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Background: Globally, societies are ageing as life expectancy increases and fertility rates decline. Many studies exploring associations between socioeconomic position (SEP) and health outcomes among the older population use conventional working-age measures of SEP (education, occupation, and income) or an area-based deprivation index. Methods: Microdata from the 2013 New Zealand Census was used to create a new measure of socioeconomic position specifically for the population aged ≥65 years (SEP65), using information about housing tenure, wealth, and receiving government benefits. We dichotomised variables representing income, assets, and housing tenure to apportion 489,264 older people in our analytic sample into low, medium and high levels of SEP. A multivariable logistic regression was used to investigate the relationship between smoking and SEP65, controlling for age, sex, ethnicity and area-level deprivation. Results: We report inequities between European, Māori and Pacific populations, which increase with age. We found an inverse relationship between the odds of smoking and levels of SEP65. Moreover, we further validated the SEP65 measure against the New Zealand Index of Deprivation (NZDep2013). At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations. Conclusion: Using an age-specific measure of SEP for the older population will aid policymakers in the appropriate allocation of resources according to need more effectively than working-age indicators. [ABSTRACT FROM AUTHOR]

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. Methods: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. Results: The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. Conclusions: Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care. [ABSTRACT FROM AUTHOR]

Aim: Socio‐economic status (SES) and ethnicity have been associated with worse maternal and fetal outcomes. Counties Manukau is a region of New Zealand which has a high portion of the population living in areas of low SES and has a higher population of ethnic minorities (Pacific Islander, Asian and Maaori). To determine whether SES and ethnicity are associated with worse mortality and morbidity in preterm infants in Counties Manukau Hospital, New Zealand. Methods: This retrospective cohort study compared the infants of mothers who live in the most deprived neighbourhoods to the infants of mothers who live in the least deprived neighbourhoods. Infants born between 2000 and 2019 were included if <30 weeks gestation or <1500 g and born in hospital. Primary outcome was combined mortality/morbidity. Results: Univariate analysis showed demographic differences between the SES and ethnic groups, for example maternal age and maternal smoking. Using logistic regression, SES was not associated with worse neonatal outcomes for the most deprived SES (n = 624) compared to least deprived SES (n = 164). Ethnicity (n = 1326) was not associated with worse neonatal outcomes. Gestational age and maternal smoking were associated with neonatal mortality/morbidity; gestational age and antenatal steroids were associated with neonatal mortality. It was notable that the proportion of the study population in the less deprived groups used for the comparisons was relatively low. Conclusions: For preterm, in‐hospital births in Counties Manukau over a 20‐year period, neonatal outcomes were the same regardless of SES or ethnicity. [ABSTRACT FROM AUTHOR]

Background: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO). We describe nurse work in relation to these models of care, populations with high health need and patient health outcomes., Methods: We conducted a cross-sectional study (at 30 September 2018) of data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥ 65 years), glucose control testing in adults with diabetes, immunisations (at 6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics., Results: Nurse clinical time, and combined nurse, nurse practitioner and general practitioner clinical time, were substantially higher in Trust/NGO, Māori, and Pacific practices than in other models. Increased patient clinical complexity was associated with more clinical input and higher scores on all outcome measures. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, depression screening, glucose control testing) were in Māori, Trust/NGO and Pacific practices. There was an eightfold difference, across models of care, in percentage of depression screening undertaken by nurses and a fivefold difference in cervical screening and glucose control testing. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree., Conclusions: Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients., (© 2024. The Author(s).)

The influence of global climate change on temperature-related health outcomes among vulnerable populations, particularly young children, is underexplored. Using a case time series design, we analysed 647,000 hospital admissions of children aged under five years old in New Zealand, born between 2000 and 2019. We explored the relationship between daily maximum temperatures and hospital admissions across 2139 statistical areas. We used quasi-Poisson distributed lag non-linear models to account for the delayed effects of temperature over a 0-21-day window. We identified broad ICD code categories associated with heat before combining these for the main analyses. We conducted stratified analyses by ethnicity, sex, and residency, and tested for interactions with long-term temperature, socioeconomic position, and housing tenure. We found J-shaped temperature-response curves with increased risks of hospital admission above 24.1 °C, with greater sensitivity among Māori, Pacific, and Asian compared to European children. Spatial-temporal analysis from 2013-2019 showed rising attributable fractions (AFs) of admissions associated with increasing temperatures, especially in eastern coastal and densely populated areas. Interactive maps were created to allow policymakers to prioritise interventions. Findings emphasize the need for child-specific and location-specific climate change adaptation policies, particularly for socioeconomically disadvantaged groups.

Background: For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by "failing to design and administer the current primary health care system to actively address persistent Māori health inequities". Many Māori (44%) have unmet needs for primary care. Seven models of primary care were identified by the funders and the research team, including Māori-owned practices. We hypothesised patient health outcomes for Māori would differ between models of care., Methods: Cross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to general practices at patient level, to measure associations between practice characteristics and patient health outcomes., Primary Outcomes: polypharmacy (≥ 55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Regressions include only Māori patients, across all models of care., Results: A total of 660,752 Māori patients were enrolled in 924 practices with 124,854 in 65 Māori-owned practices. Māori practices had: no significant association with HbA1c testing, ambulatory sensitive hospitalisations or ED attendances, and a significant association with lower polypharmacy (3.7% points) and lower childhood immunisations (13.4% points). Māori practices had higher rates of cervical smear and cardiovascular risk assessment, lower rates of HbA1c tests, and more nurse (46%) and doctor (8%) time (FTE) with patients. The average Māori practice had 52% Māori patients compared to 12% across all practices. Māori practices enrolled a higher percentage of children and young people, five times more patients in high deprivation areas, and patients with more multimorbidity. More Māori patients lived rurally (21.5% vs 15%), with a greater distance to the nearest ED. Māori patients were more likely to be dispensed antibiotics or tramadol., Conclusions: Māori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of care, despite patients having higher health risk profiles. Across all models, primary care need was unmet for many Māori, despite increased clinical input. Funding must support under-resourced Māori practices and ensure accountability for the health outcomes of Māori patients in all models of general practice., (© 2024. The Author(s).)

