ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 56 – 2015

Maori Health Review
Maori Health Review
Maori Health Review

Movers and stayers: The geography of residential mobility and CVD hospitalisations in Auckland, New Zealand

Authors: Exeter DJ et al.

Summary: This study investigated the association between residential mobility and cardiovascular disease hospitalisations in Auckland, New Zealand. The study researchers used an encrypted National Health Index number to link individual-level data recorded in routine health datasets (e.g., Primary Health Organisation [PHO] registrations, pharmaceutical dispensing, hospitalisations and mortality) to construct a cohort of approximately 670,000 patients aged ≥30 years old living in Auckland, between 1 January 2006 and 31 December 2012. Residential mobility was measured by changes in the census Meshblock of usual residence, obtained from the PHO database for every calendar quarter of the study period. The NZDep2006 area deprivation score at the start and end of a participant’s inclusion in the study was used to measure deprivation mobility. In multivariable binomial regression models that controlled for age, gender, deprivation and ethnicity, movers were 1.22 times more likely than stayers to be hospitalised for CVD. Using the 5 × 5 deprivation origin-destination matrix to model a patient’s risk of CVD based on upward, downward or sideways deprivation mobility, movers within the least deprived (NZDep2006 Quintile 1) areas were 10% less likely than stayers to be hospitalised for CVD, while movers within the most deprived (NZDep2006 Quintile 5) areas were 45% more likely than stayers to have had their first CVD hospitalisation in 2006–2012 (RR 1.45). Participants who moved upward also had higher relative risks of having a CVD event, although their risk was lower than those observed for participants experiencing downward deprivation mobility.

Comment: The Auckland population seems to be very mobile, in my experience as a researcher and GP here. If my experience is ‘real’, then this study is particularly interesting and would perhaps support calls for ‘virtual’ medical records that patients and their providers can access from anywhere.

Reference: Soc Sci Med. 2015;133:331-9


Preliminary findings from the Oranga Niho dental student outplacement project

Authors: Anderson VR et al.

Summary: This study examined stakeholder perspectives of the University of Otago Bachelor of Dental Surgery 2012–2013 clinical outplacement programme, involving 6 Māori Oral Health Providers (MOHPs) in the North Island (NZ). Pre- and post-outplacement online questionnaires were completed by 68 students; clinical supervisors from all 6 MOHPs were surveyed twice over a 12-month period (31 responses were received). Paper questionnaires were used to survey adult clients and caregivers of child clients that the students treated; 426 client and 130 caregiver questionnaire responses were received from 5 MOHPs. The majority (79%) of students felt well prepared for outplacement and 75% indicated that they would consider working for a MOHP in future. Nearly all of the clinical supervisors (93%) indicated that the students were adequately prepared for outplacement and 68% stated that they would recommend one or more students for employment. However, 58% associated the outplacements with decreased productivity. Almost 98% of adult clients and caregivers of child clients were pleased with the care that the students provided. The study researchers conclude with recommendations intended to inform and strengthen the programme’s ongoing development: increase communication between the Faculty, MOHPs and students; address the financial cost of the programme to the MOHPs; and provide more support for clinical supervisors.

Comment: An excellent evaluation of a programme that would support not only Māori providers, but importantly, their clientele as well.

Reference: N Z Dent J. 2015;111(1):6-14


Looking Māori predicts decreased rates of home ownership: Institutional racism in housing based on perceived appearance

Authors: Houkamau CA, Sibley CG

Summary: These researchers used data from a large national postal sample of 561 selfidentified Māori who completed the New Zealand Attitudes and Values Study Time 4 Māori Focus questionnaire. A statistical model assessed whether reliable differences exist in rates of home ownership within the Māori population, that is, the extent to which some Māori are more likely to own their own home (partially or fully) relative to other Māori. Specifically, the study researchers tested whether Māori who perceive themselves as appearing more stereotypically Māori are less likely to own their own home relative to those who believe they appear less stereotypically Māori. The study’s analyses indicated that self-reported appearance as Māori, or the extent to which people thought they personally displayed features which visibly identified them as Māori to others, significantly predicted decreased rates of home ownership. This association held when adjusting for numerous other possible demographic covariates that might account for the association, such as education, level of deprivation of the immediate area, household income, age, relationship status, region of residence, amongst others. The study researchers conclude that their findings suggest there is, or at least has been in the recent past, institutional racism against Māori in New Zealand’s home lending industry based on merely appearing more Māori.

Comment: Reading this paper actually bummed me out. Despite the glaringly obvious point of interest here, I want to also highlight the fact that the researchers have looked at a defined outcome – home ownership. Previous studies into the link between racism and housing have relied on subjective experience and so it is worth adding this paper to the ever-increasing body of knowledge about the impacts of racism in Aotearoa.

Reference: PLoS One. 2015;10(3):e0118540


Long-term effectiveness of a communitybased model of care in Māori and Pacific patients with type 2 diabetes and chronic kidney disease: A 4-year follow-up of the DElay Future End Stage Nephropathy due to Diabetes (DEFEND) study

Authors: Tan J et al.

Summary: In the DEFEND study, Māori and Pacific patients (aged 47–75 years) with type 2 diabetes, hypertension, stage 3/4 chronic kidney disease and proteinuria (>0.5 g/day) were randomised to receive community-based care (n=33) or usual care (n=32) for 12 months. The community-based intervention was associated with lower BP, proteinuria and less end-organ damage than usual care. After the intervention ended, all patients reverted to usual care, and were followed-up thereafter until death, end-stage renal disease (ESRD; estimated glomerular filtration rate [eGFR] ≤10 mL/min/1.73m2)/dialysis or 1 February 2014. The median post-trial follow-up was 49 months and similar in both groups. The median eGFR decline was –3.1 and –5.5 mL/min/year in the intervention and usual care groups, respectively (p=0.11). Similar numbers of deaths, renal and vascular events were observed in both groups. At the end of the 4-year follow-up, the mean number of prescribed antihypertensive medications was similar (3.4 vs 3.3, respectively; p=0.78). The median number of hospital days was 8 with the intervention compared with 15.5 days with usual care (p=0.03).

Comment: An important project showing that a Māori-led intervention in the community can have long-term impacts. This may be something that DHBs should consider, given higher rates of ESRF for Māori.

Reference: Intern Med J. 2015 Apr 14. [Epub ahead of print]