The Health of Pacific Peoples

Transcription

1 The Health of Pacific Peoples i

2 Citation: Ministry of Health Wellington: Ministry of Health. Published in April 2005 by the Ministry of Health PO Box 5013, Wellington, New Zealand ISBN X (Book) ISBN (Internet) HP 4046 This document is available on the Ministry of Health website: ii

3 Contents Introduction... 1 Section 1: Health Outcomes... 2 Key whole of life indicators years Infants and Children years Young People years Adults... 8 Section 2: Health Service Utilisation Use of primary health care services Clinical preventive service use Barriers to care Secondary care Mental health services Disability support services Section 3: Risk Factors Physical activity Fat intake Vegetable consumption Food security Overweight and obesity Tobacco and alcohol consumption iii

4 Section 4: Socioeconomic Determinants of Health Age distribution Neighbourhood deprivation Education and employment Income and housing Contact Details iv

5 Introduction is the second in a series of summaries of the current health status of the New Zealand population produced by Public Health Intelligence (PHI) at the Ministry of Health. It is a brief summary of key indicators from Tupu Ola Moui: Pacific Health Chart Book The first booklet in the series, The Health of New Zealand: Total Population 2004, focused on the health of the whole New Zealand population. A further summary will be published on the health status of Māori. Each booklet in the series gives an overview of the demographic make-up of the New Zealand population in question. This booklet includes the key indicators of health outcomes, health service utilisation, risk factors and socioeconomic determinants of health for compared to the total New Zealand population. The indicators in this summary booklet were chosen from the key indicators in Tupu Ola Moui: Pacific Health Chart Book The criteria used to select these indicators were: high impact high inequality modifiable good data quality. Most of the indicators are presented simply as rates; 95 percent confidence intervals, calculated by conventional parametric techniques, are shown where possible, in brackets after the estimates. Age-specific rates are sometimes summarised using direct age-standardisation methods, with the WHO world population as the standard. For more detailed information, refer to Tupu Ola Moui: Pacific Health Chart Book 2004, which can be accessed on the Ministry of Health s website: 1

6 Section 1: Health Outcomes Key whole of life indicators 1 Males Females Males Females Life expectancy in years, at birth, by sex, * Avoidable mortality 1, agestandardised rate per 100,000, ** 771 ( ) 471 ( ) 497 ( ) 318 ( ) Ambulatory sensitive hospitalisations 1, agestandardised rate per 100,000, ** 4780 ( ) 4539 ( ) 2964 ( ) 2745 ( ) Injury-related mortality 1, agestandardised rate per 100,000, ** 36 (27 45) 13 (7 19) 37 (35 39) 15 (14 16) Unintentional injury hospitalisations 1, agestandardised rate per 100,000, ** 3411 ( ) 2141 ( ) 2852 ( ) 1945 ( ) 2

7 Note: 1. Age-standardised to the WHO standard population. Sources: *Statistics New Zealand **New Zealand Health Information Service On average, Pacific males can expect to live for 71.5 years and Pacific females for 76.7 years, a gender gap of 5.2 years. Pacific males and females have life expectancy at birth lower than the average for New Zealand: 4.8 years lower for males, and 4.4 years lower for females. Pacific males and females have higher rates of avoidable mortality than the all New Zealand benchmark approximately a 50 percent excess risk. Pacific males and females have high rates of ambulatory sensitive hospitalisation relative to the all New Zealand benchmark approximately a 60 percent excess. Pacific males die from unintentional injury at two-and-a-half times the rate of their female counterparts. A similar sex difference is seen for the total New Zealand population, and indeed for almost all populations throughout the world. Hospitalisation rates for unintentional injuries are higher for Pacific males and females than the all New Zealand average (by approximately 15 percent). This is despite the corresponding mortality rates being similar (or slightly lower). The explanation for this inconsistency is unclear. 1 Whole of Life indicators focus on health across the whole life span, covering all age groups. 3

