Andrea Teng

Changing socioeconomic inequalities in cancer incidence and mortality: Cohort study with 54 million person‐years follow‐up 1981–2011

Cancer is increasingly responsible for the mortality gap between high and low socioeconomic position groups in high‐income countries. This study investigates which cancers are contributing more to socioeconomic gaps in mortality and how this changes over time.New Zealand census data from 1981, 1986, 1991, 1996, 2001 and 2006, were linked to three to five years of subsequent mortality and cancer registrations, resulting in 54 and 42 million years of follow‐up cancer incidence and mortality, respectively. Age‐ and ethnicity‐standardised cancer mortality rates and the slope index of inequality (SII) by income were calculated.The contribution of cancer to absolute inequalities (SII) in mortality increased from 16 to 27% for men and from 12 to 31% for women from 1981–84 to 2006–11, peaking in 1991–94 for men and in 1996–99 for women and then levelling off, parallel to peaks in lung cancer inequalities. Lung cancer was the largest driver of cancer inequality trends (49% of the cancer mortality gap in 1981–84 to 33% in 2006–11 for men and 32 to 33% for women) followed by colorectal cancer in men (2 to 11%) and breast cancer in women (declining from 44 to 13%). Women in the lowest income quintile experienced no decline in cancer mortality.The contribution of cancer to income inequalities in all‐cause mortality has expanded in this high‐income country. Action to address socioeconomic inequalities should prioritise equitable tobacco control, obesity control and improved access to cancer screening, early diagnosis and high quality treatment for those with the lowest incomes.

Living in areas with different levels of earthquake damage and association with risk of cardiovascular disease: a cohort-linkage study

BACKGROUND Cardiovascular disease rates are known to increase immediately after a severe earthquake. However, less is known about the magnitude of this increase over time in relation to the amount of housing damage. We assessed the effect of area housing damage from a major earthquake sequence in Christchurch, Canterbury province, New Zealand, on cardiovascular disease-related hospital admissions and deaths. METHODS For this cohort-linkage study, we used linked administrative datasets from the Statistics New Zealand Integrated Data Infrastructure to identify individuals aged 45 years or older living in Christchurch from the date of the first earthquake on Sept 4, 2010. Individuals were assigned the average damage level for their residential meshblock (small neighbourhood generally comprising 10-50 dwellings) using the insurance-assessed residential building damage costs obtained from the Earthquake Commission as a proportion of property value. We calculated the rates of cardiovascular disease-related hospital admissions (including myocardial infarction) and cardiovascular disease-related mortality and rate ratios (adjusted for age, sex, ethnicity, small-area deprivation index, and personal income) by level of housing damage in the first year and the 4 subsequent years after the earthquake. The rate ratio association between earthquake housing damage and cardiovascular event was examined by Poisson regression, and linear test of trends across damage categories was done by regression modeling. FINDINGS We identified 179 000 residents living in the earthquake-affected region of Christchurch, of whom 148 000 had complete data. For the first 3 months after the Feb 22, 2011 earthquake, the Poisson regression-adjusted rate ratio (RR) for cardiovascular disease-related hospital admissions for residents from areas that were most damaged (compared with residents from the least damaged areas) was 1·12 (95% CI 0·96-1·32; test for linear trend p=0·239). In the first year after the earthquake sequence, for residents from areas that were most damaged (vs the least damaged areas), Poisson regression-adjusted RRs were 1·10 (1·01-1·21; test for linear trend p=0·068) for cardiovascular disease-related hospital admissions, 1·22 (1·00-1·48; p=0·036) for myocardial infarction-related hospital admissions, and 1·25 (1·06-1·47; p=0·105) for cardiovascular disease-related mortality, corresponding to an excess of 66 (95% CI 7-125) cardiovascular disease-related hospital admissions, including 29 (0-53) additional myocardial infarction-related hospital admissions and 46 (13-73) additional deaths from cardiovascular disease. In the 4 subsequent years, we found no evidence of an association of these outcomes with earthquake damage. INTERPRETATION Rates of cardiovascular disease and myocardial infarction were increased in people living in areas with more severely damaged homes in the first year after a major earthquake. Policy responses to reduce the effect of earthquake damage on cardiovascular disease could include pre-earthquake measures to minimise building damage, early wellbeing interventions within the first year to address post-earthquake stress, and enhanced provision of cardiovascular disease prevention and treatment services. FUNDING Healthier Lives National Science Challenge and Natural Hazards Research Platform, Ministry of Business, Innovation and Employment.

