of people attending the event. In this context, gaining information about event telecast audiences is as critical as gaining information about event attendees. However, most of the research undertaken on understanding event consumers has focused on attendees who are physically present at events. Very little is known about how consumers of the telecasts of events compare with attendees at events. This research aimed to address this knowledge gap and identify whether consumers of a telecast event were similar to, or different from, those consumers who attend events in person in terms of their demographics, psychographics, and behavioral intentions. The focal event for this study was a large-scale national commemorative event in Australia and New Zealand. Data were collected using an online questionnaire from a purposive sample (n=1,152) comprising both Australian (58%) and New Zealand (42%) residents, of which 580 of the entire sample were attendees at the event and 572 participated in the event via their telecasts. The results show that the two cohorts (1: event attendees and 2: event telecast participants) with an interest in the event show significant differences. Event attendees and event telecast participants are different in terms of gender, experience with the event/telecast (first-time participation, number of prior events, and number in party), motivations, emotions experienced, satisfaction, and behavioral intentions regarding the event/telecast. However, the two cohorts did not differ on age, education, household income, or their levels of patriotism. This study contributes to the event management literature as it extends our knowledge of consumers of events and provides a comparative analysis of event attendees and event telecast participants of a large-scale event. These findings provide valuable insights for event and telecast planners as well as other stakeholders about the two cohorts of event participants. The study is novel because it reports on data collected from both Australians and New Zealanders about this event rather than focusing on just one country, as previous research has tended to do.

Integrated survey methods to estimate harvest by marine recreational fishers in New Zealand

Marine recreational fishing is a popular pastime in a growing number of countries. Obtaining reliable harvests estimates is important to produce more accurate stock assessments and more certain management decisions, however, accurate measurement of marine recreational harvest is challenging.Previous national fisher diary surveys undertaken in New Zealand during the 1990s gave inconstant estimates of marine recreational harvests. Landline telephone listings and interviews were used to estimate the proportion of New Zealand residents who had fished during the previous 12 months and to recruit diarists. Slight changes in survey method produced variable and at times implausible results.After three years of planning and pre-testing a large-scale project was undertaken to develop a robust off-site harvest survey method and corroborate the results using with two concurrent on-site survey methods. For the off-site survey, the method was based on a national population proportionate sample of dwellings to recruit a panel of 7000 fishers and 3000 non-fishers using a face-to-face household survey. Panellists were contacted regularly by SMS and telephone for a year with a 94% completion rate. Computer assisted telephone interviews collected details of all species of fish harvested by fishing method. The second was a regional aerial-access survey that collected peak period vessel counts from the air to scale up boat-based harvest from concurrent all-day creel surveys on 45 days. Harvest estimates were generated for the most commonly encountered species, snapper, kahawai, trevally, tarakihi and red gurnard. The third and smallest survey was a combined access point survey in a sub-region using fixed and bus route creel surveys covering all significant access points on different set of random stratified days to the areal access survey. The main objective was to estimate the boat-based harvest by specialist fishers targeting scallop and rock lobster. The three concurrent surveys were designed to generate harvest estimates by fishing platform (boat or land based) at overlapping spatial scales. Harvest, in numbers of fish, were estimated independently for recreational fishers using boats. However, the on-site surveys relied on the proportion of harvest from land-based platforms provided by the off-site survey to derive total regional harvest estimates for all methods. The off-site panel survey relied on average weight data for each fish stock provided by the on-site surveys to convert harvest numbers to weight for management purposes. Choosing a sample frame and survey method that is reliable and repeatable into the future is critical to providing comparable estimates and the ability to monitor trends over time.Harvest estimates for the most common species in Fisheries Management Area 1, snapper and kahawai, were very similar. The estimates for snapper ranged from 3754 t (cv 0.06) to 3981 t (cv 0.08) and for kahawai 983 t (cv 0.32) to 942 t (cv 0.08). There were greater differences in estimates between surveys for secondary species. Each survey had independent error structures and this multi-method approach has provided valuable insight into likely sources of bias. High quality recreational harvest estimates are important to support management changes in high profile fisheries.

