Ethnic inequalities in incidence, survival and mortality from abdominal aortic aneurysm in New Zealand
- 1Department of Funding and Planning, Waitemata District Health Board, Auckland, New Zealand
- 2Department of Surgery, Taranaki District Health Board, New Plymouth, New Zealand
- Correspondence to Dr Peter Sandiford, Department of Funding and Planning, Waitemata District Health Board, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand;
Contributors Dr PS contributed to conception, design, acquisition of data, analysis and interpretation. He contributed also to drafting the article and review and provides final approval for the published version. Mr DM contributed to the conception and design of the study, interpretation of the findings from a vascular surgery perspective, drafting the article, revising it critically and provides final approval of the published version. Dr DB contributed to interpretation of the data, revising the article critically for important intellectual content and provides final approval of the published version.
- Accepted 4 April 2012
- Published Online First 5 July 2012
Background Ethnic variation in abdominal aortic aneurysm (AAA) incidence, survival and mortality is not well documented and yet has important equity implications for screening programmes. This study quantifies ethnic differences in hospital incidence, mortality and survival from AAA among Māori, Pacific, Asian and European/other ethnicities in New Zealand (NZ).
Methods Retrospective analysis of linked NZ hospital and death register records identified all patients admitted to a public hospital with a diagnosis of AAA and deaths from AAA from 1996 to 2007. Patients were grouped by ethnicity as Asian, Māori, Pacific or European/other.
Results Compared with the European/other group, Māori were 8.3 years younger at first admission, had higher mortality rates (RR=1.30, 95% CI 1.06 to 1.60 for men; RR=2.66, CI 2.13 to 3.31 for women), lower 1-year cumulative relative survival (60% vs 73% for men and 56% vs 67% for women; p<0.0001 for both) and were much less likely to have their aneurysm repaired electively (39.6% vs 61.1%; p<0.00001). Also, Māori women but not men were found to have a significantly higher standardised incidence rate (RR=1.56, 95% CI 1.37 to 1.79). In contrast, the incidence rate ratio for Asians (both men and women) was just 0.38 (95% CI 0.27 to 0.54 and 0.30 to 0.47, respectively) and both sexes also had a significantly lower mortality rate than European/other. Pacific men but not women also had a significantly lower incidence rate and frequency of aneurysm repair (40.0%; p=0.027).
Conclusions Ethnic variation in the incidence, mortality and cumulative relative survival from AAA in NZ resembles ethnic inequalities in other health outcomes. This provides additional support for screening on equity grounds.
- Abdominal aortic aneurysm
- ethnic groups
- socioeconomic factors
- health status disparities
- minority health
- healthcare disparities
- demography, economics
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed
Data sharing statement Data used in the study were all from secondary sources available from the New Zealand Ministry of Health and Statistics New Zealand.