Health outcomes of children in state care in Aotearoa New Zealand.

AIM: This study aims to provide an overview of the association between being in the custody of the chief executive of Oranga Tamariki (the child welfare agency of the New Zealand (NZ) government) and all-cause hospitalisation and mortality. METHODS: This was a national retrospective cohort study using linked administrative data from the Integrated Data Infrastructure. Data were obtained for all 0-17 year-olds living in NZ on 31 December 2013. In-care status was ascertained at this point. Outcomes of all-cause hospitalisation and all-cause mortality were assessed between 1 January 2014 and 31 December 2018. Adjusted models incorporated age, sex, ethnicity, level of socioeconomic deprivation and rural/urban status. RESULTS: There were 4650 in-care children and 1 009 377 not-in-care children in NZ on 31 December 2013. Of those in care, 54% were male, 42% lived in the most deprived areas and 63% identified as Maori. Adjusted models showed that in-care children were 1.32 (95% CI 1.27-1.38) times more likely to be hospitalised than not-in-care children and 3.64 (95% CI 2.47-5.40) times more likely to die. CONCLUSION: This cohort study highlights that the care and protection system prior to 2018 was not preventing children in its care from experiencing severe adverse outcomes. Overseas research has previously been relied on when making practice and policy decisions around child care and protection in NZ, so this research will provide valuable insight into best practice in an NZ context.

Mental health inequities for Maori youth: a population-level study of mental health service data.

AIM: To examine specialist mental health service, hospital discharge, and pharmaceutical dispensing data for emotional conditions (anxiety, depression), substance use, and self-harm for Maori compared to non-Maori/non-Pasifika (NMNP) youth. METHODS: A novel population-level case identification method using New Zealand's Integrated Data Infrastructure for 232,845 Maori and 627,891 NMNP aged 10-24 years. Descriptive statistics on mental health conditions were generated and stratified by Maori/NMNP. Unadjusted and adjusted risk ratios (RRs) of mental health conditions were generated using generalised linear regression. RESULTS: Maori were less likely to be identified for anxiety (ARR=0.88; 95% CI 0.85-0.90) or depression (ARR=0.92; 95% CI 0.90-0.95) than NMNP. They were more likely to be identified for substance problems (ARR)=2.66; 95% CI 2.60-2.71) and self-harm (ARR=1.56; 95% CI 1.50-1.63). Maori living in high deprivation areas were significantly more likely to be identified for substance problems, but less likely for emotional conditions, than Maori in least deprived areas. CONCLUSION: Despite known high levels of mental health concerns for rangatahi Maori, administrative data suggests significant under-reporting, assessment, and treatment of emotional conditions relative to NMNP. These differences were exacerbated by deprivation. Maori were more likely to be referred to services for externalised symptoms of distress (substance use and self-harm).