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Objectives This paper aims to examine ethnic differences in financial barriers to access to prescriptionmedication in New Zealand. Methods Data from SoFIE-Health (wave 3), which is an add-on to the Statistics New Zealand-led longitudinal Survey of Family, Income and Employment (SoFIE) (N¼18 320), were analysed using logistic regression, adjusting for demographic, socioeconomic, health behaviour and health variables. Financial barriers to access to prescription items were measured by the following question: 'In the past 12 months, have there been any times when a doctor gave you a prescription, but you didn't collect one or more of these items because you could not afford the cost?'. Results The odds of deferring buying a prescription at least once during the preceding 12 months because they could not afford the cost of the prescription were greater for Maori and Pacific people than for NZ Europeans (OR 2.98, 95% CI 2.56 to 3.47 vs OR 3.52, 95% CI 2.85 to 4.35). Adjusting for potential confounders attenuated the ORs to 1.31 (95% CI 1.08 to 1.58) for Maori people and to 2.17 (95% CI 1.68 to 2.81) for Pacific people. Deferring buying medications because of cost was also associated with increased odds of poor self-reported health status, high/very high psychological stress and the presence of two or more comorbid conditions. Conclusion Ethnicity plays a critical role in facilitating or impeding access to primary health care. This suggests that policy measures to further reduce financial barriers to buying medication may improve access to care for everyone including Maori and Pacific people and may have positive health implications. [ABSTRACT FROM AUTHOR]

AIM: There is scarce information on rugby league injuries in female players. This paper provides an overview of the epidemiology of women''s rugby league injuries requiring medical treatment and associated costs in New Zealand. METHOD: New Zealand Accident Compensation Corporation injury data for the period 1999–2007 were searched for rugby league injury cases occurring in females. Data were analysed by demographics, body region, nature/severity of injury, and medical procedure and costs. RESULTS: There were 320 moderate to serious injury claims recorded for females participating in rugby league activities over the study period. There was a mean (SD) of 37.9 (9.5) injury claims per year. The mean cost per year for the study period was $196 514 ($99 133) (£76 066 (£38 374)) with half of the injury claims occurring in New Zealand Maori. Concussion/brain injuries accounted for 3.8% of total female moderate to serious injury claims but accounted for 5.4% of female injury costs ($84 399 (£32 688)) with the highest mean cost per claim ($7033 (£2724)). The lower limb accounted for 65% of the total female injury claims and 58.7% of total injury costs ($922 296 (£356 968)). The mean cost per claim was higher for the lower limb ($4434 (£1714)) than the upper ($3331 (£1288)) limb. Clerks recorded 16.3% of the total injury claims, 20.3% of total injury costs ($319 474 (£123 211)) and had the highest mean cost per claim ($6144 (£2370)). The 25–29 age group recorded 31.9% of injury claims and 33.8% of injury costs. The 35–39 age group recorded the highest mean cost per claim ($6200 (£2392)) but only 10.9% of total claims and 13.8% of total costs. DISCUSSION: When compared with other studies in rugby league injuries, it appears that females incur substantially fewer injuries (5.7%) than males (94.3%). Although no participation data by sex are available, it is likely that participation percentages are reflected in the injury percentages. The high frequency (65%) and cost proportion (58.7%) for lower limb injuries was higher in females than in male rugby league players (previously reported as 42.4% of the injury claims and 31.5% of the total injury claim costs for the lower limb). CONCLUSIONS: Injury prevention programmes for women''s rugby league should focus on the 25–29 age group and address ways to prevent concussion and lower limb injuries. [ABSTRACT FROM AUTHOR]

