The Health of Children and Young People with Chronic Conditions and Disabilities in the Hutt Valley and Capital & Coast DHBs This Report was prepared for the Hutt Valley and Capital & Coast DHBs by Elizabeth Craig, Anne Reddington, Judith Adams, Rebecca Dell, Susan Jack, Glenda Oben, Andrew Wicken and Jean Simpson of the NZ Child and Youth Epidemiology Service November 2013 This report was produced as the result of a contract between the District Health Boards and the University of Otago, on behalf of the NZ Child and Youth Epidemiology Service (NZCYES). The NZCYES is located in the Department of Women s and Children s Health at the University of Otago s Dunedin School of Medicine. While every endeavour has been made to use accurate data in this report, there are currently variations in the way data are collected from DHBs and other agencies that may result in errors, omissions or inaccuracies in the information in this report. The NZCYES does not accept liability for any inaccuracies arising from the use of this data in the production of these reports, or for any losses arising as a consequence thereof.
Acknowledgments The in-depth topics The Determinants and Consequences of Overweight and Obesity, and The Treatment of Obesity in Children and Adolescents were researched and written by Dr Judith Adams of the NZCYES. We gratefully acknowledge peer review undertaken by Dr Yvonne Anderson, Paediatrician, Taranaki District Health Board. The in-depth topic Children of Parents with Mental Illness and Alcohol and Other Addictions was researched and written by Dr Susan Jack of the NZCYES. We gratefully acknowledge peer review undertaken by Dr Lynne Lane, Mental Health Commissioner; Dr Bronwyn Dunachie, Senior Advisor and Dr Hiran Thabrew Deputy Director, The Werry Centre for Child and Adolescent Mental Health.
TABLE OF CONTENTS Table of Contents... 5 List of Figures... 7 List of Tables...12 INTRODUCTION AND OVERVIEW...17 Introduction and Overview...19 Background and Aims...19 Report Structure and Content...20 Overview of Report s Key Findings...22 CONDITIONS ARISING IN THE PERINATAL PERIOD...37 PERINATAL CONDITIONS...39 Fetal Deaths...41 Preterm Birth...53 CONGENITAL ANOMALIES EVIDENT AT BIRTH...69 Antenatal and Newborn Screening...71 Congenital Anomalies Evident at Birth...79 Congenital Heart Disease...97 Down Syndrome... 106 Neural Tube Defects... 117 OTHER DISABILITIES... 125 Permanent Hearing Loss... 127 Cerebral Palsy... 144 Autism Spectrum Disorder... 157 CHRONIC MEDICAL CONDITIONS... 169 Eczema and Dermatitis... 171 Inflammatory Bowel Disease... 181 Cystic Fibrosis... 193 Type 1 Diabetes... 208 Epilepsy... 221 Cancer... 236 OBESITY, NUTRITION AND PHYSICAL ACTIVITY... 259 OVERWEIGHT AND OBESITY... 261 In Depth Topic: The Determinants and Consequences of Overweight and Obesity... 263 The Distribution of Overweight and Obesity in Children and Young People... 277 The Consequences of Obesity... 292 Type 2 Diabetes... 292 Slipped Upper Femoral Epiphysis... 297 Bariatric Surgery... 303 5
In Depth Topic: The Treatment of Obesity in Children and Adolescents... 307 NUTRITION AND PHYSICAL ACTIVITY... 333 Breastfeeding and Solids... 335 Other Nutritional Indicators... 350 Physical Activity... 362 CHILDREN OF PARENTS WITH MENTAL ILLNESS AND ALCOHOL AND OTHER ADDICTIONS... 375 In-Depth Topic: Children of Parents with Mental Illness and Alcohol and Other Addictions (COPMIA)... 377 APPENDICES AND REFERENCES... 399 Appendix 1: Search Methods for Policy Documents and Evidence-Based Reviews... 401 Appendix 2: Statistical Significance Testing and its use in this Report... 403 Appendix 3: The National Minimum Dataset... 405 Appendix 4: The Birth Registration Dataset... 409 Appendix 5: National Mortality Collection... 410 Appendix 6: Measurement of Ethnicity... 411 Appendix 7: NZ Deprivation Index... 415 Appendix 8: Congenital Anomaly Codes... 416 References... 418 6
LIST OF FIGURES Figure 1. Intermediate and Late Fetal Deaths, New Zealand 2000 2010...42 Figure 2. Fetal Deaths by Gestational Age and Main Fetal Cause of Death, New Zealand 2006 2010...44 Figure 3. Intermediate and Late Fetal Deaths by Ethnicity, New Zealand 2000 2010...44 Figure 4. Intermediate and Late Fetal Deaths, Hutt Valley and Capital & Coast vs. New Zealand 2000 2010...48 Figure 5. Preterm Birth Rates in Singleton Live Born Babies by Gestational Age, New Zealand 2000 2012...54 Figure 6. Number of Preterm Births in Singleton Live Born Babies by Gestational Age, New Zealand 2000 2012...55 Figure 7. Preterm Birth Rates in Singleton Live Born Babies by Baby s Ethnicity, New Zealand 2000 2012...55 Figure 8. Gestational Age at Delivery by Plurality, New Zealand Live Births 2008 2012...58 Figure 9. Preterm Birth Rates in Live Born Babies by Plurality, New Zealand 2000 2012...60 Figure 10. Number of Preterm Live Births by Plurality, New Zealand 2000 2012...60 Figure 11. Preterm Birth Rates in Singleton Live