The new measuring multimorbidity index predicted mortality better than Charlson and Elixhauser indices among the general population

ObjectivesThe aim of the study was to develop and validate an updated morbidity index for short-term mortality risk, using chronic conditions identified from routine hospital admission ICD-10 data. Study Design and SettingRetrospective cohort study of all adult New Zealand (NZ) residents at January 1, 2012. Adult NZ residents aged 18 years and over, defined by enrollment with a Primary Healthcare Organisation or accessing public health care in preceding year. Data were split into two data sets for index development (70%, n = 2,331,645) and validation (30%, n = 1,000,166). ResultsThe M3 index was constructed using log hazard ratios for 1-year mortality modeled from presence of 61 chronic conditions. Validation results were improved for the M3 index for predicting 1-year mortality compared to Charlson and Elixhauser on the c-statistic (M3: 0.931, Charlson: 0.921, Elixhauser: 0.922; difference M3 vs. Charlson = 0.010, 95% confidence interval [CI]: 0.008, 0.012; M3 vs. Elixhauser = 0.009, 95% CI: 0.007, 0.012) and integrated discriminative improvement (M3 vs. Charlson = 0.024, 95% CI: 0.021, 0.026; M3 vs. Elixhauser = 0.024, 95% CI: 0.022, 0.027). ConclusionThe M3 index had improved predictive performance for 1-year mortality risk over Charlson and Elixhauser indices, allowing better adjustment for mortality risk from chronic conditions. This provides an important tool for population-level analyses of health outcomes.

Reforms to New Zealand superannuation eligibility: are they a good idea?

The National-led government of Prime Minister Bill English recently announced changes to the eligibility rules for receipt of New Zealand Superannuation (NZS). In 2037 the age from which New Zealand residents become eligible to receive NZS will begin to rise – by six months each year – from the current age of 65 to reach 67 by July 2040. Residency requirements will also rise, to 20 years from ten (five of which must be after age 50). This is a dramatic change for the new PM, who had been part of the previous Cabinet under Prime Minister John Key which, since 2008, steadfastly refused to consider changing the eligibility conditions for NZS. Treasury projected that without such changes the fiscal costs of NZS would rise from 4.8% of GDP in 2015 to 6.3% in 2030, reaching 7.9% by 2060 (Treasury, 2016).

Differences in the risk of cardiovascular disease for movers and stayers in New Zealand: a survival analysis.

To explore if risk of cardiovascular disease (CVD) for participants who moved before their first CVD event is higher than for stayers, and examine whether the relationship is moderated by ethnicity. The sample comprised 2,068,360 New Zealand residents enrolled in any Primary Health Organisation, aged between 30 and 84years, had complete demographic information, and no prior history of CVD. Cox proportional regression was used to compare CVD risk between movers and stayers. The analysis was conducted for the whole sample and stratified by ethnicity. The combined analysis suggested that movers have a lower risk of CVD than stayers. This is consistent for all ethnic groups with some variation according to experience of deprivation change following residential mobility. Although mobile groups may have a higher risk of CVD than immobile groups overall, risk of CVD in the period following a residential mobility event is lower than for stayers. Results are indicative of a short-term healthy migrant effect comparable to that observed for international migrants.

Considerations of response bias and value in linking an existing longitudinal cohort study with national health record data

ABSTRACTObjectiveLongitudinal cohort studies remain important sources of information in health and epidemiological research and represent a significant investment of resources. The maintenance of these cohorts over time and the representativeness of retained participants are important considerations for researchers. For those weighting the benefits of augmenting a longitudinal cohort study with data linkage to national health records, the potential for bias in consent and match rates and the utility of the newly obtained data are also key considerations. This study presents an analysis of bias associated with consent to participate and record matching in an established longitudinal cohort of older persons. We present the unique outcomes generated from this national health record data linkage project and the opportunities such variables present for longitudinal cohort studies.ApproachThe New Zealand Health, Work and Retirement study is a biennial survey of persons aged 55-85 which commenced in 2006. Over the past decade, additional cohorts have been recruited to the study, with n = 9003 older New Zealand residents participating to the year 2015. In 2013 the study began an approach to active survey participants for consent to link their longitudinal survey data to national health record data held by the New Zealand Health Information Service, including data related to hospital events, the New Zealand Cancer Registry, pharmaceutical data and mental health data. We compare self-reported longitudinal health trends associated with consent/declination to participate as well as for record match success and failure. Key outcomes derived from these national datasets for the purposes of the Health, Work and Retirement Study are described.ResultsConsent (62.5%) and declination (8.9%) to participate in the data linkage project are described in terms of the corresponding longitudinal self-reported health and socio-demographic trends for these groups. Successful and unsuccessful matches of participants to national health record data are also described. The calculation of outcomes from each of the linked datasets obtained and their potential utility in building upon existing longitudinal cohort data are also presented.ConclusionsNational health record data linkage presents a potentially valuable source of data to supplement and replicate findings related to health outcomes and expenditure derived from longitudinal cohort surveys. The challenges and successes of the New Zealand Health, Work and Retirement survey data linkage project touch upon considerations pertinent to evaluating the value of augmenting existing and ongoing longitudinal survey cohort for other researchers.