Background: Survival from out-of-hospital cardiac arrest (OHCA) is improved when public access defibrillators are used. Areas of socioeconomic deprivation may have higher rates of OHCA and thus a greater demand for public access defibrillators. We aimed to determine if there was a relationship between socioeconomic factors, the geographic distribution of public access defibrillators (PADs) and incidence of OHCA.Method: Socioeconomic deprivation data was obtained from the Census-based 2013 Index of Deprivation. Spatial information for PADs was obtained from a New Zealand PAD database (AED Locations) in 2016 and 2018. Location data for OHCA was obtained from the St John New Zealand OHCA registry for the period 1 October 2013 to 30 June 2016. Relationships between these variables were analysed using a Poisson regression analysis.Results: Cardiac arrest incidence increased with increasing deprivation. The incidence in the most deprived areas of 156.5 events per 100,000 person years (135.4-180.9, 95% CI) is double the incidence in the least deprived areas at 78.0 events per 100,000 person years (66.4-91.7, 95% CI). Significant increases in the rates of OHCA were observed with every 1% increase in proportions of Māori (1.0%, 0.61-1.4%, 95% CI, p = 0.001), Pacific Peoples (0.6%, 0.21-0.9%, p = 0.005), >65 year olds (3.7%, 3.0-4.3%, p < 0.001), and males (3.7%, 1.8-5.6%, p < 0.001). In 2018, the decile 10 areas had the lowest coverage of PADs (65% of these areas contained a PAD) compared with less deprived areas (68-84%, median 81%).Conclusions: The most socioeconomically deprived communities had the highest incidence of OHCA and the least availability of PADs. This provides impetus for targeted PAD placement in areas of higher deprivation. [ABSTRACT FROM AUTHOR]

While there is a global shift towards smaller families, some groups maintain relatively high fertility rates. The 2013 New Zealand census data were used to investigate the nature of fertility between ethnicities in New Zealand. The NZ Deprivation Index 2013 was used as a measure of socioeconomic status to determine the relationships with fertility. The results mirror research outside of New Zealand in that socioeconomic status is inversely correlated to fertility. Using crude average fertility rates, sole-ethnicity Pasifika and Māori ethnic groups still have substantially higher fertility than sole-ethnicity Europeans and Asians ethnic groups, even when simultaneously accounting for age, socioeconomic status, education, and religious affiliation. Christians have more children than individuals reportedly without any religion, and fertility rates drop on average for mothers who have higher formal qualifications. Our findings suggest that cultural, or other ethnic-specific factors differentially affect fertility for Māori, Pasifika, New Zealand European, and Asians as aggregated ethnic categories, respectively. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Dabigatran etexilate is now prescribed for 51% of the patients receiving oral anticoagulation treatment in New Zealand. Its prescribing trends in relation to patient outcomes are, however, largely unknown for these patients. AIM: To describe patient characteristics, effectiveness and safety of treatment with dabigatran etexilate in the New Zealand population. METHODS: This retrospective cohort study used administrative health data for patients dispensed dabigatran etexilate between 1 July 2011 and 31 December 2015. Adverse events (haemorrhage) and treatment failure (thromboembolism or cerebrovascular accident) data were extracted and linked to patient-specific demographic data. Baseline patient characteristics were analysed with descriptive statistics to examine trends in dabigatran etexilate prescribing. Raw and adjusted hazard ratios (HRs), including covariates, were derived using Cox proportional hazard models. RESULTS: In total, 52,413 patients were dispensed dabigatran etexilate. Multivariate analysis indicated the risk of haemorrhagic events were significantly increased for Māori (HR and 95% Confidence Interval (CI): 2.10 (1.54–2.86)) and Pacific Peoples (HR = 2.20 (1.49–3.24)); those aged >80 years (HR = 1.25 (1.08–1.43)); and more deprived populations in quintile 4 (HR = 1.24 (1.08–1.43)) and quintile 5 (HR = 1.30 (1.12–1.50)). There was an increased risk of thromboembolism and cerebrovascular accident among people aged >80 years (HR = 1.79 (1.49–2.15)). DISCUSSION: Demographic factors are associated with adverse outcomes in patients treated with dabigatran etexilate. Targeted strategies are needed to prescribe dabigatran etexilate more appropriately in these populations. [ABSTRACT FROM AUTHOR]

Aim: It is important to understand whether type 2 diabetes mellitus (T2DM) is increasing in childhood for health-care planning and clinical management. The aim of this study is to examine the incidence of T2DM in New Zealand children, aged <15 years from a paediatric diabetes centre, Auckland, New Zealand.Methods: Retrospective analysis of prospectively collected data from a population-based referral cohort from 1995 to 2015.Results: Hundred and four children presented with T2DM over the 21-year period. The female:male ratio was 1.8:1, at mean (standard deviation) age 12.9 (1.9) years, body mass index standard deviation score +2.3 (0.5), blood sugar 15.3 (8.5) mmol/L, HbA1c 76 (28) mmol/mol. At diagnosis, 90% had acanthosis nigricans and 48% were symptomatic. In all, 33% were Maori, 46% Pacific Island, 15% Asian/Middle Eastern and 6% European. There was a progressive secular increase of 5% year on year in incidence. The overall annual incidence of T2DM <15 years of age was 1.5/100 000 (1.2-1.9) (95% confidence interval), with higher rates in Pacific Island (5.9/100 000) and Maori (4.1/100 000).Conclusions: The incidence of T2DM in children <15 years of age in New Zealand has increased progressively at 5%/year over the last 21 years. The risk was disproportionately associated with girls and children from high-risk ethnic groups. [ABSTRACT FROM AUTHOR]

Socioeconomic status is a known determinant of health. In secondary data analyses, we assessed whether socioeconomic status affected health-related quality of life in a group of overweight (body mass index 25-30 kg/m2) middle-aged (45.9 ± 5.4 years) men, recruited in Auckland (New Zealand). Health-related quality of life was assessed with SF-36v2 three times: at baseline, and 12 and 30 weeks later. Socioeconomic status was determined by geo-coded deprivation scores derived from current address using the New Zealand Index of Deprivation 2006 (NZDep2006), as well as capital value of residence. Univariable and multivariable analyses showed no associations between measures of socioeconomic status and any mental or physical health domains. Our findings may reflect the fact that these men are not currently experiencing comorbidities associated with overweight. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Although vasectomy rates in New Zealand have been reported as among the highest worldwide, there is limited information about who is receiving these services and how they are being accessed. This information is needed to develop equitable access to vasectomy services. AIM: To describe the ethnicity and socioeconomic status of men accessing District Health Board-funded and self-funded vasectomies in Counties Manukau. METHODS: A retrospective cohort analysis of provider data linked to ethnicity and area deprivation as an indicator of socioeconomic status. RESULTS: Of 332 vasectomies, 66% were for New Zealand European men. Socioeconomic status was not associated with the number of procedures for New Zealand European men, but of the Maori and Pacific men who underwent vasectomies, most lived in the greatest areas of deprivation; 58% (18/31) and 50% (12/24), respectively. When vasectomies were funded, the number of procedures doubled for men from areas of high deprivation. The number of procedures was low for men of other ethnicities. DISCUSSION: Our findings indicate differential access to vasectomies by ethnicity and socioeconomic status. Funding vasectomies may provide community benefits in terms of improving equity in access and alleviating a financial burden for many families living in areas of high deprivation. [ABSTRACT FROM AUTHOR]