8 0 14 years Infants and Children Males Females Males Females Infant mortality rate, rate per 1000 live births, * 7.9 ( ) 6.2 ( ) 5.7 ( ) 4.3 ( ) Rate of asthma hospitalisations among 0 14-year-olds, rate per 100,000 1, ** 815 ( ) 679 ( ) 572 ( ) 406 ( ) Meningococcal disease notifications among 0 14-year-olds, rate per 100,000, 1, Rheumatic fever notifications among 0 14-year-olds 1, 2, rate per 100,000, *** Rate of lower respiratory tract infection hospitalisations among 0 14-year-olds 1, rate per 100,000, *** 1663 ( ) 1375 ( ) 659 ( ) 518 ( ) Notes: 1. Age-standardised to WHO standard population. 2. Confidence intervals not available. Sources: *Statistics New Zealand **New Zealand Health Information Service ***Institute for Environmental Science and Research Limited 4

9 The infant mortality rate for the Pacific population is 40 percent higher than the all New Zealand average. Pacific children have higher hospitalisation rates (approximately 50 percent higher) for asthma than the all New Zealand average. Pacific children have twice the rate of meningococcal disease and up to five times the rate of rheumatic fever as the all New Zealand average. Pacific infants and children are approximately 2.5 times more likely to be hospitalised for lower respiratory tract infection than the national average. 5

10 15 24 years Young People Males Females Males Females Incidence of chlamydia (confirmed and probable) at sexual health clinics 1, Incidence of gonorrhoea at sexual health clinics 1, Note: 1. Confidence intervals are not available for STIs. Source: Institute for Environmental Science and Research Limited Pacific youth have higher rates of chlamydia and gonorrhoea than the national youth average (among clinic attendees). Males Females Males Females Youth suicide rate, rate per 100,000, (22 48) 9 (4 18) 37 (34 41) 12 (10 14) Source: New Zealand Health Information Service The rate of suicide among Pacific youth (both males and females) is similar to the national average. 6

11 15 24 years Young People Birth rate, rate per 1000, years, (20 44) 19 (18 19) Pregnancy rate 1, rate per 1000, years, (62 69) 37 (37 38) Abortion rate, rate per 1000, years, (13 16) 13 (13 14) Note: 1. Pregnancy rate includes live births, stillbirths, induced abortions and an estimate of early miscarriages. Source: Statistics New Zealand Pacific teenagers have higher pregnancy and birth rates than the all New Zealand average but a similar abortion rate. 7

12 25+ years Adults Cardiovascular disease and Diabetes Cardiovascular disease mortality 1, rate per 100,000* Males Females Males Females years 57 (44 71) 31 (22 42) 27 (25 29) 11 (10 13) years 554 ( ) 235 ( ) 253 ( ) 100 (96 105) Prevalence of self-reported diabetes 1, 2, rate per 100 ** years 6.2 ( ) 1.4 ( ) 1.4 ( ) years 20.1 ( ) 7.9 ( ) 6.2 ( ) Notes: 1. Age-standardised within each age group to WHO standard population. 2. When ethnic and age groups were not represented in adequate numbers for reliable estimates, results have been suppressed and dashs are shown in the cells. Sources: *New Zealand Health Information Service **2002/03 New Zealand Health Survey, Ministry of Health 8

13 Pacific cardiovascular disease mortality rates are consistently and significantly higher than those of the total population (about twice as high in middle age and 1.5 times higher in old ages). Male cardiovascular disease mortality rates are higher than the corresponding female rates for all adult age groups. 9

14 Cancer Males Male cancer mortality, selected cancers, rate per 100,000, by age group, years Lung cancer years Lung cancer Prostate 65+ years Lung cancer Prostate Note: 1. Age-standardised within each age group to WHO standard population. Source: New Zealand Health Information Service For prostate and lung cancer, Pacific men aged 65 and older have above average mortality rates. 10

15 Cancer Females Female cancer mortality, selected cancers, rate per 100,000, by age group, years Cervical cancer Breast cancer years Cervical cancer Breast cancer 65+ years Cervical cancer Breast cancer Note: 1. Age-standardised within each age group to WHO standard population. Source: New Zealand Health Information Service Pacific women have higher than average mortality rates for breast cancer (all age groups) and cervical cancer (45 64 age group). 11