Water Safety and Aquatic Recreation among International Tourists in New Zealand

Little is known about the water safety knowledge, attitudes, and behaviors of international tourists holidaying in New Zealand. An online survey was conducted among New Zealand residents (n = 413) and international tourists (n =181) in August 2015. Significantly more New Zealand residents (69%) than tourists (40%) reported swimming at a beach. Tourists were more likely to hold unsafe beliefs related to swimming and boating activity. More tourists agreed that they would swim at a non-patrolled beach. Both residents and visitors had a poor understanding of rip currents at surf beaches. Ways of promoting water safety messaging to address these shortcomings are discussed. Language: en

The concept of near money in loyalty programmes

Loyalty reward schemes often have their own currency, for example, frequent flyer miles, which is a form of near money or quasi money. In a variation of earlier work by Snelders et al. (1992), when examining both New Zealand (Study 1) and Hong Kong (Study 2) residents, respondents provided typicality ratings, similarity ratings, and answers and reaction times to the question “Is X a type of money?” for examples of money, near money and objects of value. The results from both studies showed that near money is conceptualised in a way that is like but distinct from legal tender. Two further studies investigated implications of this conceptualisation. Study 3 found that preferences for spending near money were influenced by the ostensible purpose of the currency, and Study 4 showed that near money seemed to be placed outside of regular legal tender mental accounts.

Initiation and maintenance of statins and aspirin after acute coronary syndromes (ANZACS-QI 11).

INTRODUCTION Prior New Zealand studies suggest that only approximately two-thirds of patients who present with an acute coronary syndrome (ACS) are maintained on a statin/aspirin post-discharge. This could be due to sub-optimal initiation or poor longer-term adherence. AIM To identify the pattern of statin/aspirin maintenance following ACS from initial prescription to 3 years post-discharge. METHODS All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry data for consecutive New Zealand residents (2007-2011), who were hospitalised with ACS, were anonymously linked to national datasets to derive a medication possession ratio (MPR) to assess medication maintenance. An MPR ≥ 0.8 is considered adequate maintenance. RESULTS Of the 1846 patients discharged alive, 95% were prescribed a statin at discharge and 92% were dispensed a statin within 3 months, but only 75% had a MPR ≥ 0.8 in the first year, and 67% in year 3. In the same cohort, 98% were prescribed aspirin and 88% were dispensed aspirin within the 3 months of discharge. In the first year, 72% had an aspirin MPR ≥ 0.8 and 71% maintained this in year 3. Fifty-nine percent were maintained on both aspirin and a statin in the third year, but 20% were maintained on neither. Regression analysis identified the independent predictors of inadequate maintenance in the third year as age < 45 years, no prior statin, and Māori and Pacific ethnicity. CONCLUSION Longer-term maintenance of evidenced-based secondary prevention medications after ACS is suboptimal despite high levels of initial prescribing and dispensing. Understanding the barriers to longer-term maintenance is required to improve patient outcomes.

High perceived sensitivity to medicines is associated with higher medical care utilisation, increased symptom reporting and greater information-seeking about medication

The belief that one is especially sensitive to the actions and side effects of medicines can influence treatment adherence and side-effect reporting. In this study, we investigated the prevalence of perceived medication sensitivity in the general population and its relationship to symptom complaints, information seeking about medications, use of medical care and demographic factors. A nationally representative sample of 1000 New Zealand residents completed the Perceived Sensitivity to Medicines scale and symptoms experienced during the previous 7 days. Demographic data and medical visits, medication use and information seeking about medicines were also collected. Over 20% of the general population reported being very sensitive to the effects of medication (20.2%) and that small amounts of medicines can upset their body (25.3%). Participants who reported high levels of perceived sensitivity to medicines reported significantly more symptoms (M = 9.54, SE = 0.47) than people with low (M = 5.04, SE = 0.49) or moderate (M = 5.91, SE = 0.24) levels, ps < .001. This relationship was strongest in participants who were currently taking prescription medication. Those with high perceived sensitivity also reported being more likely to seek information about medicines, and had significantly more general practitioner visits. Perceived sensitivity to medicines is common in the population and associated with important clinical variables including information seeking, GP visits and symptom reporting. Identifying patients with higher perceived sensitivity to medicines may improve patient care by providing the basis for targeted and personalised interventions to reduce side effects and improve adherence to medications.

