Social class, ethnic group, and male mortality in New Zealand, 1974-8.

Social class mortality differences in New Zealand males aged 15 to 64 were investigated for the period 1974-8 using the Registrar-General's classification. The mortality gradient was similar to that previously found in England and Wales, but the New Zealand pattern was non-linear with particularly high mortality in class V. Smoking patterns accounted for much of the increased risk for classes III and IV but did not appear to explain the high mortality in class V. The patterns for the major disease groupings also paralleled those previously found in England and Wales, coronary heart disease and neoplasms displaying weaker gradients than accidents, respiratory diseases, digestive diseases, and infectious diseases. Maori and non-Maori males had comparable social class mortality gradients, but the Maori mortality rates were approximately 50% higher than the non-Maori rates in each class.

Intercensal trends in cigarette smoking in New Zealand 2: Social and occupational factors.

In all major occupational groups the proportion of smokers has fallen in the intercensal period from 1976 to 1981. Half as many male professional workers are smokers (21%) compared with service workers (42%) and production workers (43%). Women have shown an increase or little change in the percentage of smokers in many occupations. The unemployed have the highest proportion of smokers (56% men, 52% women). More than half of those receiving sickness and domestic purposes benefits are smokers as are 57% of men and women living in a de facto relationship. Higher rates of income are in general correlated with a lower proportion of smokers. Smoking rates are high for members of the Ratana religion (58% men and 65% women). For other denominations, rates in men vary from 5% for Jehovah's Witnesses to 39% for Roman Catholics. The proportion of smokers is higher with lower levels of educational attainment. Those who had attended both university and training college have low rates of smoking (19% men, 16% women).

Intercensal trends in cigarette smoking in New Zealand 1: age, sex and ethnic status.

The 1981 New Zealand census has shown that since 1976 the proportion of cigarette smokers has fallen from 40% to 35% in men and from 32% to 29% in women. In men, there has been a reduction in smoking in every age group, but in women smoking has increased in those aged 20-24 and 70-74 years. More girls aged 15-19 years are smokers than boys. Maori rates of smoking are much higher than other ethnic groups but since 1976 there has been a considerable reduction in the proportion of Maori men and women who smoke. The important exception is that smoking by Maori women aged 20-24 years has increased to very high levels (70%). Almost half the men and a third of the women who smoke consume 20 or more cigarettes a day. The average number of cigarettes smoked per day has fallen since the 1976 census to 18 for men and 14 for women. From 1976 to 1981, the prevalence of smoking in New Zealand has shown a considerable reduction in non-Maori and Maori men and women of most ages, except for younger women.

Mortality and social class in New Zealand. III: male mortality by ethnic group.

Social class differences in male mortality in New Zealand were investigated separately for Maori, Pacific Island and other New Zealand males aged 15-64. All three groups displayed strong social class mortality gradients but, for each class, the Maori mortality rates were approximately 50% higher than the rates for the "other" category, while the Pacific Islander rates generally occupied an intermediate position. The Maori mortality rates were particularly high for the disease groupings of respiratory diseases, infectious diseases, genito-urinary diseases, endocrine, nutritional and metabolic disorders and diseases of the circulatory system other than coronary heart disease and cerebrovascular disease--even when the data were adjusted for age and social class factors. The Pacific Islander rates were high for the same disease groupings except for endocrine, nutritional and metabolic disorders. Overall, there were substantial social class differences and ethnic differences in mortality and these were largely independent so that only about one-fifth of the Maori mortality excess was attributable to social class factors. Four-fifths of the Maori excess was not attributable to such factors indicating that interventions aimed specifically at lower socio-economic groups will not eliminate the current mortality differences between Maoris and non-Maoris.

Mortality and social class in New Zealand II: male mortality by major disease groupings.

Social class differences in male mortality in New Zealand were investigated for each major disease grouping. The patterns found were similar to those for England and Wales with the lower social classes having mortality rates significantly higher than those of the upper social classes for each major cause of death. The strongest social class mortality gradients were found for deaths from accidents, poisonings and violence; diseases of the respiratory system; endocrine, nutritional and metabolic diseases; diseases of the genito-urinary system; and diseases of the digestive system. The gradients for coronary heart disease and neoplasms were weaker, but in the same direction as those found for other disease groupings.

Mortality and social class in New Zealand. I: overall male mortality.

Social class differences in New Zealand male mortality are investigated using two different systems of social class classification. In each case it is found that the lower social classes have mortality rates significantly higher than those of the upper social classes with the mortality rate of the lowest class being approximately twice that of the highest class on a six-category scale. The relative risk is higher in the younger age-groups. When the British Registrar-General's scale is used New Zealand exhibits a social class mortality gradient similar to that previously found in England and Wales, but the lowest social class experiences a particularly high mortality rate.

Changes in social and biological factors in New Zealand perinatal mortality.

Perinatal mortality in New Zealand decreased substantially during the 1970s. In 1979 it had fallen by five per 1000 to 12. The decrease applied to both high risk and low risk infants. The greater reductions occurred in infants born to mothers younger than 20 or older than 35, in infants with birthweights under 2500 g and in infants of fathers with semiskilled or unskilled occupations. The differential between the rates for nuptial and ex-nuptial infants narrowed.

Trends in coronary heart disease mortality and associated risk factors in New Zealand.