16 Section 2: Health Service Utilisation Use of primary health care services Males Females Males Females Percentage of people who selfreport having a usual carer, 15+ years, 2002/ ( ) 97.3 ( ) 89.7 ( ) 96.0 ( ) Percentage of people who selfreport having been to a dentist in the past year, 15+ years, 2002/ ( ) 22.3 ( ) 36.8 ( ) 44.8 ( ) Note: 1. Age-standardised to WHO standard population. Source: 2002/03 New Zealand Health Survey, Ministry of Health Ninety-five percent of had a usual carer (total New Zealand population 93 percent). Only one-fifth of Pacific adults visited a dentist in the previous year, compared with two-fifths of all New Zealanders, a statistically significant difference. These findings refer to 2002/03 and so do not yet reflect the impact of The Primary Health Care Strategy or Primary Health Organisations (PHOs). 12

17 Use of primary health care services Percentage of people registered with Primary Health Organisation, Source: Yan, Ministry of Health, personal communication, 2004 In January 2004, 96 percent of all were registered with a Primary Health Organisation, compared with about 62 percent for the total population. This high rate of Primary Health Organisation registration suggests that access to and quality of primary health care for has the potential to improve in the near future. This may apply particularly to clinical preventive services. These findings refer to 2004 and so do not yet reflect the impact of The Primary Health Care Strategy or Primary Health Organisations (PHOs). 13

18 Clinical Preventive Service Use Pacific peoples 1 Proportion of children fully immunised at 2 years of age, Northern RHA region, rate per 100, Note: 1. Total calculated from ethnic estimates. Source: Northern Regional Health Authority Immunisation Survey, unpublished report The percentage of children fully immunised at 2 years of age is less for than for the total population approximately 53 percent compared with 63 percent. The only data available are eight years old and restricted to the northern half of the North Island (although that area includes a high proportion of the Pacific population). 14

19 Clinical Preventive Service Use Uptake of cervical 1 and breast 2 cancer screening programmes, rate per 100, 2002 Cervical screening Breast screening Notes: 1. Screening within three years, adjusted for hysterectomy and age. 2. Screening within two years. Source: National Screening Unit, Ministry of Health Pacific women have an uptake of cervical and breast screening that is one-third lower than the general population. This could be a contributor to the relatively high incidence (and mortality rates) of these cancers among Pacific women (see page 11). 15

20 Barriers to care Males Females Males Females Proportion reporting one or more foregone GP visit(s), rate per 100, 15+ years, 2002/ ( ) 18.1 ( ) 11 ( ) 14.3 ( ) Self-reported percentage of people who did not collect one or more prescriptions, rate per 100, 15+ years, 2002/ ( ) 21.1 ( ) 13.5 ( ) 21.4 ( ) Note: 1. Age-standardised to WHO standard population. Source: 2002/03 New Zealand Health Survey, Ministry of Health 16

21 were more likely than average not to have seen a doctor even though they perceived a need to (a statistically significant difference). were about as likely to report that they had foregone a prescription as the national average (approximately 17 percent of prescriptions were not filled). These findings refer to 2002/03 and so do not yet reflect the impact of The Primary Health Care Strategy or Primary Health Organisations (PHOs). 17

22 Secondary care Males Females Males Females Self-reported percentage of people who saw a medical specialist in the previous year, rate per 100, 15+ years, 2002/ ( ) 20.1 ( ) 28 ( ) 32.6 ( ) Self-reported percentage of people who used hospital inpatients 1 in the previous year, rate per 100, 15+ years, 2002/ ( ) 20.5 ( ) 8.8 ( ) 13.7 ( ) Notes: 1. The hospital inpatients category is only for publicly funded hospitals and includes day patients. 2. Age-standardised to WHO standard population. Source: 2002/03 New Zealand Health Survey, Ministry of Health 18

