Journal of the New Zealand Medical Association, 21-February-2003, Vol 116 No 1169
Ischaemic heart disease, deprivation and smoking: a small area study in Te Tairawhiti
Ischaemic heart disease (IHD) inflicts an enormous burden on individuals, whanau, communities, and the New Zealand Health Service. IHD is the leading cause of years of life lost (YLL) in NZ for both males (38 570 YLL) and females (25 526 YLL). In addition, IHD is a significant cause of years of life lost to disability (YLD) in NZ. It is the seventh leading cause of YLD in men (5412 YLD), and the eighth leading cause in women (4296 YLD). The burden of IHD in terms of hospitalisations is significant. In 1997, over 4% of day and inpatient hospitalisations were for the treatment of IHD.1
Hospital discharge data relating to residents in Te Tairawhiti for the financial years 1996–1999 citing ICD code 410–414 (ischaemic heart disease) in any of the first five diagnosis columns, were accessed from NZHIS. Age- and gender-standardised hospital discharge rates were calculated for both the Maori and NZ European/Pakeha ethnic groups (based on the total population for the district). Deprivation in this analysis was measured using an area-based measure called NZDep96,2 while data relating to current and former smoking status were obtained from the 1996 Census.
Maori male and female discharge rates are almost identical, at almost 7.5 per 1000 per annum (7.48 and 7.47 respectively). However, among the Pakeha population there is no such convergence, with the male rate being over 60% higher than female rate. The Pakeha female rate is 5.97 per 1000 per annum, while the Pakeha male rate is 9.75.3
Area-based (ecological) analysis was conducted to investigate the relationship between discharge rates citing IHD, current smoking rates, ‘ever smoked’ rates, and deprivation. No significant relationship was observed between ‘ever smoked’ rates and hospital discharges citing IHD for any gender/ethnic group.
Stepwise multiple regression analysis revealed no significant predictive relationship between either deprivation or smoking rates and hospital discharge rates citing IHD, for either Pakeha males or females. However, stepwise multiple regression analysis of the predictive relationship of deprivation and current smoking rates on Maori male and female hospital discharge rates identified deprivation as the sole significant predictor. Among Maori males, 22.8% of the variance in hospitalisation rates citing IHD was predicted by NZDep96 raw scores, while among females this factor predicted 14.3% of the variance.
The relationship between deprivation and hospital discharges citing IHD for Maori, seems clear. However, further analysis is required to determine significant predictors among the Pakeha population.
Public Health Unit, Tairawhiti District Health
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