Background Evidence that exposure to tobacco 'powerwalls' increases young people's susceptibility to smoking has led many countries to require the removal of these displays. Despite this important step, tobacco remains widely available and policy action appears to have stalled. Methods We conducted an online survey of 364 smokers and 402 non-smokers aged 18 years and above, who were sampled from a commercial internet panel in January 2013. Results Six months after the removal of all tobacco products from open display in New Zealand retail outlets, strong support for the new law exists. Although daily smokers were less supportive than other groups, smokers intending to quit within the next 6 months were more likely than not to believe the law would facilitate quitting. Irrespective of their smoking status, respondents supported not selling tobacco products within 500 m of a school, and requiring tobacco retailers to sell nicotine replacement therapy products. Conclusions Public support for more progressive 'endgame' retail measures could catalyse policy action which, in turn, could offer greater protection to young people and accelerate declines in smoking prevalence. Mandatory tobacco-free retail zones around schools, and requiring stores selling tobacco to stock cessation products received strong support, even among daily smokers; both measures would reduce youth exposure to tobacco while providing smokers with better access to cessation aids. [ABSTRACT FROM AUTHOR]

Objective: Studies indicate that age-standardised heart failure (HF) incidence has been decreasing internationally; however, contrasting trends in different age groups have been reported, with rates increasing in younger people and decreasing in the elderly. We aimed to describe age-specific trends in HF incidence in New Zealand (NZ).Methods: In this nationwide data linkage study, we used routinely collected hospitalisation data to identify incident HF hospitalisations in NZ residents aged ≥20 years between 2006 and 2018. Age-specific and age-standardised incidence rates were calculated for each calendar year. Joinpoint regression was used to compare incidence trends.Results: 116 113 incident HF hospitalisations were identified over the 13-year study period. Between 2006 and 2013, age-standardised incidence decreased from 403 to 323 per 100 000 (annual percentage change (APC) -2.6%, 95% CI -3.6 to -1.6%). This reduction then plateaued between 2013 and 2018 (APC 0.8%, 95% CI -0.8 to 2.5%). Between 2006 and 2018, rates in individuals aged 20-49 years old increased by 1.5% per year (95% CI 0.3 to 2.7%) and decreased in those aged ≥80 years old by 1.2% per year (95% CI -1.7 to -0.7%). Rates in individuals aged 50-79 years old initially declined from 2006 to 2013, and then remained stable or increased from 2013 to 2018. The proportion of HF hospitalisations associated with ischaemic heart disease decreased from 35.1% in 2006 to 28.0% in 2018.Conclusion: HF remains an important problem in NZ. The decline in overall incidence has plateaued since 2013 due to increasing rates of HF in younger age groups despite an ongoing decline in the elderly. [ABSTRACT FROM AUTHOR]

Objectives: To examine recent trends in first and recurrent ischaemic heart disease (IHD) deaths and hospitalisations.Methods: Using anonymous patient-linkage of routinely collected data, all New Zealanders aged 35-84 years who experienced an International Statistical Classification of Diseases and Related Health Problems I(CD)-coded IHD hospitalisation and/or IHD death between 1 January 2005 and 31 December 2015 were identified. A 10-year look-back period was used to differentiate those experiencing first from recurrent events. Age-standardised hospitalisation and mortality rates were calculated for each calendar year and trends compared by sex and age.Results: 160 109 people experienced at least one IHD event (259 678 hospitalisations and 35 548 deaths) over the 11-year study period, and there was a steady decline in numbers (from almost 24 000 in 2005 to just over 16 000 in 2015) and in age-standardised rates each year. With the exception of deaths in younger (35-64 years) women with prior IHD, there was a significant decline in IHD events in men and women of all ages, with and without a history of IHD. The decline in IHD mortality was greater for those experiencing a first rather than recurrent IHD event (3.8%-5.2% vs 0%-3.7% annually on average). In contrast, the decline in IHD hospitalisations was greater for those experiencing a recurrent compared with a first IHD event (5.6%-7.3% vs 3.2%-5.7% annually on average).Conclusions: The substantial decline in IHD hospitalisations and mortality observed in New Zealanders with and without prior IHD between 2005 and 2015 suggests that primary and secondary prevention efforts have been effective in reducing the occurrence of IHD events. [ABSTRACT FROM AUTHOR]