23 were much less likely to have seen a medical specialist than the New Zealand population. Pacific women reported a significantly higher level of hospital admission than the total New Zealand population (20.5 percent compared with 13.7 percent). Many of these admissions will have been for maternity and related reasons. By contrast, Pacific men reported a similar level of hospital admission in the total New Zealand population (8.6 percent compared with 8.8 percent). Pacific females are just over twice as likely as their male counterparts to be admitted to hospital. 19

24 Secondary Care Medical admissions for, percentage of expected rate (standardised discharge ratio 1 ), 2002/03 Surgical admissions for, percentage of expected rate (standardised discharge ratio 1 ), 2002/ Note: 1. Standardised discharge ratio (SDR) is the ratio of observed to expected discharge rates. SDRs are standardised by the indirect method for both age and level of deprivation (NZDep2001). Source: New Zealand Health Information Service The rate of hospital discharges was 16 percent higher than expected for medical admissions and 10 percent lower for surgical admissions comparing the Pacific population to the total New Zealand population after adjusting for both age and NZDep distributions. 20

25 Mental health services Use of community outpatient care, rate per 100,000, , 3 Use of forensic services, rate per ,000, , 3 Notes: 1. Community Outpatient Care = Service Code T Forensic = Service Code T11-T Not standardised for age or NZDep distributions. Source: Mental Health Information National Collection, New Zealand Health Information Service utilisation of outpatient care is lower than the national average. Utilisation of forensic psychiatric services is signicantly elevated compared to the general population (164 percent). 21

26 Disability support services Non-Pacific 2 Help with everyday activities, rate per 100 disabled people, Disability equipment use, rate per 100 disabled people, Notes: 1. Help with everyday activities includes help with meal preparation, shopping, housework, personal care, etc. 2. Calculated from Disability Services directorate data on non- (Pacific peoples make up 3.8 percent of the disabled population). Source: New Zealand Disability Survey, Ministry of Health with disabilities are more likely than average to receive personal assistance with everyday activities but less likely to receive assistive devices to ameliorate their disability. living with a disability report a similar, and low, level of unmet need for services as the general population. 22

27 Section 3: Risk Factors Physical activity Males Females Males Females Percentage of children (5 17 years) physically active 1, * 53 ( ) 52 ( ) 73 ( ) 64 ( ) Percentage of adults (18+ years) physically active 1, * 68 ( ) 58 ( ) 69 (68 70) 66 (65 67) Note: 1. Active means took part in at least 2.5 hours of physical activity in the seven days before the survey interview. Sources: *1997/98, 1998/99, 2000/01 Sport and Physical Activity Surveys, SPARC Pacific women are significantly less likely to be physically active than women overall, but the difference is small (not statistically significant) for men. 23

28 Fat intake Males Females Males Females Mean percent energy from total fat for children (5 14 years), 2002 * 35 ( ) 34.3 ( ) 33.2 ( ) 32.9 ( ) Mean percent energy from total fat 2 for adults (15+ years), 1997 ** 35 ( ) 33 ( ) 35 ( ) 35 ( ) Note: 1. These data were not adjusted for intra-individual variation, as the number of Pacific people in the survey was too low. Sources: *2002 Children s Nutrition Survey, Ministry of Health **1997 National Nutrition Survey, Ministry of Health The mean percentage of energy obtained from total fat was higher for Pacific boys than the national average but not significantly so for Pacific girls. Pacific male and female adults obtained very similar percentages of their energy from total fat as male and female adults in the total population. 24

29 Vegetable consumption Males Females Males Females Percentage of children 1 (5 14 years) who eat at least three servings of vegetables per day, 2002 * Percentage of adults (15+ years) who eat at least three servings of vegetables per day, 1997 ** 42.9 ( ) 39.4 ( ) 63.3 ( ) 71.1 ( ) Note: 1. Standard errors were not published, so confidence intervals cannot be calculated. Sources: *2002 Children s Nutrition Survey, Ministry of Health **1997 National Nutrition Survey, Ministry of Health More Pacific boys (59 percent) and girls (65 percent) consumed the recommended three or more servings of vegetables per day than the national averages for boys (55 percent) and girls (58 percent). Fewer Pacific males (43 percent) and females (39 percent) consumed the recommended three or more servings of vegetables per day than the corresponding national averages for males (63 percent) and females (71 percent). 25