Residential mobility can have negative impacts on health, with some studies finding that residential mobility can contribute to widening health gradients in the population. However, ethnically differentiated experiences of residential mobility and the relationship with health are neglected in the literature. To examine the relationship between residential mobility, risk of cardiovascular disease (CVD) and ethnicity, we constructed a cohort of 2,077,470 participants aged 30 + resident in New Zealand using encrypted National Health Index (eNHI) numbers linked to individual level routinely recorded data. Using binary logistic regression, we model the risk of CVD for the population stratified by ethnic group according to mover status, baseline deprivation and transitions between deprivation statuses. We show that the relationship between residential mobility and CVD varies between ethnic groups and is strongly influenced by the inter-relationship between residential mobility and deprivation mobility. Whilst residential mobility is an important determinant of CVD, much of the variation between ethnic groups is explained by contrasting deprivation experiences. To reduce inequalities in CVD within New Zealand, policies must focus on residentially mobile Māori, Pacific and South Asian populations who already have a heightened risk of CVD living in more deprived areas. [ABSTRACT FROM AUTHOR]

Background: Geographic perspectives of disease and the human condition often involve point-based observations and questions of clustering or dispersion within a spatial context. These problems involve a finite set of point observations and are constrained by a larger, but finite, set of locations where the observations could occur. Developing a rigorous method for pattern analysis in this context requires handling spatial covariates, a method for constrained finite spatial clustering, and addressing bias in geographic distance measures. An approach, based on Ripley's K and applied to the problem of clustering with deliberate self-harm (DSH), is presented.Methods: Point-based Monte-Carlo simulation of Ripley's K, accounting for socio-economic deprivation and sources of distance measurement bias, was developed to estimate clustering of DSH at a range of spatial scales. A rotated Minkowski L1 distance metric allowed variation in physical distance and clustering to be assessed. Self-harm data was derived from an audit of 2 years' emergency hospital presentations (n = 136) in a New Zealand town (population ~50,000). Study area was defined by residential (housing) land parcels representing a finite set of possible point addresses.Results: Area-based deprivation was spatially correlated. Accounting for deprivation and distance bias showed evidence for clustering of DSH for spatial scales up to 500 m with a one-sided 95 % CI, suggesting that social contagion may be present for this urban cohort.Conclusions: Many problems involve finite locations in geographic space that require estimates of distance-based clustering at many scales. A Monte-Carlo approach to Ripley's K, incorporating covariates and models for distance bias, are crucial when assessing health-related clustering. The case study showed that social network structure defined at the neighbourhood level may account for aspects of neighbourhood clustering of DSH. Accounting for covariate measures that exhibit spatial clustering, such as deprivation, are crucial when assessing point-based clustering. [ABSTRACT FROM AUTHOR]

This paper describes the creation of two new geographical boundary files, known respectively as lower zones and upper zones, for investigating social phenomena and visualising disparities in health outcomes in the Auckland Region of New Zealand. We test the effectiveness of contemporary automated zone design tools before applying an interactive approach which integrated computational power with expert local knowledge and visual interpretation to develop meaningful zones. We demonstrate that an interactive approach addresses multiple zone design criteria (e.g. respecting physical barriers, compactness and homogeneity) more effectively than is possible with an automated approach. [ABSTRACT FROM AUTHOR]

Census-based deprivation indices have been widely used in Aotearoa/New Zealand, Canada and UK to measure area-based socio-economic inequalities. This paper examines the indicators used in census-based area deprivation indices using a political ecology approach. We question whether the current indicators of deprivation derived from census data are meaningful for the all age groups and minority groups in the population, with a particular focus on deprivation indicators used in New Zealand, Canada and the United Kingdom. We comparatively reviewed methodological papers and reports that describe the indicators of deprivation in Aotearoa/New Zealand, Canada and the UK from 1975 to 2014. We consider the relationship between the notion of standards of living and measurements of deprivation and explore how hegemonic cultural constructs are implicit in measures of deprivation that privilege a Eurocentric, ageist and gender normative construction of statistics. We argue for more political ecological analyses to studying the relationship between social inequalities, geographies, health inequities and political economy to transform structures of oppression and inequality. This requires turning the analytical gaze on the wealthy and privileged instead of defaulting into deficit models to account for inequality. Studies of deprivation and inequality would benefit from understanding the processes and operations of power in the (re)production of socio-economic and health inequities to inform holistic strategies for social justice. [ABSTRACT FROM AUTHOR]

Relative deprivation was defined by Townsend (1987, p. 125) as “a state of observable and demonstrable disadvantage, relative to the local community or the wider society or nation to which an individual, family or group belongs”. This definition is widely used within social and health sciences to identify, measure, and explain forms of inequality in human societies based on material and social conditions. From a multi-disciplinary social science perspective, we conducted a systematic literature review of published material in English through online database searches and books since 1966. We review the concept and measurement of relative ‘deprivation’ focussing on area-based deprivation in relation to inequities in health and social outcomes. This paper presents a perspective based in Aotearoa/New Zealand where colonisation has shaped the contours of racialised health inequities and current applications and understandings of ‘deprivation’. We provide a critique of Townsend's concept of deprivation and area-based deprivation through a critical, structural analysis and suggest alternatives to give social justice a better chance. Deprivation measures used without critical reflection can lead to deficit framing of populations and maintain current inequities in health and social outcomes. We contend therefore that the lack of consideration of (bio)power, privilege, epistemology and (bio)politics is a central concern in studies of deprivation. Our review highlights the need for the academy to balance the asymmetry between qualitative and quantitative studies of deprivation through trans-disciplinary approaches to understanding deprivation, and subsequently, social and health inequities. We recommend that deprivation research needs be critically applied through a decolonising lens to avoid deficit framing and suggest that there is space for a tool that focuses on measuring the unequal distribution of power and privilege in populations. [ABSTRACT FROM AUTHOR]