Objectives To investigate the impact of repeat chlamydi testing on annual population coverage estimates and to examine repeat testing patterns in a New Zealand district with high chlamydia testing rates. Methods Chlamydia testing data for 15-44-year-old e men and women in a single New Zealand district during February 2008 to January 2011 were analysed. Annual coverage of testing was estimated in two ways, using the number of tests and the number of individuals as the numerator. Rates of repeat testing were calculated using survival analysis. Results There were 73 879 tests (12 251 men, 61 628 women) from 41 342 individuals (8437 men, 32 905 women) during 3 years. Coverage estimates in 2010 using the number of individuals as the numerator were 17% lower for men and 26% lower for women than when the number of tests was used (5.9% vs 4.9% for men and 28.7% vs 21.2% for women). The rate of repeat testing was 16.9 per 100 person-years among men (95% CI 16.2 to 17.7) and 31.6 among women (95% CI 31.1 to 32.2). Rates of repeat testing were higher among women, in younger age groups and following a positive rather than a negative baseline test (p<0.001). Conclusion Relatively high rates of repeat testing were observed among young women in Waikato district during 2008 to 2010. Estimates of population coverage by test for this group therefore considerably overestimate individual coverage. The findings will inform discussions about improving surveillance to capture more accurate chlamydia testing coverage rates in New Zealand. [ABSTRACT FROM AUTHOR]

Background Evidence for a cross-sectional relationship between income and health is strong but is probably biased by substantial confounding. Longitudinal data with repeated income and health measures on the same individuals can be analysed to control completely for time-invariant confounding, giving a more accurate estimate of the impact of short-term changes in income on health. Methods 4 years of annual data (2002--2005) from the New Zealand longitudinal Survey of Family, Income and Employment were used to investigate the relationship between annual household income and self-rated health (SRH) using a fixed-effects ordinal logistic regression model. Possible effect modification of the income--SRH relationship by poverty and baseline health was tested with interactions. Results An increase in income of $10 000 over the past year increased the odds of reporting better SRH by 1% (OR 1.01, 95% CI 1.00 to 1.02). Poor baseline health significantly modified the association between income and SRH. A $10 000 increase in income increased the odds of better SRH by 10% for those with two or more chronic conditions. Poverty or deprivation did not modify the income--health association. Conclusions The overall small, positive, but statistically non-significant, income--health effect size is consistent with similar analyses from other longitudinal studies. Despite the overwhelming consensus that income matters for health over the medium and long-term, evidence free of time-invariant confounding for the short-run association remains elusive. However, measurement error in income and health has probably biased estimates towards the null. [ABSTRACT FROM AUTHOR]

Background Few cohort studies of the health effects of urban air pollution have been published. There is evidence, most consistently in studies with individual measurement of social factors, that more deprived populations are particularly sensitive to air pollution effects. Methods Records from the 1996 New Zealand census were anonymously and probabilistically linked to mortality data, creating a cohort study of the New Zealand population followed up for 3 years. There were 1.06 million adults living in urban areas for which data were available on all covariates. Estimates of exposure to air pollution (measured as particulate matter with an aerodynamic diameter less than 10 &mgr;m, PM10) were available for census area units from a previous land use regression study. Logistic regression analyses were conducted to investigate associations between causespecific mortality rates and average exposure to PM10 in urban areas, with control for confounding by age, sex, ethnicity, social deprivation, income, education, smoking history and ambient temperature. Results The odds of all-cause mortality in adults (aged 30e74 years at census) increased by 7% per 10 μg/m3 increase in average PM10 exposure (95% CI 3% to 10%) and 20% per 10 μg/m3 among Maori, but with wide CI (7% to 33%). Associations were stronger for respiratory and lung cancer deaths Conclusions An association of PM10 with mortality is reported in a country with relatively low levels of air pollution. The major limitation of the study is the probable misclassification of PM10 exposure. On balance, this means the strength of association was probably underestimated. The apparently greater association among Maori might be due to different levels of co-morbidity. INSETS: What is already known on this subject;What this study adds. [ABSTRACT FROM AUTHOR]