Born Babies, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012...63 Figure 12. Preterm Birth Rates in Singleton Live Born Babies by Baby s Ethnicity, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012...63 Figure 13. Babies with Congenital Anomalies Evident at Birth, New Zealand Hospital Births 2000 2012...83 Figure 14. Babies with Congenital Anomalies Evident at Birth by Maternal Age, New Zealand Hospital Births 2008 2012...83 Figure 15. Babies with Congenital Anomalies Evident at Birth by Ethnicity, New Zealand Hospital Births 2000 2012...85 Figure 16. Babies with Congenital Anomalies Evident at Birth, Hutt Valley and Capital & Coast vs. New Zealand Hospital Births 2000 2012...90 Figure 17. Babies with Cardiovascular Anomalies Evident at Birth, New Zealand Hospital Births 2000 2012...99 Figure 18. Babies with Cardiovascular Anomalies Evident at Birth by Maternal Age, New Zealand Hospital Births 2008 2012... 100 Figure 19. Babies with Cardiovascular Anomalies Evident at Birth by Prioritised Ethnicity, New Zealand Hospital Births 2000 2012... 100 Figure 20. Babies with Cardiovascular Anomalies Evident at Birth, Hutt Valley and Capital & Coast vs. New Zealand Hospital Births 2000 2012... 103 Figure 21. Babies with Down Syndrome Evident at Birth, New Zealand Hospital Births 2000 2012... 109 Figure 22. Babies with Down Syndrome Evident at Birth by Maternal Age, New Zealand Hospital Births 2008 2012... 109 Figure 23. Babies with Down Syndrome Evident at Birth by Ethnicity, New Zealand Hospital Births 2000 2012... 111 Figure 24. Babies with Down Syndrome Evident at Birth, Hutt Valley and Capital & Coast vs. New Zealand Hospital Births 2000 2012... 112 Figure 25. Babies with Neural Tube Defects Evident at Birth, New Zealand Hospital Births 2000 2012... 119 7
Figure 26. Babies with Neural Tube Defects Evident at Birth by Maternal Age, New Zealand Hospital Births 2008 2012... 119 Figure 27. Average Age of Suspicion and Confirmation of Hearing Loss, New Zealand Deafness Notification Database 2001 2005 and 2010 2012... 129 Figure 28. Number of Notifications to the Deafness Notification Database by Age, New Zealand 2010 2012... 130 Figure 29. Hospital Admissions (2008 2012) and Mortality (2006 2010) for New Zealand Children and Young People with Cerebral Palsy by Age... 148 Figure 30. Hospital Admissions for Children and Young People Aged 0 24 Years with Cerebral Palsy by Ethnicity, New Zealand 2000 2012... 149 Figure 31. Hospital Admissions for Children and Young People Aged 0 24 Years with Cerebral Palsy, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012... 150 Figure 32. Hospital Admissions for Children and Young People with Autism or Other Pervasive Developmental Disorders by Age, New Zealand 2008 2012... 160 Figure 33. Hospital Admissions for Children and Young People 0 24 Years with Autism or Other Pervasive Developmental Disorders by Ethnicity, New Zealand 2000 2012... 161 Figure 34. Hospital Admissions for Children and Young People Aged 0 24 Years with Autism or Other Pervasive Developmental Disorders, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012... 162 Figure 35. Hospital Admissions for Children with a Primary Diagnosis of Eczema or Dermatitis by Age, New Zealand 2008 2012... 173 Figure 36. Hospital Admissions for Children Aged 0 14 Years with a Primary Diagnosis of Eczema or Dermatitis by Ethnicity, New Zealand 2000 2012... 174 Figure 37. Hospital Admissions for Children Aged 0 14 Years with a Primary Diagnosis of Eczema or Dermatitis, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012... 177 Figure 38. Hospital Admissions for Children and Young People with Crohn s Disease or Ulcerative Colitis by Age, New Zealand 2008 2012... 184 Figure 39. Hospital Admissions for Children and Young People Aged 0 24 Years with Crohn s Disease or Ulcerative Colitis by Ethnicity, New Zealand 2000 2012... 185 Figure 40. Hospital Admissions for Children and Young People 0 24 Years with Crohn s Disease or Ulcerative Colitis, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012... 187 Figure 41. Hospital Admissions (2008 2012) and Mortality (2006 2010) for New Zealand Children and Young People with Cystic Fibrosis by Age... 197 Figure 42. Hospital Admissions for Children and Young People Aged 0 24 Years with Cystic Fibrosis by Ethnicity, New Zealand 2000 2012... 198 Figure 43. Hospital Admissions for Children and Young People Aged 0 24 Years with Cystic Fibrosis, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012... 199 Figure 44. Hospital Admissions (2008 2012) and Mortality (2006 2010) for New Zealand Children and Young People with Type 1 Diabetes by Age... 211 Figure 45. Hospital Admissions for Children and Young People Aged 0 24 Years with Type 1 Diabetes by Ethnicity, New Zealand 2000 2012... 212 Figure 46. Hospital Admissions for Children and Young People Aged 0 24 Years with Type 1 Diabetes, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012... 213 Figure 47. Hospital Admissions (2008 2012) and Mortality (2006 2010) for New Zealand Children and Young People with Epilepsy or Status Epilepticus by Age... 222 Figure 48. Hospital Admissions for Children and Young People Aged 0 24 Years with Epilepsy or Status Epilepticus by Ethnicity, New Zealand 2000 2012... 226 8