Uncontrolled hypertension prevalence, treatment and blood pressure levels: An analysis of New Zealand primary care data

Background: Prior studies suggest that only about twothirds of patients who present with an acute coronary syndrome (ACS) are maintained on a statin post-discharge. This could be due to sub-optimal initiation or poor longer-term adherence. The aim of this study was to identify the pattern of statin adherence following ACS from initial prescription to three years post-discharge. Methods: ANZACS-QI registry data for consecutive New Zealand residents hospitalised with ACS was anonymously linked to national datasets to derive a Statin Possession Ratio (SPR) to assess maintenance. Results: Of 1846 patients discharged alive 95% were prescribed a statin at discharge and 92% were dispensed a statin within 3 months, but only 75% had an adequate SPR 0.8 in the first year, and 67% in year 3. In year 3, 11% had no statin dispensed and another 21% had intermittent statin dispensing (SPR >0 to <0.8). Only 33% had an ideal SPR of 1. Statin prescribing at discharge was high across ethnic groups (94% to 97%), slightly higher in men than women (96% and 92%, respectively) and in those <65y than 65y (97% vs 93%). In the third year, on regression analysis, the independent predictors of inadequate maintenance were age<45 (p<0.05), female gender (p<0.05), no prior statin (p<0.01) and Pacific ethnicity (p=0.05). Conclusion: Ninety-five percent of ACS patients were prescribed a statin at discharge and nearly all had it dispensed. However, over the first year only three-quarters were adequately maintained on statin and by three years this fell to two-thirds.

Twelve-month post-injury outcomes for Māori and non-Māori: findings from a New Zealand cohort study.

To examine the prevalence of key outcomes among Māori and non-Māori 12 months post-injury, and to estimate the risk of these outcomes for Māori compared to non-Māori. The Prospective Outcomes of Injury Study recruited 2,856 New Zealand residents from five regions of New Zealand. This paper examines outcomes at 12 months post-injury for the Māori (n=405) and non-Māori (n=1,875) groups. High levels of adverse outcomes at 12 months post-injury were observed in both groups. A greater proportion of Māori than non-Māori were experiencing disability, problems with mobility and psychological distress 12 months post-injury. After controlling for pre-injury and injury-related characteristics, Māori were found to be at greater risk of disability, problems with mobility, having trouble performing usual activities, psychological distress and reporting 'barely/not enough' household income at 12 months compared to non-Māori. Explanations for higher risk of these poor outcomes are unclear. Future research to identify potential explanations will include experiences with health services and rehabilitation support following injury, subsequent injury and illness, and major life events post-injury. Adequate post-injury care focused on physical and psychological health and financial security is required to reduce the burden experienced by Māori due to injury.

Twenty-eight day and one-year case fatality after hospitalisation with an acute coronary syndrome: a nationwide data linkage study.

To determine 28-day and one-year case fatality in patients hospitalised with acute coronary syndromes (ACS) and identify factors associated with mortality. All New Zealand residents admitted with ACS between 2007 and 2009 were followed for one year using individual patient linkage of national hospitalisation and mortality datasets. Deaths from any cause were used to calculate 28-day and one-year case fatality. Cox-proportional hazards models were constructed to identify factors associated with mortality after an ACS hospitalisation. The cohort included 42,920 ACS patients. Case fatality increased steeply with age. Māori and Pacific peoples had 1.5 times the risk of 28-day, and twice the risk of one-year, mortality as Europeans/Others. Low (compared to high) socioeconomic status was associated with significantly higher mortality at 28 days but not one year. Patients with unstable angina had half the risk of short-term mortality as NSTEMI patients, whereas STEMI patients had double the NSTEMI risk. The major determinant of increasing case fatality was increasing age. There were also substantial differences in case fatality by ethnicity, deprivation and diagnostic category. Further research is needed to explore the possible mechanisms by which ethnic and deprivation disparities occur and effective strategies to address them.

The development and exploratory analysis of the Back Pain Attitudes Questionnaire (Back-PAQ)

ObjectivesTo develop an instrument to assess attitudes and underlying beliefs about back pain, and subsequently investigate its internal consistency and underlying structures.DesignThe instrument was developed by a multidisciplinary team of...

Cross-sectional survey of attitudes and beliefs about back pain in New Zealand

ObjectivesTo explore the prevalence of attitudes and beliefs about back pain in New Zealand and compare certain beliefs based on back pain history or health professional exposure.DesignPopulation-based cross-sectional survey.SettingPostal survey.ParticipantsNew...