The association between area-level disadvantage and health and social outcomes is unequivocal. However, less is known about the health impact of residential mobility, particularly at intra-urban scales. We used an encrypted National Health Index (eNHI) number to link individual-level data recorded in routine national health databases to construct a cohort of 641,532 participants aged 30+ years to investigate the association between moving and CVD hospitalisations in Auckland, New Zealand. Residential mobility was measured for participants according to changes in the census Meshblock of usual residence, obtained from the Primary Health Organisation (PHO) database for every calendar quarter between 1/1/2006 and 31/12/2012. The NZDep2006 area deprivation score at the start and end of a participant's inclusion in the study was used to measure deprivation mobility. We investigated the relative risk of movers being hospitalised for CVD relative to stayers using multi-variable binomial regression models, controlling for age, gender, deprivation and ethnicity. Considered together, movers were 1.22 (1.19–1.26) 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 Q5) areas were 45% more likely than stayers to have had their first CVD hospitalisation in 2006–2012 (RR: 1.45 [1.35–1.55]). Participants who moved upward also had higher relative risks of having a CVD event, although their risk was less than those observed for participants experiencing downward deprivation mobility. This research suggests that residential mobility is an important determinant of CVD in Auckland. Further investigation is required to determine the impact moving has on the risk of CVD by ethnicity. [ABSTRACT FROM AUTHOR]

Ambulatory sensitive hospitalizations (ASH) are those thought to be preventable by timely and effective primary health care. Better access to primary health care has been associated with lower ASH rates. Funding increases to primary health care in New Zealand beginning in 2001 led to an improvement in access. Analysis of hospitalizations to all New Zealand public hospitals revealed that, for most age groups, ASH rates did not show long-term reductions from 2001 to 2009, while socioeconomic differences in ASH rates widened across this period. We conclude that increasing funding and access to primary health care will not, by itself, reduce ASH rates. [ABSTRACT FROM AUTHOR]

Background: Indigenous Māori women experience a 60% higher breast cancer mortality rate compared with European women in New Zealand. We explored the impact of differences in rates of screen detected breast cancer on inequities in cancer stage at diagnosis and survival between Māori and NZ European women. Methods: All primary breast cancers diagnosed in screening age women (as defined by the New Zealand National Breast Cancer Screening Programme) during 1999-2012 in the Waikato area (n = 1846) were identified from the Waikato Breast Cancer Register and the National Screening Database. Stage at diagnosis and survival were compared for screen detected (n = 1106) and non-screen detected (n = 740) breast cancer by ethnicity and socioeconomic status. Results: Indigenous Māori women were significantly more likely to be diagnosed with more advanced cancer compared with NZ European women (OR = 1.51), and approximately a half of this difference was explained by lower rate of screen detected cancer for Māori women. For non-screen detected cancer, Māori had significantly lower 10-year breast cancer survival compared with NZ European (46.5% vs. 73.2%) as did most deprived compared with most affluent socioeconomic quintiles (64.8% vs. 81.1%). No significant survival differences were observed for screen detected cancer by ethnicity or socioeconomic deprivation. Conclusions: The lower rate of screen detected breast cancer appears to be a key contributor towards the higher rate of advanced cancer at diagnosis and lower breast cancer survival for Māori compared with NZ European women. Among women with screen-detected breast cancer, Māori women do just as well as NZ European women, demonstrating the success of breast screening for Māori women who are able to access screening. Increasing breast cancer screening rates has the potential to improve survival for Māori women and reduce breast cancer survival inequity between Māori and NZ European women. [ABSTRACT FROM AUTHOR]

Existing indices of multiple deprivation exclude indicators specifically relevant to the population aged ≥65 years. In this study we create a whole-of-population cohort of people aged ≥65 years living in private dwellings and who completed the 2013 New Zealand Census of Populations and Dwellings to create an Older Persons' Index of Multiple Deprivation (OPIMD). We combined 22 indicators representing 6 domains of deprivation (Income, Housing, Health, Assets, Connectedness and Geographic access) to establish this individual-level measure of deprivation. We used smoking data from the census to validate the OPIMD and describe the geography of the OPIMD by District Health Board, contrasting these patterns with a conventional area deprivation index. The OPIMD has the potential to inform policies concerning resource allocation for the older population. An accompanying website with an interactive atlas and an online OPIMD calculator is available for wider use of the data. Further research is required to explore associations between the OPIMD and other major health and social outcomes affecting this population. [ABSTRACT FROM AUTHOR]

The socio-spatial arrangement of alcohol retailers is potentially important in understanding the relationship between neighbourhood context and 'excessive' alcohol consumption. This New Zealand study examines whether the availability of alcohol products is associated with individual-level alcohol consumption. Measures capturing the availability of alcohol retailers were calculated for neighbourhoods across the country and then appended to a national health survey. At the national level there was no evidence for an association between hazardous consumption and alcohol outlet access. However, there was evidence of associations with neighbourhood retailing for younger Māori and Pacific peoples males; younger European females; middle-aged European men; and older men. The findings provide evidence that 'alcogenic' environments are associated with excessive drinking in New Zealand, albeit that the associations are restricted to particular vulnerable groups. [ABSTRACT FROM AUTHOR]

Abstract: Geographical inequalities in health are omnipresent with health and related behaviours typically worse in socioeconomically deprived places. However, this is not always true. Deprived places with unexpectedly good health outcomes, or what might be considered ‘resilient’ places, have been noted. Few studies have quantitatively examined resilience in neighbourhoods or investigated potential explanations for this resilience. This paper examines the paradox of low mortality despite high social deprivation in New Zealand neighbourhoods and considers possible neighbourhood characteristics that contribute to unanticipated positive health outcomes. Using area-level mortality (2005–2007) and socioeconomic data, we developed the Resilience Index New Zealand to quantify neighbourhood levels of resilience across the country. We then examined relationships between this measure and a suite of built, physical and social characteristics. We found that resilient places tended to be densely populated, urban areas. We observed gradients and increases/decreases in the most resilient groups in access to or levels of physical environment factors (environmental deprivation, safe drinking water, air quality) and unhealthy living infrastructure (alcohol and gambling outlets). Since these factors are amenable to change, these findings are the strongest evidence that such improvements may lower mortality in similarly deprived places. The social environment of resilient areas was characterised by high levels of incoming residents. We also found some surprising associations and observed U-shaped relationships for a number of the neighbourhood factors. Such findings suggest the need to develop a better proxy of community cohesion and a better understanding of the interactions between people and their neighbourhoods, rather than simply the presence of certain factors. We argue that this study has identified amenable neighbourhood characteristics and highlighted the importance of ‘place-specific’ resilience factors that may be effective in reducing mortality in some neighbourhoods, but be less effective in others. [Copyright &y& Elsevier]