Figure 49. Hospital Admissions for Children and Young People Aged 0 24 Years with Epilepsy or Status Epilepticus, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012... 227 Figure 50. NZ Cancer Registry Notifications for Cancers of the Lymphoid/Haematopoietic Tissues in Children and Young People Aged 0 24 Years, New Zealand 2000 2011... 240 Figure 51. NZ Cancer Registry Notifications for Cancers of the Lymphoid/Haematopoietic Tissues in Children and Young People by Age, New Zealand 2002 2011... 240 Figure 52. NZ Cancer Registry Notifications for Malignant Melanoma and Melanoma In Situ in Children and Young People Aged 0 24 Years, New Zealand 2000 2011... 242 Figure 53. NZ Cancer Registry Notifications for Malignant Melanoma and Melanoma In Situ in Children and Young People by Age, New Zealand 2002 2011... 242 Figure 54. NZ Cancer Registry Notifications for Cancer and Carcinoma In Situ of the Cervix and Cancer of the Ovary in Children and Young People by Age, New Zealand 2002 2011... 243 Figure 55. NZ Cancer Registry Notifications for Selected Other Cancers in Children and Young People Aged 0 24 Years, New Zealand 2000 2011... 245 Figure 56. NZ Cancer Registry Notifications for Cancers of the Brain, Retina and Bone and Cartilage in Children and Young People by Age, New Zealand 2002 2011... 245 Figure 57. NZ Cancer Registry Notifications for Cancers of the Adrenal, Kidney and Thyroid in Children and Young People by Age, New Zealand 2002 2011... 246 Figure 58. Proportion of Children Aged 2 14 Years who were either Overweight or Obese by Gender and Ethnicity, 2006/07 and 2011/12 New Zealand Health Surveys... 280 Figure 59. Proportion of Children Aged 2 14 Years Who Were Obese by Region, 2006/07 and 2011/12 New Zealand Health Surveys... 281 Figure 60. Proportion of Children and Young People Aged 2 24 Years who were either Overweight or Obese by Gender and Age, 2011/12 New Zealand Health Survey... 282 Figure 61. Proportion of Children Aged 2 14 Years who were either Overweight or Obese by Gender and Ethnicity, 2011/12 New Zealand Health Survey... 282 Figure 62. Proportion of Children Aged 2 14 Years Who Were Either Overweight or Obese by Gender and NZ Deprivation Index Decile, 2011/12 New Zealand Health Survey... 283 Figure 63. Proportion of Secondary School Students Aged 13 17+ Years who were Underweight, a Healthy Weight, Overweight or Obese by Gender, New Zealand Youth 07 and Youth 12 Surveys... 285 Figure 64. Proportion of Secondary School Students Aged 13 17+ Years who were Overweight or Obese by Gender, Age and NZ Deprivation Index, New Zealand Youth 12 Survey... 285 Figure 65. Hospital Admissions for Children and Young People with Type 2 Diabetes by Age, New Zealand 2008 2012... 293 Figure 66. Hospital Admissions for Children and Young People Aged 0 24 Years with Type 2 Diabetes by Ethnicity, New Zealand 2000 2012... 295 Figure 67. Hospital Admissions for Children and Young People Aged 0 24 Years with Type 2 Diabetes, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012... 297 Figure 68. Hospital Admissions for Children and Young People with a Slipped Upper Femoral Epiphysis by Age and Gender, New Zealand 2008 2012... 300 Figure 69. Hospital Admissions for Children and Young People Aged 0 24 Years with a Slipped Upper Femoral Epiphysis by Ethnicity, New Zealand 2000 2012... 301 9
Figure 70. Hospital Admissions for Children and Young People 0 24 Years with a Slipped Upper Femoral Epiphysis, Hutt Valley and Capital & Coast vs. New Zealand 2000 2012... 302 Figure 71. Hospital Admissions for Bariatric Surgery by Primary Procedure in Young People Aged 15 24 Years, New Zealand 2008 2012... 304 Figure 72. Hospital Admissions for Bariatric Surgery in Young People Aged 15 24 Years, New Zealand 2000 2012... 304 Figure 73. Hospital Admissions for Bariatric Surgery in Young People Aged 15 24 Years by Age, New Zealand 2008 2012... 305 Figure 74. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age, New Zealand, Years Ending June 2006 2012... 336 Figure 75. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age and Ethnicity, New Zealand, Years Ending June 2006 2012... 337 Figure 76. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age and NZ Deprivation Index Decile, New Zealand, Year Ending June 2012... 337 Figure 77. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age, Hutt Valley and Capital & Coast vs. New Zealand, Years Ending June 2006 2012... 338 Figure 78. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age and Ethnicity, Hutt Valley and Capital & Coast vs. New Zealand, Years Ending June 2006 2012... 