30 Food security Percentage of households with child(ren) (5 14 years) that can afford to eat properly only sometimes, Percentage of households with child(ren) (5-14 years) that use food banks sometimes, Note: 1. Options Never and Don t know were not reported. Whenever adult members of the households of the children that participated were available, they were asked to respond on the children s behalf. Children were not asked these questions. Standard errors were not published, so confidence intervals cannot be calculated. Source: 2002 Children s Nutrition Survey, Ministry of Health Forty-eight percent of households with dependent Pacific children can afford to eat properly only sometimes (compared to a national average of 20 percent). Eighteen percent of households with dependent Pacific children sometimes use food banks (compared to a national average of less than 9 percent). 26

31 Overweight and obesity Males Females Males Females Percentage of children (5 14 years) overweight 1, 2002 * Percentage of adults (15+ years) overweight 2, 3, 4, 2002/03 ** 43.9 ( ) 34.8 ( ) 40.5 ( ) 27.5 ( ) Percentage of children (5 14 years) obese 1, 2002 * Percentage of adults (15+ years) obese 2,3,4, 2002/03 ** 38 ( ) 47.8 ( ) 19.2 ( ) 21 ( ) Notes: 1. BMI > cut-off values defined by Cole et al (2002) 2. Standard errors were not published so confidence intervals could not be calculated. 2. Age-standardised to WHO standard population. 3. For : Overweight: BMI 26.0 kg/m 2 and <32.0 kg/m 2 ; Obese: BMI 32.0 kg/m For total population: Overweight: BMI 25.0 kg/m 2 and <30.0 kg/m 2 ; Obese: BMI 30.0 kg/m 2. Sources: *2002 Children s Nutrition Survey, Ministry of Health **2002/03 New Zealand Health Survey, Ministry of Health 2 Cole TJ, Bellizzi MC, Flegal KM, et al Establishing a standard definition for child overweight and obesity worldwide: international survey. British Medical Journal 320:

32 Pacific boys (60 percent) and girls (64 percent) have higher rates of overweight and obesity (combined) than the national averages (29 percent and 34 percent respectively) approximately 50 percent higher for overweight and 200 percent higher for obesity. Pacific male (82 percent) and female (79 percent) adults have higher rates of overweight and obesity (combined) to their total population counterparts (60 percent and 47 percent respectively). Pacific adults are not significantly more likely to be overweight than the national average but are approximately twice as likely to be obese. This is despite using a higher cut-off for overweight and obesity for the Pacific ethnic group. 28

33 Tobacco and alcohol consumption Males Females Males Females Prevalence (%) of at least weekly smoking (14 15 years) 1, 2, 2002 * Cigarette smoking prevalence (%) (15+ years) 1, 2, 2002 ** Prevalence (%) of hazardous drinking (15 24 years) 1, 2002 *** 18.1 ( ) 18.1 ( ) 41.5 ( ) 26.7 ( ) Prevalence (%) of hazardous drinking (25 44 years) 1, 2002 *** 40 ( ) 7.8 ( ) 29.4 ( ) 10.4 ( ) Notes: 1. Age-standardised to the WHO standard population. 2. Confidence intervals were not provided. Sources: *Action on Smoking and Health 2003 **AC Nielson (NZ) Ltd 2002 ***2002/03 New Zealand Health Survey, Ministry of Health 29

34 Pacific males and females aged years have similar rates of at least weekly smoking to their counterparts in the total New Zealand population. Controlling for age, Pacific males aged 15 years and over have a higher prevalence of cigarette smoking than the males in the total population (about one-third higher). Female rates are similar for the Pacific and total populations. Pacific youth (male and female) appear to have lower rates of potentially hazardous drinking than the national average, but the differences are not statistically significant for females. By contrast, Pacific adult males (25 44 years) appear to have higher than average rates of hazardous drinking, although again the differences do not reach conventional levels of statistical significance (perhaps because of small sample sizes), so chance cannot be excluded as an explanation for the findings. 30