Personality Resilience Following a Natural Disaster

We examine changes in the Big Six personality markers (Extraversion, Agreeableness, Conscientiousness, Emotional Stability, Openness to Experience, and Honesty–Humility) before and after the 2010/2011 Christchurch earthquakes in a longitudinal study of New Zealand residents (N = 3,914). Results show remarkable stability in personality, save for one exception: Those who were affected by the earthquakes evidenced a slight decrease in Emotional Stability over the 2-year test–retest period relative to those unaffected by the earthquakes. These findings indicate that most aspects of personality are resilient following a major natural disaster. The slight decrease in Emotional Stability, however, points to a possible increase in vulnerability to depression and anxiety for those affected by the earthquakes. Our study provides important insights into a central question about stability and change in personality following major life events.

Pacific peoples three months after injury: a comparison of outcomes between Pacific and non‐Pacific participants in a NZ cohort study

To: describe pre-injury characteristics of Pacific (n=239) and non-Pacific (n=2,611) participants and compare their outcomes three months after injury. Participants were New Zealand residents aged 18-64 years referred to the Accident Compensation Corporation's injury entitlement claims register. Univariate and multivariable analyses compared pre-injury and injury-related characteristics of Pacific and non-Pacific people and assessed the unadjusted and adjusted relative risks for selected outcomes. Of the 2,856 participants, 239 identified at least one Pacific ethnicity. Adjusted relative risks (aRR; 95% confidence intervals) for Pacific peoples, with the non-Pacific group as the reference, indicate Pacific peoples were: less likely to have no/lesser problems with disability (aRR=0.82; 0.70,0.95); less likely to have no problems with EQ-5D self-care (aRR=0.88; 0.80,0.98); less likely not to report EQ-5D anxiety/depression (aRR=0.84; 0.76,0.93); and less satisfied with social relationships three months after injury (aRR=0.89; 0.83,0.95). Evidence does not suggest Pacific peoples' likelihood of paid employment differs from non-Pacific people three months after injury. However, Pacific peoples appear to have an increased likelihood of problems with disability, self-care, anxiety/depression and social relationships. This study provides information about a range of previously unknown outcomes following injury for Pacific peoples in New Zealand, and suggests areas of possible focus for health and rehabilitation service providers and policy-makers interested in improving outcomes for injured Pacific peoples.

Injury severity and 3-month outcomes among Maori: results from a New Zealand prospective cohort study.

To examine the prevalence of health and social outcomes pre- and 3 months post-injury, and the association between New Injury Severity Scores (NISS) and 3-month outcomes, for the Maori cohort of the Prospective Outcomes of Injury Study. New Zealand residents were recruited from the Accident Compensation Corporation's entitlement claims register and participants interviewed at 3 months post-injury. Those who reported Maori ethnicity (n=566) were included in the Maori cohort. States indicative of favourable health were less prevalent among the cohort post-injury than pre-injury for all measures examined. Approximately half the cohort were experiencing difficulties walking 3 months after their injury, over two-thirds a level of pain or discomfort, and more than half a level of psychological distress. The prevalence of disability was 49%. The prevalence of some adverse outcomes increased with increasing NISS but a high level of problems were still experienced by those classified as having a 'minor' injury. Nonetheless, a majority of the cohort were satisfied with life and they considered themselves to be of good to excellent overall health. Findings emphasise the importance of injury prevention and appropriate post-injury care to reduce the burden experienced by Maori due to injury.

Migration and Pacific Mortality: Estimating Migration Effects on Pacific Mortality Rates Using Bayesian Models

Pacific people living in New Zealand have higher mortality rates than New Zealand residents of European/Other ethnicity. The aim of this paper is to see whether Pacific mortality rates vary by natality and duration of residence. We used linked census-mortality information for 25- to 74-year-olds in the 2001 census followed for up to three years. Hierarchical Bayesian modeling provided a means of handling sparse data. Posterior mortality rates were directly age-standardized. We found little evidence of mortality differences between the overseas-born and the New Zealand-born for all-cause, cancer, and cardiovascular disease (CVD) mortality. However, we found evidence for lower all-cause (and possibly cancer and CVD) mortality rates for Pacific migrants resident in New Zealand for less than 25 years relative to those resident for more than 25 years. This result may arise from a combination of processes operating over time, including health selection effects from variations in New Zealand's immigration policy, the location of Pacific migrants within the social, political, and cultural environment of the host community, and health impacts of the host culture. We could not determine the relative importance of these processes, but identifying the (modifiable) drivers of the inferred long-term decline in health of the overseas-born Pacific population relative to more-recent Pacific migrants is important to Pacific communities and from a national health and policy perspective.