339 Figure 79. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age and NZ Deprivation Index Decile, Hutt Valley and Capital & Coast, Year Ending June 2012... 340 Figure 80. Proportion of Babies and Children Aged 4 Months to 4 Years Who Were Given Solid Food Before Four Months of Age by Gender and Ethnicity, 2006/07 and 2011/12 New Zealand Health Surveys... 341 Figure 81. Proportion of Babies and Children Aged 4 Months to 4 Years Who Were Given Solid Food Before Four Months of Age by Region, 2006/07 and 2011/12 New Zealand Health Surveys... 342 Figure 82. Proportion of Babies and Children Aged 4 Months to 4 Years Who Were Given Solid Food Before Four Months of Age by Gender, Ethnicity and NZ Deprivation Index Decile, 2011/12 New Zealand Health Survey... 343 Figure 83. Proportion of Children Aged 2 14 Years Who Ate Breakfast at Home Every Day in the Past Week by Gender and Ethnicity, 2006/07 and 2011/12 New Zealand Health Surveys... 351 Figure 84. Proportion of Children Aged 2 14 Years Who Ate Breakfast at Home Every Day in the Past Week by Region, 2006/07 and 2011/12 New Zealand Health Surveys... 352 Figure 85. Proportion of Children Aged 2 14 Years Who Ate Breakfast at Home Every Day in the Past Week by Gender, Age Group, Ethnicity and NZ Deprivation Index Decile, 2011/12 New Zealand Health Survey... 353 Figure 86. Proportion of Children Aged 2 14 Years Who Ate Fast Food Three or More Times in the Past Week by Gender and Ethnicity, 2006/07 and 2011/12 New Zealand Health Surveys... 354 Figure 87. Proportion of Children Aged 2 14 Years Who Ate Fast Food Three or More Times in the Past Week by Gender, Age, Ethnicity and NZ Deprivation Index Decile, 2011/12 New Zealand Health Survey... 355 Figure 88. Proportion of Children Aged 2 14 Years Who Had Fizzy Drinks Three or More Times in the Past Week by Gender and Ethnicity, 2006/07 and 2011/12 New Zealand Health Surveys... 356 10
Figure 89. Proportion of Children Aged 2 14 Years Who Had Fizzy Drinks Three or More Times in the Past Week by Gender, Age, Ethnicity and NZ Deprivation Index Decile, 2011/12 New Zealand Health Survey... 357 Figure 90. Frequency of Eating Breakfast in Secondary School Students Aged 13 17+ Years by Gender, Age, NZ Deprivation Index Decile and Geography, New Zealand Youth 12 Survey... 358 Figure 91. Fruit and Vegetable Consumption in Secondary School Students Aged 13 17+ Years by Gender, Age, NZ Deprivation Index Decile and Geography, New Zealand Youth 12 Survey... 359 Figure 92. Proportion of Secondary School Students Aged 13 17+ Years Who Engaged in More than 20 Minutes of Vigorous Physical Activity on 3+ Occasions in Past 7 Days, or Who Did 60+ Minutes Physical Activity Daily, New Zealand Youth 12 Survey... 363 Figure 93. Proportion of Secondary School Students Aged 13 17+ Years Who Walked, Biked or Skated To/From School 6+ Times in Past 7 Days, New Zealand Youth 12 Survey... 364 Figure 94. Time Spent Per Day on Selected Sedentary Leisure Activities, Secondary School Students Aged 13 17+ Years, New Zealand Youth 12 Survey... 366 Figure 95. Proportion of Secondary School Students Aged 13 17+ Years who Spend 3+ Hours Each Day on Selected Sedentary Leisure Activities, New Zealand Youth 12 Survey... 366 Figure 96. Proportion of Children Aged 5 14 Years Who Usually Use Active Transport to and From School by Gender and Ethnicity, 2006/07 and 2011/12 NZ Health Surveys... 368 Figure 97. Proportion of Children Aged 5 14 Years Who Usually Use Active Transport to and From School by Gender, Age, Ethnicity and NZ Deprivation Index Decile, 2011/12 NZ Health Survey... 368 Figure 98. Proportion of Children Aged 2 14 Years Who Usually Watch 2+ Hours of Television per Day by Gender, Age, Ethnicity and NZ Deprivation Index Decile, 2011/12 New Zealand Health Survey... 370 11
LIST OF TABLES Table 1. Overview of the Health of Children and Young People with Chronic Conditions and Disabilities in Hutt Valley and Capital & Coast... 23 Table 2. Intermediate and Late Fetal Deaths by Main Fetal Cause of Death, New Zealand 2006 2010... 43 Table 3. Intermediate and Late Fetal Deaths by Ethnicity, NZ Deprivation Index Decile, Gender and Maternal Age, New Zealand 2006 2010... 45 Table 4. Intermediate Fetal Deaths by Main Fetal Cause of Death, Hutt Valley and Capital & Coast 2006 2010... 46 Table 5. Late Fetal Deaths by Main Fetal Cause of Death, Hutt Valley and Capital & Coast 2006 2010... 47 Table 6. Intermediate and Late Fetal Deaths, Hutt Valley and Capital & Coast vs. New Zealand 2006 2010... 47 Table 7. Local Policy Documents and Evidence-Based Reviews Relevant to Fetal Deaths... 48 Table 8. Preterm Birth Rates in Singleton Live Born Babies by Ethnicity, NZ Deprivation Index Decile, Gender and Maternal Age, New Zealand 2008 2012... 56 Table 9. Preterm Birth Rates in Singleton Live Born Babies by Ethnicity, NZ Deprivation Index Decile, Gender, Maternal Age and Gestational Age, New Zealand 2008 2012... 