Abstract: International debate posits that when groups feel deprived relative to reference groups in society, there may be psychosocial impacts. Deprivation varies geographically and deprived areas may be proximal to advantaged areas. In theory, this leads to chronic stress and poor mental health. This research explored whether socioeconomically isolated deprived areas experience increased levels of anxiety/mental disorder treatment, compared to other deprived areas. We developed a spatial isolation measure to characterise deprived areas surrounded by advantaged areas in Auckland, New Zealand. We found that isolated areas were characterised by fewer Māori and Pacific people, high density and shorter travel time to General Practitioners. We found significantly higher rates of anxiety/mood disorder treatment in highly isolated versus non-isolated areas and a statistically significant relationship with anxiety/mood disorders for each isolation level, both before and after confounder adjustment. This evidence suggests that mental health within small areas may be sensitive to the neighbourhood interactions, through social comparison or discrimination which lead to psychosocial stress. [Copyright &y& Elsevier]

INTRODUCTION: Measures of socioeconomic position (SEP) are widely used in health research. AIM: To provide future researchers with empirically based guidance about the relative utility of five measures of SEP in predicting health outcomes. METHODS: Data from 12 488 adults were obtained from the 2006 New Zealand Health Survey. Seven health-related outcome measures with expected variations by SEP are modelled using five measures of SEP: a census-based small-area index of relative socioeconomic deprivation, NZDep2006; a questionnaire-based individual-level index of socioeconomic deprivation, NZiDep; an index of living standards, ELSI; education, measured by highest qualification; and equivalised household income. RESULTS: After including the individual measure of deprivation, the area-based measure of deprivation adds useful explanatory power, and, separately, the broader spectrum provided by the living standards index adds only a small amount of extra explanatory power. The education and household income variables add little extra explanatory power. DISCUSSION: Both NZiDep and ELSI are useful health-outcome predictors. NZiDep is the cheapest data to obtain and less prone to missing data. The area index, NZDep, is a useful addition to the arsenal of individual SEP indicators, and is a reasonable alternative to them where the use of individual measures is impracticable. Education and household income, using commonly used measurement tools, may be of limited use in research if more proximal indicators of SEP are available. NZDep and NZiDep are cost-effective measures of SEP in health research. Other or additional measures may be useful if costs allow and/or for topic-related hypothesis testing. [ABSTRACT FROM AUTHOR]

The article discusses a study which explored the relationships between area measures of deprivation and the use of mental health legislation in New Zealand. The study found that high levels of relative deprivation are positively correlated with use of acute and long-term community care provisions of mental health legislation. The implications of the study findings for regional allocation of funding for mental health and social services to support community-based care are discussed.

We report on the development and validation of a neighbourhood measure of social fragmentation. Firstly, we developed a theoretical model of neighbourhood-level social fragmentation, as the structural antecedent to collective social functioning, with three domains (attachment, resources, and means of sharing of norms and values). Secondly, utilising the New Zealand 1996 and 2001 Censuses, variables were constructed to create the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag) at the small-area level. Nine census variables contributed substantively to a principal components analysis: homeownership, mobility, marital status, nonfamily households, single-person households, children, immigrants, non-English/Maori speakers, and long-term residents. Thirdly, relationships between NeighFrag and other contextual measures were examined, as well as its relationship with individual perceptions of neighbourhood cohesion. The NeighFrag index had a moderate association with deprivation and social capital. It was inversely associated with individual perception of neighbourhood cohesion in multilevel analyses, after adjusting for individual factors and neighbourhood deprivation. Combined, this suggests that NeighFrag provides a meaningful national-level index of neighbourhood social environments for use in analyses. [ABSTRACT FROM AUTHOR]

Abstract: Studies investigating relationships between mental health and residential areas suggest that certain characteristics of neighbourhood environments matter. After developing a conceptual model of neighbourhood social fragmentation and health we examine this relationship (using the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag)) with self-reported mental health (using SF-36). We used the nationally representative 2002/3 New Zealand Health Survey dataset of urban adults, employing multilevel methods. Results suggest that increasing neighbourhood-level social fragmentation is associated with poorer mental health, when simultaneously accounting for individual-level confounding factors and neighbourhood-level deprivation. The association was modified by sex (stronger association seen for women) and labour force status (unemployed women more sensitive to NeighFrag than those employed or not in labour force). There was limited evidence of any association of fragmentation with non-mental health outcomes, suggesting specificity for mental health. Social fragmentation as a property of neighbourhoods appears to have a specific association with mental health among women, and particularly unemployed women, in our study. [Copyright &y& Elsevier]

Abstract: Burns are a complex phenomenon with multiple interactive factors. Age, ethnicity and socioeconomic deprivation have been identified in the literature as important determinants of this form of injury. Objective: The primary objective of this study was to undertake a descriptive analysis of the socioeconomic factors associated with burn injuries in New Zealand. This analysis will help to identify those individuals at greatest risk of burn and assist with the design of targeted interventions that are more likely to be effective. Method: A retrospective review of the medical records of patients admitted acutely to hospital in New Zealand with a burn between 1996 and 2006. We reviewed the records with regards to patient demographics and socioeconomic position. Results: A total of 14,708 admissions were reviewed. Stratification by age indicated that admissions were highest in the 0–4-year age group. The rate of admission was highest in the Maori ethnic group. The rate of admissions increased in proportion with increasing deprivation. Conclusion: This study confirms marked ethnic and socioeconomic disparities in burn injuries requiring hospital admission. This is unacceptable and preventable. We propose active targeting of burn prevention strategies at high-risk groups as a cost-effective way of reducing disparities. [Copyright &y& Elsevier]

Abstract: People living in poor areas suffer higher mortality than those in wealthy areas. Environmental factors partly explain this association, including exposure to pollutants and accessibility of healthcare. We sought to determine whether proximity to alcohol outlets varied by area deprivation in New Zealand. Roadway travel distance from each census unit to the nearest alcohol outlet was summarised according to socioeconomic deprivation for each area. Analyses were conducted by license type (pubs/bars, clubs, restaurants, off-licenses) and community urban–rural status. Strong associations were found between proximity to the nearest alcohol outlet and deprivation, there being greater access to outlets in more-deprived urban areas. [Copyright &y& Elsevier]

This study investigated the combined effects of ethnicity, deprivation and geographical access to health services on the likelihood of survival from a range of common cancers in New Zealand. Individual cancer registry records of 99,062 cases of melanoma, colorectal, lung, breast and prostate cancers diagnosed in the period 1994–2004 were supplemented with small area information on social deprivation and estimates of travel time to the nearest primary care and cancer centre. Logistic regression was used to identify the variables associated with advanced extent of the disease at diagnosis. Adverse influences on survival were investigated using Cox proportional hazards models. Controlling for age and gender, Māori and Pacific peoples' ethnicity was strongly associated with poorer survival, partly because ethnicity was also linked to the likelihood of advanced disease at diagnosis. Living in a deprived area was related to later stage presentation and poorer survival of people with melanoma, but there was no other evidence that living in a deprived area or in a remote location were associated with later stage presentation. Some disease-specific trends in survival were observed. Colorectal and lung cancers were more likely to be fatal for people living in deprived areas, survival from prostate cancer was poor for men living remote from primary care, and people with colorectal, breast and prostate cancers had adverse survival chances if they lived distant from a cancer centre. [Copyright &y& Elsevier]