Changing ethnic inequalities in mortality in New Zealand over 30 years: linked cohort studies with 68.9 million person-years of follow-up

BackgroundInternationally, ethnic inequalities in mortality within countries are increasingly recognized as a public health concern. But few countries have data to monitor such inequalities. We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous], Pacific, and European/Other) in mortality for a country with high quality ethnicity data, using both standard and novel visualization methods.MethodsCohort studies of the entire New Zealand population were conducted, using probabilistically-linked Census and mortality data from 1981 to 2011 (68.9 million person years). Absolute (standardized rate difference) and relative (standardized rate ratio) inequalities were calculated, in 1–74-year-olds, for Māori and Pacific peoples in comparison to European/Other.ResultsAll-cause mortality rates were highest for Māori, followed by Pacific peoples then European/Other, and declined in all three ethnic groups over time. Pacific peoples experienced the slowest annual percentage fall in mortality rates, then Māori, with European/Other having the highest percentage falls – resulting in widening relative inequalities.Absolute inequalities, however, for both Māori and Pacific males compared to European/Other have been falling since 1996. But for females, only Māori absolute inequalities (compared with European/Other) have been falling.Regarding cause of death, cancer is becoming a more important contributor than cardiovascular disease (CVD) to absolute inequalities, especially for Māori females.ConclusionsWe found declines in all-cause mortality rates, over time, for each ethnic group of interest. Ethnic mortality inequalities are generally stable or even falling in absolute terms, but have increased on a relative scale. The drivers of these inequalities in mortality are transitioning over time, away from CVD to cancer and diabetes; such transitions are likely in other countries, and warrant further research. To address these inequalities, policymakers need to enhance prevention activities and health care delivery, but also support wider improvements in educational achievement and socioeconomic position for highest need populations.BACKGROUND Internationally, ethnic inequalities in mortality within countries are increasingly recognized as a public health concern. But few countries have data to monitor such inequalities. We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous], Pacific, and European/Other) in mortality for a country with high quality ethnicity data, using both standard and novel visualization methods. METHODS Cohort studies of the entire New Zealand population were conducted, using probabilistically-linked Census and mortality data from 1981 to 2011 (68.9 million person years). Absolute (standardized rate difference) and relative (standardized rate ratio) inequalities were calculated, in 1-74-year-olds, for Māori and Pacific peoples in comparison to European/Other. RESULTS All-cause mortality rates were highest for Māori, followed by Pacific peoples then European/Other, and declined in all three ethnic groups over time. Pacific peoples experienced the slowest annual percentage fall in mortality rates, then Māori, with European/Other having the highest percentage falls - resulting in widening relative inequalities. Absolute inequalities, however, for both Māori and Pacific males compared to European/Other have been falling since 1996. But for females, only Māori absolute inequalities (compared with European/Other) have been falling. Regarding cause of death, cancer is becoming a more important contributor than cardiovascular disease (CVD) to absolute inequalities, especially for Māori females. CONCLUSIONS We found declines in all-cause mortality rates, over time, for each ethnic group of interest. Ethnic mortality inequalities are generally stable or even falling in absolute terms, but have increased on a relative scale. The drivers of these inequalities in mortality are transitioning over time, away from CVD to cancer and diabetes; such transitions are likely in other countries, and warrant further research. To address these inequalities, policymakers need to enhance prevention activities and health care delivery, but also support wider improvements in educational achievement and socioeconomic position for highest need populations.

A screening program to test and treat for Helicobacter pylori infection: Cost-utility analysis by age, sex and ethnicity

BackgroundThe World Health Organization recommends all countries consider screening for H. pylori to prevent gastric cancer. We therefore aimed to estimate the cost-effectiveness of a H. pylori serology-based screening program in New Zealand, a country that includes population groups with relatively high gastric cancer rates.MethodsA Markov model was developed using life-tables and morbidity data from a national burden of disease study. The modelled screening program reduced the incidence of non-cardia gastric cancer attributable to H. pylori, if infection was identified by serology screening, and for the population expected to be reached by the screening program. A health system perspective was taken and detailed individual-level costing data was used.ResultsFor adults aged 25–69 years old, nation-wide screening for H. pylori was found to have an incremental cost of US

Changing smoking-mortality association over time and across social groups: National census-mortality cohort studies from 1981 to 2011

196 million (95% uncertainty interval [95% UI]:

The long history of health inequality in New Zealand: occupational class and lifespan in the late 1800s and early 1900s

182–

A typology for charting socioeconomic mortality gradients: “Go south-west”

211 million) with health gains of 14,200 QALYs (95% UI: 5,100–26,300). Cost per QALY gained was US

Ethnic inequalities in cancer incidence and mortality: census-linked cohort studies with 87 million years of person-time follow-up

16,500 (

The contribution of Helicobacter pylori to excess gastric cancer in Indigenous and Pacific men: a birth cohort estimate

7,600–

Socioeconomic and Tobacco Mediation of Ethnic Inequalities in Mortality over Time: Repeated Census-mortality Cohort Studies, 1981 to 2011

38,400) in the total population and 17% (6%-29%) of future gastric cancer cases could be averted with lifetime follow-up. A targeted screening program for Māori only (indigenous population), was more cost-effective at US