Heart health equityWhat prospects?Norman Sharpe

2

Disproportionate universalism: CVD mortality

An increasing burden

for Māori 1981-1985

1986-1990

1991-1995

1996-2000

2001-2005

2006-2010

2011-2015

0

50

100

150

200

250

300

350

400

Period

Female

Male

Average annualised count

(Projected)

For Māori, an actual increase in the

absolute number of deaths is projected for males and a relatively

stable number for females

IHD Mortality in NZ Trends and Projections

Tobias et al NZMedJ April 2006

Cigarette smoking, obesity prevalence and NZ Dep

NZ Health Survey 2006-7

NZ Dep Quintile

I II III IV V

Smoking % 11.8 17.0 20.0 24.4 33.1

Obesity %BMI >40 %

20.9 2.1

20.6 1.7

23.0 2.8

26.0 2.2

37.6 7.9

Poverty and health risk in New Zealand

Risk Factors for Acute Rheumatic Fever 0-24 years New Zealand 2002-2006

NZ Dep Score RR

1-2 1.00

3-4 2.74

5-6 5.52

7-8 7.83

9-10 28.65

Maori (29/100,000) 22.97Pacific (62/100,000) 48.62

European (1.3/100,000) 1.00Asian/Indian (1.3/100,000) 0.99

Maori 23 times and Pacific ~50 times more affected

Poor

Smaller health inequalities

Lakes

Whanganui

Tairawhiti

Waitemata

Cap/Coast

Canty

Counties M

Wairarapa

H BayW Coast

S’land

MidC

Taranaki

HuttOtago

Auckland

S Canty

BoP

Waikato

N-M

Northland

Shorter life expectancy

Longer life expectancy

Greater health inequalities

“Health inequality” = variation in life

expectancy within each DHB’s area.

Life expectancy and health inequalities in NZ Variation amongst DHB areas

0.00

10.00

20.00

30.00

40.00

50.00

60.00

Standardised Discharge Rate per 10,000 National Discharge Rate per 10,000 Raw Discharge Rate per 10,000

DHB of Domicile

Dis

ch

arg

es

pe

r 1

0,0

00

Po

pu

lati

on

Inequality of Access to Health ServicesHospital Discharges in 2009 with an Angiography Procedure

Acute Coronary Syndrome Revascularisation Cohort Study

5,456 Māori and 62,294 non-Māori 1st acute admissions 2000-2008 with ACS

Diagnostic PCI CABG0.4

0.690000000000002

0.57

0.81

0.73

0.620000000000002

0.770.80

0.690000000000002

0.820.82

0.720000000000001

0.81

Māori/non-Māori Hazard Ratios for Procedure Receipt After First Acute ACS Admission 2000-2008

Adjusted for age, sex, principal diagnosis + comorbidities + procedure centre + NZDep

Hazard ratio (log scale)