Abstract: Previous studies have noted that in many countries there has been a disproportionate increase in suicide in rural areas, contributing to greater urban/rural inequalities in health. This paper evaluates whether this trend was also apparent in New Zealand during the 1980s and 1990s, a period of rapid social and economic change. Using suicide incidence data for the period 1980–2001, we investigate whether urban/rural status had an effect upon rates of suicide independently of socioeconomic deprivation. While both male and female suicide rates were significantly higher in urban than rural areas in 1980–1982, by the end of the 1990s, urban/rural differences in suicide rates were not significant. The narrowing of urban/rural differences was, to some extent, a result of the growth in suicide rates in more isolated rural communities and small rural service centres. Recent geographical variations in suicide in New Zealand are therefore to a large extent similar to trends observed elsewhere, but are less marked. Potential explanations are offered for the fluctuating urban/rural inequalities in suicide including compositional arguments, rural restructuring and economic decline, social isolation and health service utilisation. [Copyright &y& Elsevier]

Objective: It has previously been reported that rates of suicide among men aged 15-44 increased rapidly during the 1980s and 1990s. The present study examines whether geographical inequalities in suicide rates among men in this age group rose during the period 1980-2001 in New Zealand. Methods: Age-standardized rates of suicide for men aged 15-44 were calculated for District Health Boards (DHBs) and in deprivation quintiles (using the 2001 New Zealand deprivation score) for the periods 1980-1982, 1985-1987, 1990-1992, 1995-1997 and 1999-2001. Geographical inequality was measured by calculating the ratio of the suicide rate deprivation quintile 5 to quintile 1. Results: Age-standardized rates of suicide among men aged 15-44 increased in all but two DHBs between 1980 and 2001. The ratio of inequality in suicide between the least deprived and most deprived areas of New Zealand rose from 1.68 in 1980-1982 to a high of 1.94 in 1990-1992, followed by a small reduction to 1.86 by the end of the study period. Conclusions: Geographical inequalities in suicide among men aged 15-44 grew during the period 1980-2001 and remain at high levels. The greatest increase in inequality was during the late 1980s and early 1990s, a period of rapid social and economic change to New Zealand society. [ABSTRACT FROM AUTHOR]

Abstract: Numerous studies have noted a strong social gradient in many types of ill health. In particular, people in more deprived areas tend to be less healthy than those in more affluent communities, even once the demographic and socio-economic differences of the people in those areas have been taken into account. The social gradient is evident for many types of health outcomes, including diseases such as cancer. However, this positive relationship is not evident for rates of melanoma incidence and mortality, with rates of the disease tending to decrease with measures of disadvantage. In this study, we assess the relationship between the incidence of melanoma and deprivation in New Zealand, a country with particularly high rates of the disease. In the light of greater public awareness of the risk factors associated with melanoma, through public awareness campaigns such as ‘Slip! Slap! Slop’ and ‘No Suntan is Safe’, we analyse small-area data on standardised rates of melanoma for the period 1995–2000. We found that melanoma rates increase with social status, even once other confounding factors are controlled for, but that the relationship is very small. Furthermore, the relationship between melanoma incidence and deprivation is context-dependent. Possible explanations for the relationship between melanoma and deprivation are discussed, including more frequent exposure to intermittent sunshine among less disadvantaged groups and the underreporting of melanoma incidence in the New Zealand cancer registry among individuals in lower social groups. [Copyright &y& Elsevier]

We discuss the pivotal role that housing plays for both social and economic outcomes. All people need to be housed, and housing circumstances help determine social outcomes, especially for vulnerable groups. We outline an analytical framework that treats housing as a dynamic system, incorporating the life-cycles of both individuals/ households and houses. Each is long-lived; decisions impact on housing for decades. This approach is relevant to the development of housing research and housing policy. We illustrate the issues with reference to the relationship between rental yields and measures of deprivation across New Zealand. The surprising nature of this relationship has consequences regarding potential poverty traps and wealth disparities. While highlighting an important housing market issue, any policy response to this issue is complicated by the need to take account of the life-cycles of both individuals and of houses, and by the long-lasting impacts of decisions. [ABSTRACT FROM AUTHOR]

Objectives: To describe adult oral health inequalities using an area-based and household-based measure of socioeconomic status (SES).Methods: Self-report questionnaires (seeking information on sociodemographic, oral health and oral self-care) were sent to a random sample of adults from the Dunedin South Electorate, New Zealand. Household- and area-based SES measures were collected. The main outcome measures were edentulism prevalence, average-poor self-rated oral health and not having visited a dentist for 2+ years. Data were weighted to produce population-based estimates.Results: The response rate was 78.2%; the sample mean age was 47 years (sd, 17; range 18-92 years) and females comprised 54.0%. Edentulism was most prevalent among those from low-SES households who were resident in high-deprivation areas (P<0.0001). Poor self-rated oral health (P<0.0001) and 2+ years since the last dental visit (P<0.0001) were also most prevalent among these same individuals. In contrast, respondents from high-SES households located in the least deprived areas had the lowest prevalence of edentulism, poor self-reported oral health or 2+ years since their last dental visit. Those from the other household/area SES combinations occupied intermediate positions.Conclusions: There may be added value to dental public health in using a dual socio-economic measurement approach to population research, with greater oral health gains perhaps being possible by concentrating resources and clinical effort on people living in low-SES households in highly-deprived areas, rather than those living in low-SES households in areas that are not deprived. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this research was to identify a small set of indicators of an individual''s deprivation that is appropriate for all ethnic groups and can be combined into a single and simple index of individual socioeconomic deprivation in New Zealand. The NZiDep index of socioeconomic deprivation was derived using the same theoretical basis as the national census-based small-area indices of relative socioeconomic deprivation. The index has been created and validated from the analysis of representative sample survey data obtained from approximately 300 Maori, 300 Pacific, and 300 non-Maori, non-Pacific adults. Twenty-eight deprivation-related characteristics, derived from New Zealand and overseas surveys, were analysed by standard statistical techniques (factor analysis, Cronbach''s coefficient alpha, item-total correlations, principal component analysis). The index was validated using information on tobacco smoking, which is known to be strongly related to deprivation. The NZiDep index is based on eight simple questions which take 2–3min to administer. The index is a significant new (non-occupational) tool for measuring socioeconomic position for individuals. We argue that the index has advantages over existing measures, including a specific focus on deficits, applicability to all adults (not just the economically active), and usefulness for all ethnic groups. Its strengths include focus, simplicity, utility, acceptability across ethnic groups, construct validity, statistical validity, criterion validity (measured with reference to tobacco smoking), and relevance to the current New Zealand context. The index is indicative of deprivation in general, and is designed for use as a variable in research, and for elucidating the relationships between socioeconomic position and health/social outcomes. [Copyright &y& Elsevier]