Background: New Zealand is a temperate country with substantial excess winter mortality. We investigated whether this excess winter mortality varies with social factors.Methods: Records from New Zealand censuses in 1981,1986, 1991, 1996 and 2001 were each anonymously and probabilistically linked to 3 years of subsequent mortality data creating five cohort studies of the New Zealand adult population (age 30-74 years at census) each with3 years' follow-up. Logistic regression analysis was used to model the risk of dying in winter compared to summer with winter deaths classified '1' and summer deaths '0'.There were 75 138 eligible mortality records with complete data on social variables recorded for 58 683(78%).Results: Adjusting for age, sex, census year, ethnicity and tenure, those in the lowest tertile of income were at increased risk of winter death compared to those in the highest tertile: OR 1.13 (95% CI 1.08 to 1.19). Compared to home owners, people living in rented accomadation were at greater risk of winter death: OR 1.05 (95% CI1.01 to 1.10). Urban dwellers were also at significantlyincreased risk. The strongest associations were seen for infectious diseases.Conclusions: There was an increased risk of dying in winter for most New Zealanders, but more so among low-income people, those living in rented accommodation and those living in cities. Exact casual mechanisms are not known but possibly include correlated poorer health status, low indoor temperatures and household crowding. [ABSTRACT FROM AUTHOR]

Background: A recent increase in the absolute number of hospitalisations for acute myocardial infarction (AMI) in New Zealand may signal a new epidemic of coronary heart disease (CHD). Objective: To quantity the impact of factors other than incidence of disease on these national hospitalisation trends. Methods: A total of 324 663 electronic records of New Zealand public CHD hospitalisations from 1993 to 2005 were examined. Repeat admissions were identified by record linkage using a unique national health identifier for each patient. Results: Hospitalisations for AMI increased by about 8% a year throughout the 13-year study period. Interhospital transfers increased by 117% over the study period, while readmissions increased by 42%. By 2005 over 60% of all admissions for CHD were readmissions. After accounting for readmissions, hospital transfers and population changes, the age-standardised first AMI hospitalisation rate peaked in 1995 and has since declined by 15%. Reciprocal trends in AMI and angina hospitalisations were seen, indicating changing diagnostic criteria. Overall hospitalisation rates for first CHD events remained relatively steady at about 216.4 events per 100 000 between 1993 and 2000 and subsequently declined by 25% to 162.2 events per 100 000 in 2005. Conclusion: Recent trends in hospitalisation rates for AMI are significantly influenced by factors other than underlying changes in CHD incidence. Increasing absolute numbers of admissions coded as AMI in New Zealand between 1993 and 2005 can be accounted for by increases in readmissions, increases in interhospital transfers, changes in diagnostic criteria for AMI and in demography. [ABSTRACT FROM AUTHOR]

Study objective: To evaluate the New Zealand evidence for three theories of population health change: compression of morbidity, expansion of morbidity, and dynamic equilibrium. Design: Using the Sullivan method, repeated cross sectional survey information on functional limitation prevalence was combined with population mortality data and census information on the utilisation of institutional care to produce health expectancy indices for 1981 and 1996. Setting: The adult population of New Zealand in 1981 and 1996. Participants: 6891 respondents to the 1981 social indicators survey; 8262 respondents to the 1996 household disability survey. Main results: As a proportion of overall life expectancy at age 15 the expectation of non-institutionalised mobility limitations increased from 3.5% to 6% for men, and from 4.5% to 8% for women; the expectation of agility limitation increased from 3% to 7.5% for men and from 4.5% to 8.5% for women, and the expectation of self care limitations increased from 2.0% to 4.5% for men and from 3.0% to 6.0% for women. These changes were primarily attributable to increases in the expectation of moderate functional limitation. Conclusion: The dynamic equilibrium scenario provides the best fit to current New Zealand evidence on changes in population health. Although an aging population is likely to lead to an increase in demand for disability support services, the fiscal impact of this increase may be partially offset by a shift from major to moderate limitations, with a consequential reduction in the average levels of support required. [ABSTRACT FROM AUTHOR]