Coronary heart disease mortality declined by 17 percent and 14 percent for New Zealand European men and women respectively between 1968 and 1978. The fall occurred in all age groups and in Maoris and cannot be attributed to change in diagnostic fashions. The decline has been associated with a decrease in the consumption of diary products and more recently with a levelling off of cigarette smoking, an increased awareness of the importance of treating hypertension, and an apparent increase in habitual physical activity in the community. There have also been improvements in the medical management of patients with coronary heart disease which may be contributing to the continuing decline in mortality rates. A programme to monitor trends in CHD incidence and case fatality and the level of risk factors in the community is required to elucidate the reasons for the decline in CHD mortality.

The influence of race, religion, occupation and other social factors on cigarette smoking in New Zealand.

97% of the New Zealand population 15 years and over (2.1 million persons) responded to a question on cigarette smoking in the 1976 population census. 38% of New Zealand men and 30% of women other than Maoris or Pacific Islanders were cigarette smokers. 56% of Maori men and 59% of Maori women smoked regularly; the corresponding figures for Pacific Islanders, a relatively recent migrant population, were 46% and 24%. In all age groups more Maoris smoked than non-Maoris. More than two-thirds of Maori women aged 20-24 were smokers. Cigarette consumption rates were high; the men and over one third of the women smokers smoked more than 20 cigarette a day. Smoking was higher then expected among Roman Catholics and among those who objected to stating their religion. Those who were divorced or separated had smoking rates 38% to 56% higher than expected. Smoking was inversely related to the level of education attained. Those in the professions were least likely to be smokers (average 27%) whereas at least half those in labouring or unskilled occupations were smokers.

Trends in perinatal mortality.

PIP: In 1973, Austria, Cuba, England and Wales, Hungary, Japan, New Zealand, Sweden and the U.S. collaborated with the World Health Organization (WHO) to produce a report on the impact of social and biological factors on perinatal mortality. This article explores trends in perinatal mortality in each of the 8 participating countries in the years after the study was done; data were supplied by WHO for the years 1968-78. Perinatal mortality in 1973 ranged between 14/1000 in Sweden to 33/1000 in Hungary. At that time perinatal mortality was already decreasing in most countries, and kept decreasing at least until 1978. Austria is the country which recorded the greatest reduction, from 26/1000 in 1973 to 15/1000 in 1978, or a reduction of 43%. To summarize, between 1973 and 1978 all countries showed decreases going from 24% in Cuba to 43% in Austria. Between 1970-73 and in 1978 the greatest reductions in late fetal death were recorded in Japan (39%) and in Sweden (36%); the lowest in Hungary (18%) and in the U.S. (15%). During the same period early neonatal mortality rates decreased even more rapidly, between 26% in Cuba to 49% in Austria. The general pattern was that the ratios of early neonatal death to late fetal death tended to approach 1.0, with the exception of the U.S. and New Zealand. Moreover, there was some evidence that during the 1970s a general fall in perinatal mortality rates had occurred in many countries outside of those considered in the 1973 study. There is no indication of the eventual level below which reduction in perinatal death can be expected to occur. The data presented in the 1973 study showed that the level of perinatal mortality was due to the interplay of both social and biological factors.^ieng

Fluoridation and cancer mortality in New Zealand.

Claims that fluoridation of the municipal water supply causes cancer in humans have not been substantiated by independent objective studies in the United States of America, Canada, or New Zealand. After thorough reexamination of the earlier publications from other countries, and our own study of data available for the New Zealand population, we consider the 1976 statement of the Royal College of Physicians seems more than ever justified: "There is no evidence that fluoride increases the incidence or mortality of cancer in any organ".

Colon and rectum cancer in the New Zealand population.

To test the hypothesis that the high rates of large bowel cancer in New Zealand were attributable to geographic location, occupation, or country of birth, we reviewed 4,760 cases registered in that country between 1964 and 1968. Analyses demonstrated that significantly high rates existed for certain rural populations, for small subsections of the immigrant population, and for certain occupations. However, the number of persons-at-risk represented in these groups collectively were not large enough to account for the high New Zealand rates.

Cancer registry in New Zealand.

Cancer registration, introduced in New Zealand in 1948, evolved from a clinically oriented to a population-based collection scheme. The registry, located within the National Health Statistics Centre, can draw on a wide range of other health data reported to that office. New Zealand has a population of 3 million, 8% of whom are Maoris. Findings indicated that cancer is the second leading cause of death and that Maori women have a much higher overall cancer death toll than other New Zealand women. Significantly higher incidence rates for cancers of the stomach, pancreas, lung, thyroid gland, and uterus and lower rates for cancer of the large bowel and melanoma of the skin were found in Maoris.

Mortality patterns in acute coronary heart disease in New Zealand.

An analysis has been made of death certificate information from 4885 persons classified as having died from acute myocardial infarction or other acute or subacute forms of ischaemic heart disease. One-third of non-Maori deaths occur in a public hospital and half the deaths occur at home. One-third of the deaths occur within five minutes, half within one hour, and by 24 hours, two-thirds of all those who die within two months of an acute coronary heart attack, have already died. Sudden death is more common in the elderly and far more common in those who die outside hospital. Post-mortems were performed in approximately a quarter of the patients. In public hospitals, 36 percent of non-Maoris had a post-mortem examination and 10 percent of Maoris.