A cohort study comparing cardiovascular risk factors in rural Maori, urban Maori and non-Maori communities in New Zealand.

OBJECTIVES: To understand health disparities in cardiovascular disease (CVD) in the indigenous Maori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Maori in an area remote from health services with urban Maori and non-Maori in a city well served with health services. DESIGN: Prospective cohort study. SETTING: Hauora Manawa is a cohort study of diagnosed and previously undiagnosed CVD, diabetes and risk factors, based on random selection from electoral rolls of the rural Wairoa District and Christchurch City, New Zealand. PARTICIPANTS: Screening clinics were attended by 252 rural Maori, 243 urban Maori and 256 urban non-Maori, aged 20-64 years. MAIN OUTCOME MEASURES: The study documented personal and family medical history, blood pressure, anthropometrics, fasting lipids, insulin, glucose, HbA1c and urate to identify risk factors in common and those that differ among the three communities. RESULTS: Mean age (SD) was 45.7 (11.5) versus 42.6 (11.2) versus 43.6 (11.5) years in rural Maori, urban Maori and non-Maori, respectively. Age-adjusted rates of diagnosed cardiac disease were not significantly different across the cohorts (7.5% vs 5.8% vs 2.8%, p=0.073). However, rural Maori had significantly higher levels of type-2 diabetes (10.7% vs 3.7% vs 2.4%, p<0.001), diagnosed hypertension (25.0% vs 14.9% vs 10.7%, p<0.001), treated dyslipidaemia (15.7% vs 7.1% vs 2.8%, p<0.001), current smoking (42.8% vs 30.5% vs 15.2%, p<0.001) and age-adjusted body mass index (30.7 (7.3) vs 29.1 (6.4) vs 26.1 (4.5) kg/m(2), p<0.001). Similarly high rates of previously undocumented elevated blood pressure (22.2% vs 23.5% vs 17.6%, p=0.235) and high cholesterol (42.1% vs 54.3% vs 42.2%, p=0.008) were observed across all cohorts. CONCLUSIONS: Supporting integrated rural healthcare to provide screening and management of CVD risk factors would reduce health disparities in this indigenous population.

Community screening for cardiovascular risk factors and levels of treatment in a rural Maori cohort.

OBJECTIVES: To document levels of cardiovascular disease (CVD), diagnosed and undiagnosed risk factors and clinical management of CVD risk in rural Maori. METHODS: Participants (aged 20-64 years), of Maori descent and self-report, were randomly sampled to be representative of age and gender profiles of the community. Screening clinics included health questionnaires, fasting blood samples, blood pressure and anthropometric measures. Data were obtained from participants' primary care physicians regarding prior diagnoses and current clinical management. New Zealand Cardiovascular Guidelines were used to identify new diagnoses at screening and Bestpractice electronic-decision support software used to estimate 5-year CVD risk. RESULTS: Mean age of participants (n=252) was 45.7 ± 0.7, 8% reported a history of cardiac disease, 43% were current smokers, 22% had a healthy BMI, 30% were overweight and 48% obese. Hypertension was previously diagnosed in 25%; an additional 22% were hypertensive at screening. Dyslipidaemia was previously diagnosed in 14% and an additional 43% were dyslipidaemic at screening. Type-2 diabetes was previously diagnosed in 11%. Glycaemic control was achieved in only 21% of those with type-2 diabetes. Blood pressure and cholesterol were above recommended targets in more than half of those with diagnosed CVD risk factors. CONCLUSIONS: High levels of diagnosed and undiagnosed CVD risk factors, especially hypertension, dyslipidaemia and diabetes were identified in this rural Maori community. IMPLICATIONS: There is a need for opportunistic screening and intensified management of CVD risk factors in this indigenous population group.

Renal stone disease in Christchurch, New Zealand. Part 1: presentation and epidemiology.

