The burden of coronary heart disease in Maori: population-based estimates for 2000-02

Objective: To estimate coronary heart disease (CHD) incidence, prevalence, survival, case fatality and mortality for Maori, in order to support service planning and resource allocation. Methods: Incidence was defined as first occurrence of a major coronary event, i.e. the sum of first CHD hospital admissions and out-of-hospital CHD deaths in people without a hospital admission for CHD in the preceding five years. Data for the years 2000-02 were sourced from the New Zealand Health Information Service and record linkage was carried out using a unique national identifier, the national health index. Results: Compared to the non-Maori population, Maori had both elevated CHD incidence and higher case fatality. Median age at onset of CHD was younger for Maori, reflecting both higher age specific risks and younger population age structure. The lifetable risk of CHD for Maori was estimated at 37% (males) and 34% (females), only moderately higher than the corresponding estimates for the non-Maori population, despite higher Maori CHD incidence. This reflects the offsetting effect of the higher 'other cause' mortality experienced by Maori. Median duration of survival with CHD was similar to that of the non-Maori population for Maori males but longer for Maori females, which is most likely related to the earlier age of onset. Conclusions: This study has generated consistent estimates of CHD incidence, prevalence, survival, case fatality and mortality for Maori in 2000-02. The inequality identified in CHD incidence calls for a renewed effort in primary prevention. The inequality in CHD case fatality calls for improvement in access for Maori to secondary care services. Key words: coronary disease, epidemiology, lifetable, New Zealand, ethnicity. doi: 10.1111/j.1753-6405.2009.00412.x