35 Section 4: Socioeconomic Determinants of Health Age distribution Pacific population 2001 Age-group (years) Males Females Total population 2001 Age-group (years) Males Females Percent Percent Source: Statistics New Zealand Pacific Progress. Wellington: Statistics New Zealand. In comparison with the total New Zealand population, constitute a very youthful population. In 2001, 39 percent of were aged under 15 years, compared with only 23 percent of the total population. By contrast, only 3 percent of were aged over 65 years in 2001, compared with 12 percent of the total population. The median age for in 2001 was 21 years, compared with 35 years for the total population. 31

36 Neighbourhood deprivation Percentage of population Decile Note: 1. Line indicates general population distribution (approximately 10 percent in each decile). Source: Salmond and Crampton 2002 The Pacific population is highly skewed, with 42 percent living in decile 10 areas (most deprived) instead of the expected 10 percent. make up 22 percent of the population living in NZDep2001 decile 10 small areas, but only 6.5 percent of the total population. That is, are over-represented in decile 10 areas by almost four-fold. 32

37 Education and employment Pacific peoples Percentage enrolled in early childhood education (0 4 years), 2001 * Percentage enrolled in tertiary education (18 24 years), 2001 * Percentage of adult population (18+ years) with no formal educational qualification, 2001 * Labour force participation rates, March ** Unemployment rates, March 2004 ** Sources: * Statistics New Zealand Pacific Progress. Wellington: Statistics New Zealand **Statistics New Zealand Participation of Pacific preschoolers enrolled in early childhood education (all types combined) has been increasing over the past decade, from 26 percent of children aged 0 4 years in 1991 to 33 percent in The proportion of Pacific youth (18 24 years) enrolled in tertiary study was only half the national average in 2001 (15 percent versus 32 percent). 33

38 In 1986, over half the Pacific population (54 percent) over 18 years of age and not still at school had no formal educational qualifications, but by 2001, this had fallen to 36 percent. However, this is still higher than the national figure of 28 percent. As of March 2004, the Pacific unemployment rate stood at 7.9 percent, well down from its peak of 28.8 percent in 1992 and an improvement over the 2001 rate of 11.2 percent. Despite this improvement, the unemployment rate among Pacific peoples remains almost twice that of the total population, for both sexes and at all ages. 34

39 Income and housing Real median annual income 1, ages 15+ $14,600 $18,600 years, 2001 * Proportion of population (15+ years) owning (with or without a mortgage) the dwelling in which they usually live, 2001 ** Proportion of the population living in dwellings with more than two occupants per bedroom, 2001 ** Note: 1. Age-standardised. Sources: * Statistics New Zealand ** Statistics New Zealand Pacific Progress. Wellington: Statistics New Zealand median hourly wage and salary earnings equated to an average of 78 percent of the national median earnings from wages and salaries between 1997 and are considerably less likely than the overall New Zealand population to own or partly own the dwelling in which they usually live. In 2001, 26 percent of Pacific people aged 15+ years stated they owned or partly owned their home. This compares to the national rate of 55 percent. In 2001, 21 percent of Pacific people were living with more than two occupants per bedroom, compared with 3 percent of the national population. 35

40 Charting Our Health Public Health Intelligence, Ministry of Health Public Health Intelligence (PHI) is a group of epidemiologists, statisticians, geographers and social scientists in the Public Health Directorate of the Ministry of Health. PHI carries out the Ministry of Health s statutory responsibility to monitor the health of the New Zealand population by: measuring how healthy the New Zealand population is over time by analysing population health outcomes, risks and determinants examining inequalities in health across regional boundaries and between population groups (including age, sex, ethnic and socioeconomic groups). The guiding principles and behaviours of PHI are to be: professional in the pursuit of excellence scientific and evidence based stakeholder driven and client focused. Contact Details Public Health Intelligence Ministry of Health PO Box 5013, Wellington, New Zealand Tel: +64 (4) Fax: +64 (4) phi@moh.govt.nz Webpage: 36