AIM: To document the modes of presentation and the epidemiology of radiologically diagnosed renal stone disease over a 1-year period in the region of Christchurch, New Zealand. METHOD: Data on the presentation and epidemiology of renal stone disease was prospectively collected in a 1-year cohort of patients who had a new radiological diagnosis of renal stone disease. RESULTS: The incidence of new renal stone diagnoses was 105 per 100,000 per annum. Renal stone disease was more common in men than women, most common in the three decades from 30 to 59 years, and more common in people in trades or machine operating jobs. There was no significant difference in incidence by ethnicity or season. 58% of people presented with stones located in the ureter. Renal stones tended to be larger and were more likely to present incidentally or with haematuria, whilst ureteric stones were smaller and presented more typically with pain. 33% had a personal history of previous renal stone episodes and 20% had a family history of previous stones. CONCLUSIONS: Kidney stone disease is a significant health condition that affects people of predominantly working ages and men more than women. Both personal and family history are significant risk factors. Patients presenting with pain are more likely to have stones located in the ureter. Renal stones are more likely to present with haematuria or incidentally.

Renal stone disease in Christchurch, New Zealand. Part 2: a community study on the burden of renal stone disease.

AIM: To quantify the annual burden of a 12-month cohort of newly diagnosed renal stones in the defined community of Christchurch, New Zealand, and to assess this burden by stone size and position. METHOD: In this prospective study of stone burden, patients in the Christchurch region of New Zealand with newly diagnosed renal stones maintained a weekly diary for a 12-month period to record the utilisation of health services and financial and social costs to families and partners. Patient records were matched with diagnostic and clinical information to provide a comprehensive database. The economic costs of the various services were estimated. RESULTS: From November 2001 to November 2002, 422 newly diagnosed renal stones were detected--an annual incidence of 105 per 100,000 population. The annual mean cost of these stones was NZ$4274 per person in the first 12 months. The greatest costs were those for emergency visits, hospitalisations and for operative procedures (23.8%, 22.7%, and 21.8% of total financial burden respectively). Patient workdays lost accounted for 10.9% of total costs. Ureteric stones caused greater social burden than kidney stones. Costs were influenced by stone location and size, being significantly higher for ureteric stones and for larger stones. CONCLUSIONS: Renal stone disease places a considerable burden on the community. The main burdens were related to health service costs, with personal and pharmaceutical costs representing only a small component. The financial burden to society is estimated at $450,000 per 100,000 population ($NZ in 2001/02).

The costs of not treating hepatitis C virus infection in injecting drug users in New Zealand.

This paper estimates future health service costs of the current practice in New Zealand of not funding treatment of hepatitis C virus (HCV) infections. Costs are estimated separately for Maori and non-Maori, male and female IDUs. Markov modelling is used to track the infection and progression of HCV to severe liver disease and death, and accumulated costs are estimated for the life of the cohort. Upper and lower estimates of costs are calculated based on different assumptions of the rate of progression of HCV to more severe liver disease. Costs are estimated at dollars 24.6 million per 1000 non-Maori men IDUs (discounted at 3%), under progression assumptions based on liver clinic studies, compared with dollars 10.3 million per 1000 using lower rates of progression based on community studies. Similarly, corresponding costs for non-Maori women are estimated at dollars 27.6 million and $11.2 million per 1000 IDUs. Costs for women are higher because their greater life expectancy is associated with more cases of liver cirrhosis (LC) at older ages. Future costs for Maori are lower than non-Maori, because Maori are more likely to die at younger ages and hence fewer progress to more advanced liver disease. The current situation in New Zealand of not treating HCV infections will result in considerable future costs as some people with HCV progress to more severe liver disease. Provisional estimates are that the accumulated costs of HCV-related liver disease for all IDUs currently infected will be between dollars 166 million at lower rates of disease progression (discounted at 3%) to dollars 400 million at upper rates. Some of the associated morbidity and mortality could have been avoided if the HCV infections had been treated.