57 Table 10. Preterm Birth Rates by Plurality, New Zealand 2008 2012... 59 Table 11. Preterm Birth Rates in Live Born Twins by Ethnicity, NZ Deprivation Index Decile, Gender and Maternal Age, New Zealand 2008 2012... 61 Table 12. Preterm Birth Rates in Singleton Live Born Babies by Gestational Age, Hutt Valley and Capital & Coast vs. New Zealand 2008 2012... 62 Table 13. Local Policy Documents and Evidence-Based Reviews Relevant to Preterm Birth... 64 Table 14. Conditions Included in New Zealand s Newborn Metabolic Screening Programme... 72 Table 15. Local Policy Documents and Evidence-Based Reviews Relevant to Antenatal and Newborn Screening... 73 Table 16. Congenital Anomalies Evident at Birth, New Zealand 2008 2012 (Table 1 of 2)... 81 Table 17. Congenital Anomalies Evident at Birth, New Zealand 2008 2012 (Table 2 of 2)... 82 Table 18. Babies with Congenital Anomalies Evident at Birth by Ethnicity, NZ Deprivation Index Decile, Gender and Maternal Age, New Zealand Hospital Births 2008 2012... 84 Table 19. Congenital Anomalies Evident at Birth, Hutt Valley 2008 2012 (Table 1 of 2)... 86 Table 20. Congenital Anomalies Evident at Birth, Hutt Valley 2008 2012 (Table 2 of 2)... 87 Table 21. Congenital Anomalies Evident at Birth Capital & Coast 2008 2012 (Table 1 of 2)... 88 Table 22. Congenital Anomalies Evident at Birth Capital & Coast 2008 2012 (Table 2 of 2)... 89 Table 23. Babies with Congenital Anomalies Evident at Birth, Hutt Valley and Capital & Coast vs. New Zealand Hospital Births 2008 2012... 90 12
Table 24. Local Policy Documents and Evidence-Based Reviews Relevant to Congenital Anomalies...91 Table 25. Cardiovascular Anomalies Evident at Birth, New Zealand Hospital Births 2008 2012...99 Table 26. Distribution of Babies with Cardiovascular Anomalies Evident at Birth by Prioritised Ethnicity, NZ Deprivation Index Decile, Gender and Maternal Age, New Zealand Hospital Births 2008 2012... 101 Table 27. Cardiovascular Anomalies Evident at Birth, Hutt Valley and Capital & Coast Hospital Births 2008 2012... 102 Table 28. Number of Babies with One or More Cardiovascular Anomalies Evident at Birth, Hutt Valley and Capital & Coast vs. New Zealand Hospital Births 2008 2012... 102 Table 29. Local Policy Documents and Evidence-Based Reviews Relevant to Cardiovascular Anomalies... 104 Table 30. Chromosomal Anomalies Evident at Birth, New Zealand 2008 2012... 107 Table 31. Babies with Down Syndrome who also had Other Congenital Anomalies Evident at Birth, New Zealand Hospital Births 2008 2012... 108 Table 32. Babies with Down Syndrome Evident at Birth by Ethnicity, NZ Deprivation Index Decile, Gender and Maternal Age, New Zealand Hospital Births 2008 2012... 110 Table 33. Chromosomal Anomalies Evident at Birth, Hutt Valley and Capital & Coast 2008 2012... 111 Table 34. Babies with Down Syndrome Evident at Birth, Hutt Valley and Capital & Coast vs. New Zealand Hospital Births 2008 2012... 112 Table 35. Local Policy Documents and Evidence-Based Reviews Relevant to Down Syndrome and Other Chromosomal Anomalies... 113 Table 36. Nervous System Anomalies Evident at Birth, New Zealand 2008 2012... 118 Table 37. Babies with Neural Tube Defects Evident at Birth by Ethnicity, NZ Deprivation Index Decile, Gender and Maternal Age, New Zealand Hospital Births 2008 2012... 120 Table 38. Nervous System Anomalies Evident at Birth, Hutt Valley and Capital & Coast Hospital Births 2008 2012... 121 Table 39. Babies with Neural Tube Defects Evident at Birth, Hutt Valley and Capital & Coast vs. New Zealand Hospital Births 2008 2012... 121 Table 40. Local Policy Documents and Evidence-Based Reviews Relevant to Neural Tube Defects... 122 Table 41. Notifications to the Deafness Notification Database by Degree of Hearing Loss, Using the Old Notification Criteria, New Zealand 2001 2004 and 2010 2012... 129 Table 42. Number of Notifications Meeting the Old Criteria for Inclusion in the Deafness Notification Database by Region of Residence, New Zealand 1998 2004... 131 Table 43. Number of Notifications Meeting New Criteria for Deafness Notification Database by District Health Board, New Zealand 2010 2012... 132 Table 44. Newborn Hearing Screening Indicators by District Health Board, New Zealand 1st October 2011 31st March 2012... 135 Table 45. Newborn Audiology Indicators by District Health Board, New Zealand 1st October 2011 31st March 2012... 136 Table 46. Number of Babies Identified by Newborn Hearing Screening as Having Permanent Congenital Hearing Losses by District Health Board and Monitoring Period, New Zealand 1st April 2010 31st March 2012... 137 Table 47. Local Policy Documents and Evidence-Based Reviews Relevant to the Early Detection and Management of Permanent Hearing Loss in Children... 138 13