This article explores patterns of access to services, amenities and facilities in two neighbouring New Zealand cities. An area-level indicator of community resource access, based on priorities identified by caregivers of young children, is analysed alongside census data to examine associations with community resource access in each city. Analysis reveals variations in resource access between the two cities that could not be solely explained by population density. Associations were found between resource access and patterns of deprivation, population density, age, and families with children. Of particular note was a positive association between areas of higher levels of resource access and areas of higher levels of deprivation within cities. There were, however, higher overall levels of resource access in the city with a less deprived profile. These findings support action by both central and local government to ensure equitable resource distribution to promote local well-being. [ABSTRACT FROM AUTHOR]

Abstract The present paper examines the relationship between deprivation and changing patterns of public hospital admissions in Christchurch, New Zealand, between 1992 and 1997, during a time of economic restructuring and rapid change in the health sector. The total set of admissions into Christchurch Hospital was geocoded according to the meshblock domicile of each patient. Domiciles were classified into 10 decile categories using the NZDep91 and NZDep96 measures of deprivation. Regression analysis was used to measure changes in the relationship between deprivation and different types of admissions. Differences between admission rates for people living in the most and least deprived areas increased over time, especially following the implementation of the 1993 health reforms. This was most marked for younger adults (ages = 25–44 years), day patients, and especially, acute day patients, ambulatory-care-sensitive admissions and re-admissions. The average length of stay also varied by deprivation and appeared to be an important cause of the increasingly high rate of re-admissions. On average, patients from more affluent areas are hospitalised longer than low-income patients, although the differences narrow over time. The results suggest that the widening social gap in hospitalisation rates is a result of the effects of poverty and problems of access to primary care. However, more research on different admission pathways and causes of admissions for different patients from different parts of the city is needed to confirm these observations. [ABSTRACT FROM AUTHOR]

The economic and social philosophies of the "New Right" which emphasise individualism and self-fulfillment have become widespread. In the last two decades it has grown particularly strong in Western societies. Self-fulfillment of the individual now commands its own moral imperative, and promotes the shutting out of the greater issues and concerns (political, historical and religious) that transcend the self. This paper examines the impact of "New Right" ideologies on social workers and social work practice, with particular reference to social workers in New Zealand's largest mental health institution, Porirua Hospital. It argues that a life course approach is necessary to understand social variations in health. It explores the accumulation of risk for the underprivileged in the market environment, with its concomitant constraints on human services. The paper reviews the inherent and fundamental conflict of objectives in the ethical positioning of social organizations, as against those of the "New Right." Finally, the paper argues for social and economic policies that would defend the socio-economically disadvantaged against an accumulation of risk in the critical periods of their life. It highlights survival strategies for social work in a marginalizing practice environment. [ABSTRACT FROM AUTHOR]

This paper examines the issue of targeting primary health-care benefits in favour of low-income recipients and other high users of health care. Specifically we examine the New Zealand case where, despite the introduction of such benefits in 1992, financial barriers appear to remain a significant determinant of utilization. We address this issue through a case study conducted in the city of Christchurch. Through a survey-based research design, we seek to determine the extent to which price barriers remain important by comparing patient utilization of a free community health clinic (n = 202) with a low-income control sample of patients who continue to use conventional (for New Zealand) fee-for-service providers (n = 148). We found that a large proportion of respondents delayed seeking care because of cost. Further, for respondents using the fee-for-service providers, levels of use were not related to need, whereas at the free clinic there was an inverse relationship between income and consultation rates. We conclude that if a universality of benefits is not possible, then there is a need for better targeting of primary care benefits. We believe there is a danger in such initiatives being evaluated primarily in terms of their validity as funding mechanisms, rather than in terms of their success in meeting the health-care needs of the disdavantaged. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has asked unprecedented questions of governments around the world. Policy responses have disrupted usual patterns of movement in society, locally and globally, with resultant impacts on national economies and human well-being. These interventions have primarily centred on enforcing lockdowns and introducing social distancing recommendations, leading to questions of trust and competency around the role of institutions and the administrative apparatus of state. This study demonstrates the unequal societal impacts in population movement during a national 'lockdown'., Methods: We use nationwide mobile phone movement data to quantify the effect of an enforced lockdown on population mobility by neighbourhood deprivation using an ecological study design. We then derive a mobility index using anonymised aggregated population counts for each neighbourhood (2253 Census Statistical Areas; mean population n=2086) of national hourly mobile phone location data (7.45 million records, 1 March 2020-20 July 2020) for New Zealand (NZ)., Results: Curtailing movement has highlighted and exacerbated underlying social and spatial inequalities. Our analysis reveals the unequal movements during 'lockdown' by neighbourhood socioeconomic status in NZ., Conclusion: In understanding inequalities in neighbourhood movements, we are contributing critical new evidence to the policy debate about the impact(s) and efficacy of national, regional or local lockdowns which have sparked such controversy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Children residing in neighbourhoods of high deprivation are more likely to have poorer health, including excess body size. While the availability of unhealthy food outlets are increasingly considered important for excess child body size, less is known about how neighbourhood deprivation, unhealthy food outlets and unhealthy dietary behaviours are interlinked., Methods: This study involves children aged 8-13 years (n=1029) and resided in Auckland, New Zealand. Unhealthy dietary behaviours (frequency of consumption of unhealthy snacks and drinks) and food purchasing behaviour on the route to and from school were self-reported. Height and waist circumference were measured to calculate waist-to-height ratio (WtHR). Geographic Information Systems mapped neighbourhood deprivation and unhealthy food outlets within individual, child-specific neighbourhood buffer boundaries (800 m around the home and school). Associations between neighbourhood deprivation (calculated using the New Zealand Index of Deprivation 2013), unhealthy food outlets, unhealthy dietary behaviours and WtHR were investigated using structural equation modelling in Mplus V.8.0. Age, sex and ethnicity were included as covariates, and clustering was accounted for at the school level., Results: Structural equation models showed that unhealthy food outlets were unrelated to unhealthy dietary behaviours (estimate 0.029, p=0.416) and excess body size (estimate -0.038, p=0.400). However, greater neighbourhood deprivation and poorer dietary behaviours (estimate -0.134, p=0.001) were associated with greater WtHR (estimate 0.169, p<0.001)., Conclusion: Excess child body size is associated with neighbourhood deprivation and unhealthy dietary behaviours but not unhealthy outlet density or location of these outlets near home and school., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Summary: Background: There is a relationship between childhood obesity and area‐level deprivation. While the New Zealand Index of Deprivation (NZDep) has been used widely in research for the past 20 years, the Index of Multiple Deprivation (IMD) was released in 2017. This study aims to investigate the association between deprivation and childhood obesity in New Zealand and compare measures of deprivation. Methods: Data from 316 794 4‐year‐olds in New Zealand undertaking the B4 School Check in 2010 to 2016, a national health and development screen, were analysed. Multilevel logistic regression models assessed the relationship between area‐level deprivation and individual‐level child obesity. Models were adjusted for age, sex, immigration status, ethnicity, and year. Deprivation was measured using the census‐based NZDep2013 (deciles) and the administrative data‐based IMD (deciles). The seven domains of the IMD were also considered. Results: The relationship between deprivation and obesity was very similar for the IMD and NZDep2013, point estimates were near identical, and confidence intervals overlapped substantially. Higher levels of deprivation were associated with a higher prevalence of child obesity. The relationship between deprivation and child obesity varied considerably across IMD domains. The education domain had the strongest association with child obesity and had an association with child obesity independent of the other domains of deprivation. Conclusion: Overall, there was little difference between the NZDep and IMD. However, the IMD's domains and IMD‐1 approach reveal more nuanced understandings of the deprivation‐obesity gradient, including the importance of area‐level education deprivation for predicting child obesity rates. [ABSTRACT FROM AUTHOR]