Table 48. Acute and Arranged Hospital Admissions for Children and Young People Aged 0 24 Years with Cerebral Palsy by Primary Diagnosis, New Zealand 2008 2012... 146 Table 49. Waiting List Hospital Admissions in Children and Young People Aged 0 24 Years with Cerebral Palsy by Primary Procedure, New Zealand 2008 2012... 147 Table 50. Hospital Admissions for Children and Young People Aged 0 24 Years with Cerebral Palsy by Ethnicity and Gender, New Zealand 2008 2012... 148 Table 51. Hospital Admissions for Children and Young People Aged 0 24 Years with Cerebral Palsy, Hutt Valley and Capital & Coast vs. New Zealand 2008 2012... 150 Table 52. Policy Documents and Evidence-Based Reviews Relevant to Cerebral Palsy... 151 Table 53. Hospital Admissions in Children and Young People Aged 0 24 Years with Autism or Other Pervasive Developmental Disorders by Primary Diagnosis, New Zealand 2008 2012... 159 Table 54. Hospital Admissions for Children and Young People Aged 0 24 Years with Autism or Other Pervasive Developmental Disorders by Ethnicity and Gender, New Zealand 2008 2012... 160 Table 55. Hospital Admissions for Children and Young People Aged 0 24 Years with Autism or Other Pervasive Developmental Disorders, Hutt Valley and Capital & Coast vs. New Zealand 2008 2012... 161 Table 56. Local Policy Documents and Evidence-Based Reviews Relevant to Autism... 162 Table 57. Hospital Admissions for Children Aged 0 14 Years with Eczema or Dermatitis, by Primary Diagnosis, New Zealand 2008 2012... 172 Table 58. Hospital Admissions for Children Aged 0 14 Years with a Primary Diagnosis of Eczema or Dermatitis by Ethnicity and Gender, New Zealand 2008 2012... 174 Table 59. Hospital Admissions for Children 0 14 Years with Eczema or Dermatitis by Primary Diagnosis, Hutt Valley and Capital & Coast 2008 2012... 175 Table 60. Hospital Admissions for Children Aged 0 14 Years with a Primary Diagnosis of Eczema or Dermatitis, Hutt Valley and Capital & Coast vs. New Zealand 2008 2012... 176 Table 61. Local Policy Documents and Evidence-Based Reviews Relevant to Eczema and Dermatitis... 177 Table 62. Hospital Admissions for Children and Young People Aged 0 24 Years with Crohn s Disease by Admission Type and Primary Diagnosis or Procedure, New Zealand 2008 2012... 182 Table 63. Hospital Admissions in Children and Young People Aged 0 24 Years with Ulcerative Colitis by Admission Type and Primary Diagnosis or Procedure, New Zealand 2008 2012... 183 Table 64. Hospital Admissions for Children and Young People Aged 0 24 Years with Crohn s Disease or Ulcerative Colitis by Ethnicity and Gender, New Zealand 2008 2012... 185 Table 65. Hospital Admissions for Children and Young People 0 24 Years with Crohn s Disease or Ulcerative Colitis, Hutt Valley and Capital & Coast vs. New Zealand 2008 2012... 186 Table 66. Local Policy Documents and Evidence-Based Reviews Relevant to Inflammatory Bowel Disease... 187 Table 67. Hospital Admissions in Children and Young People Aged 0 24 Years with Cystic Fibrosis by Primary Diagnosis, New Zealand 2008 2012... 195 Table 68. Secondary Diagnosis in Children and Young People Aged 0 24 Years Hospitalised with Cystic Fibrosis as a Primary Diagnosis, New Zealand 2008 2012... 196 14
Table 69. Hospital Admissions for Children and Young People Aged 0 24 Years with Cystic Fibrosis by Ethnicity and Gender, New Zealand 2008 2012... 197 Table 70. Hospital Admissions for Children and Young People Aged 0 24 Years with Cystic Fibrosis, Hutt Valley and Capital & Coast vs. New Zealand 2008 2012... 199 Table 71. Local Policy Documents and Evidence-Based Reviews Relevant to Cystic Fibrosis... 200 Table 72. Hospital Admissions in Children and Young People Aged 0 24 Years with Type 1 Diabetes by Primary Diagnosis, New Zealand 2008 2012... 210 Table 73. Hospital Admissions for Children and Young People Aged 0 24 Years with Type 1 Diabetes by Ethnicity and Gender, New Zealand 2008 2012... 211 Table 74. Hospital Admissions for Children and Young People Aged 0 24 Years with Type 1 Diabetes, Hutt Valley and Capital & Coast vs. New Zealand 2008 2012... 212 Table 75. Hospital Admissions in Children and Young People Aged 0 24 Years with Type 1 Diabetes by Primary Diagnosis, Hutt Valley and Capital & Coast 2008 2012... 214 Table 76. Local Policy Documents and Evidence-Based Reviews Relevant to Type 1 Diabetes in Children and Young People... 215 Table 77. Hospital Admissions in Children and Young People Aged 0 24 Years with Epilepsy or Status Epilepticus by Primary Diagnosis, New Zealand 2008 2012... 223 Table 78. Secondary Diagnoses in Children and Young People Aged 0 24 Years Hospitalised with Epilepsy or Status Epilepticus as a Primary Diagnosis, New Zealand 2008 2012... 224 Table 79. Hospital Admissions for Children and Young People Aged 0 24 Years with Epilepsy or Status Epilepticus by Ethnicity and Gender, New Zealand 2008 2012... 225 Table 80. Hospital Admissions for Children and Young People Aged 0 24 Years with Epilepsy or Status Epilepticus, Hutt Valley and Capital & Coast vs. New Zealand 2008 12... 227 Table 81. Hospital Admissions in Children and Young People Aged 0 24 Years with Epilepsy or Status Epilepticus by Primary Diagnosis, Hutt Valley and Capital & Coast 2008 2012... 228 Table 82. Policy Documents and Evidence-Based Reviews Relevant to the Diagnosis or Management of Epilepsy or Status Epilepticus... 229 Table 83. NZ Cancer Registry Notifications for Children and Young People Aged 0 24 Years by Cancer Type, New Zealand 2002 2011... 238 Table 84. Cancer Deaths in Children and Young People Aged 0 24 Years by Cancer Type, New Zealand 2001 2010... 239 Table 85. NZ Cancer Registry Notifications for Acute Lymphoblastic Leukaemia and Hodgkin Disease in Children and Young People Aged 0 24 Years by Gender and Ethnicity, New Zealand 2002 2011... 241 Table 86. NZ Cancer Registry Notifications for Malignant Melanoma and Melanoma In Situ in Children and Young People Aged 0 24 Years by Gender and Ethnicity, New Zealand 2002 2011... 243 Table 87. NZ Cancer Registry Notifications for Carcinoma In Situ of the Cervix in Young Women Aged 15 24 Years by Ethnicity, New Zealand 2002 2011... 244 Table 88. NZ Cancer Registry Notifications for Cancers of the Brain in Children and Young People Aged 0 24 Years by Gender and Ethnicity, New Zealand 2002 2011... 246 Table 89. NZ Cancer Registry Notifications for Children and Young People Aged 0 24 Years by Cancer Type, Hutt Valley 2002 2011... 247 Table 90. NZ Cancer Registry Notifications for Children and Young People Aged 0 24 Years by Cancer Type, Capital & Coast 2002 2011... 248 Table 91. Cancer Deaths in Children and Young People Aged 0 24 Years by Cancer Type, Hutt Valley and Capital & Coast 2001 2010... 249 15
Table 92. Local Policy Documents and Evidence-Based Reviews Relevant to Cancer in Children and Young People... 250 Table 93. Local Policy Documents and Evidence-Based Reviews Relevant to Overweight and Obesity in Children and Young People... 286 Table 94. Hospital Admissions in Children and Young People Aged 0 24 Years with Type 2 Diabetes by Primary Diagnosis, New Zealand 2008 2012... 294 Table 95. Hospital Admissions for Children and Young People Aged 0 24 Years with Type 2 Diabetes by Ethnicity and Gender, New Zealand 2008 2012... 295 Table 96. Hospital Admissions for Children and Young People Aged 0 24 Years with Type 2 Diabetes, Hutt Valley and Capital & Coast vs. New Zealand 2008 2012... 296 Table 97. Hospital Admissions in Children and Young People Aged 0 24 Years with a Slipped Upper Femoral Epiphysis by Primary Procedure, New Zealand 2008 2012... 299 Table 98. Hospital Admissions for Children and Young People Aged 0 24 Years with a Slipped Upper Femoral Epiphysis by Ethnicity and Gender, New Zealand 2008 2012... 300 Table 99. Hospital Admissions for Children and Young People 0 24 Years with a Slipped Upper Femoral Epiphysis, Hutt Valley and Capital & Coast vs. New Zealand 2008 2012... 302 Table 100. Hospital Admissions for Bariatric Surgery by Primary Diagnosis in Young People Aged 15 24 Years, New Zealand 2008 2012... 304 Table 101. Hospital Admissions for Young People Aged 15 24 Years for Bariatric Surgery by Ethnicity and Gender, New Zealand 2008 2012... 305 Table 102. Local Policy Documents and Evidence-Based Reviews Relevant to Breastfeeding and Infant Nutrition... 344 Table 103. Local Policy Documents and Evidence-Based Reviews Relevant to Nutrition... 359 Table 104. Participation in Sports Teams and Clubs Outside of School and Reasons for Non-Participation, Secondary School Students Aged 13 17+ Years, New Zealand Youth 12 Survey... 365 Table 105. Local Policy Documents and Evidence-Based Reviews Relevant to Physical Activity... 371 Table 106: Preventive interventions for children of parents with depression (adapted from Beardslee et al [457])... 384 Table 107. Variables used in the NZDep2006 Index of Deprivation [548]... 415 Table 108. ICD-10-AM Congenital Anomaly Coding Used in this Report (Table 1 of 2)... 416 Table 109. ICD-10-AM Congenital Anomaly Coding Used in this Report (Table 2 of 2)... 417 16
17 INTRODUCTION AND OVERVIEW
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INTRODUCTION AND OVERVIEW BACKGROUND AND AIMS Background The 2006 Disability Survey [1] estimated that 10% of New Zealand children aged 0 14 years had a disability, with the most common disability cited (5% of all children) being the requirement for special education. A further 4% of children had chronic health conditions such as severe asthma, cerebral palsy, or diabetes, while 2% had a psychiatric or psychological disability. Around half (52%) of disabled children in the Survey had a disability arising from a condition that had existed since birth, while 26% had disabilities that were caused by a disease or illness, and 3% by an injury [1]. More recently, the 2011/12 NZ Health Survey [2] estimated that 20.7% of New Zealand children aged 2 14 years were overweight and that 10.3% were obese. Further, it was found that the proportion of children who