Early-life intervention to reduce obesity and poor dental health through early-life nutrition will improve health outcomes in later life. This study examined the prevalence of overweight and obesity and visual dental decay in 4-year old children in New Zealand between 2013 and 2017, and the impact of a nutrition and physical activity intervention programme, Under-5-Energize (U5E), on prevalence of these conditions within ethnic groups and by deprivation. The data set included 277,963 4-year-old children, including 25,140 from the Waikato region children of whom 8067 attended one of the 121 early childhood centres (ECC) receiving the U5E programme from 2014. Purposively the U5E-ECC selected were attended by higher proportions of indigenous Māori children and children living in higher deprivation areas than non-U5E-ECC. From 2013 to 2017, the overall prevalence of obesity, as defined by World Health Organisation criteria, declined slightly but rates of dental decay did not change. In the Waikato region, the prevalence of obesity declined in non-Māori children from 2015 to 2017 and children attending U5E-ECC had lower rates of dental decay than non-U5E children. Binary logistic regression showed that between 2015 and 2017 visible dental decay was more likely in children who were Māori (3.06×3.17), living in high deprivation (1.54×1.66) and male (1.10) but less likely if attending an U5E-ECC (0.83×0.79). Early-life intervention had efficacy at reducing dental decay, and demonstrated that the origins of disparities in health such as ethnicity and deprivation need to be addressed further to break the intergenerational cycles of poor health.

There is a growing movement to integrate conceptual tools from the health inequalities field into research that examines the relationship between inequalities and chances of child protection system contact. This article outlines the key concepts of an inequalities perspective, and discusses how these apply to inequalities in child protection in the Aotearoa New Zealand context. Drawing on existing research, this article shows that while there is evidence of links between deprivation, ethnicity, location and system contact, a more systematic research agenda shaped by an inequalities perspective would contribute to understanding more fully the social determinants of contact with the child protection system. An inequalities perspective provides balance to the current ‘social investment’ policy approach that targets individuals and families for service provision, with little attention to how structural inequalities impact on system contact. Directions for research are discussed, with some specific questions suggested. These include questions relating to the relationships between social inequalities and various decision points in the child protection system; if a social gradient exists and how steep it is; the inter-relationship between ethnicity, deprivation and patterns of system contact; and how similarly deprived children in different locations compare with each other in relation to child protection system contact, that is, is there an ‘inverse intervention law’ operating? [ABSTRACT FROM AUTHOR]

We used longitudinal information on area deprivation status to explore the relationship between residential-deprivation mobility and Cardiovascular Disease (CVD). Data from 2,418,397 individuals who were: enrolled in any Primary Health Organisation within New Zealand (NZ) during at least 1 of 34 calendar quarters between 1st January 2006 and 30th June 2014; aged between 30 and 84 years (inclusive) at the start of the study period; had no prior history of CVD; and had recorded address information were analysed. Including a novel trajectory analysis, our findings suggest that movers are healthier than stayers. The deprivation characteristics of the move have a larger impact on the relative risk of CVD for younger movers than for older movers. For older movers any kind of move is associated with a decreased risk of CVD., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: 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., Methods: The sample comprised 2,068,360 New Zealand residents enrolled in any Primary Health Organisation, aged between 30 and 84 years, 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., Results: 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., Conclusions: 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.

Introduction: Obesity is a global pandemic that affects all socioeconomic strata, however, the highest figures have been observed in the most disadvantaged social groups. Evidence from the USA and Canada showed that specific urban settings encourage obesogenic behaviour in the population living and/or working there. We aim to examine the evidence on the association between local food environments and obesity in the UK, Ireland, Australia and New Zealand., Methods: Six databases from 1990 to 2017 will be searched: MEDLINE (Ovid), Embase (Ovid), Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science. Grey literature will also be sought by searching Opengrey Europe, The Grey Literature Report and relevant government websites. Additional studies will be retrieved from the reference lists of the selected articles. It will include cohort, longitudinal, case study and cross-sectional studies that have assessed the relationship between local food environments and obesity in the UK, Ireland, Australia and New Zealand regardless of sex, age and ethnicity of the population. Two researchers will independently select the studies and extract the data. Data items will incorporate: author names, title, study design, year of study, year exposure data collected, country, city, urban/rural, age range, study exclusions, special characteristics of study populations, aims, working definitions of food environments and food outlets, exposure and methods of data collection, outcomes and key findings. A narrative synthesis and a summary of the results will be produced separately for children and adults, according to the type of food exposure-outcome. All the selected studies will be assessed using The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies., Ethics and Dissemination: This study will be based on published literature, and therefore ethical approval has not been sought. Our findings will be presented at relevant national and international scientific conferences and published in a peer-reviewed journal., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)