were obese had increased significantly since the 2006/07 NZ Health Survey. Such increases are of concern, as in addition to being associated with conditions like Type 2 diabetes and slipped upper femoral epiphysis in adolescence [3] [4], childhood obesity increases the risk of high blood pressure, coronary heart disease, and stroke in later life [5] [3]. Aims of this Report While such surveys provide very broad prevalence estimates, their lack of clinical precision means it is very difficult to obtain a detailed understanding of the nature and causes of disabilities and chronic conditions (including obesity) in New Zealand children and young people. This paucity of information in turn, makes it difficult for those working in the health sector to plan services to meet future demand, or to develop evidence-based strategies for prevention. Despite this, children and young people with disabilities and chronic conditions require a range of health and disability support services to reach their full potential, and it is undesirable that a paucity of data should preclude them featuring prominently in prioritisation, planning and resource allocation decisions. With these issues in mind, this report collates a range of routinely collected data sources with a view to: 1. Estimating the prevalence of conditions arising in the perinatal period (e.g. preterm births, congenital and chromosomal anomalies) which may lead to greater health and disability support service demand during childhood and adolescence 2. Identifying the numbers of children and young people with specific chronic conditions and disabilities, who are accessing secondary healthcare services 3. Reviewing the distribution of overweight and obesity and its determinants (nutrition, physical activity) in children and young people In-Depth Topics In addition, two issues were selected for more in-depth review by participating DHBs at the beginning of the year, with one of these issues, the treatment of obesity in children and adolescents, being split onto two parts due to the large volume of literature in this area. This year s in depth topics are thus: 1. The Determinants and Consequences of Overweight and Obesity: This in-depth topic begins by providing some background information on the distribution of obesity, including its prevalence in different population groups, before reviewing the range of definitions for overweight and obesity currently used in the literature. The natural history of obesity over the lifespan is then briefly described, before the determinants of obesity are reviewed and the short and long term consequences discussed. 2. The Treatment of Obesity in Children and Adolescents: This in depth topic provides information on evidence-based interventions for the treatment of obesity in children Introduction and Overview - 19
and adolescents. It begins by discussing some of the difficulties associated with identifying and engaging children (and their parents) who are candidates for weight management interventions, before considering the findings of a 2009 Cochrane review of obesity interventions. Insights from other relevant reviews are then discussed, before current New Zealand interventions are summarised. The evidence for the effectiveness of brief primary care interventions is then considered, with a number of individual primary care programmes being presented. The in-depth topic concludes with a brief summary of the key findings from the literature in this area. 3. Children of Parents with Mental Illness and Alcohol and Other Addictions (COPMIA): This in-depth topic considers issues experienced by the children of parents with mental health issues and alcohol and other addictions and identifies evidencebased programmes that could be implemented to reduce risk and enhance resilience in these children. It begins by reviewing the New Zealand prevalence and health and support needs of children of parents with mental illness and addiction issues, as well as the impacts on their health, development and psycho-social wellbeing. Optimal service delivery models are then reviewed from an international perspective, with an example of a best practice systems model being presented. New Zealand strategies and plans are then briefly summarised, along with current COPMIA services in this country. The review concludes with a series of recommendations as to how services for COPMIA might be improved locally. REPORT STRUCTURE AND CONTENT This report is the third of a three-part series on the health of children and young people in the Hutt Valley and Capital & Coast DHBs and fits into the reporting cycle as follows: Year 1 Year 2 Year 3 The Health Status of Children and Young People The Determinants of Health for Children and Young People Children and Young People with Chronic Conditions and Disabilities As previously, this report is based on an Indicator Framework [6] developed by the NZ Child and Youth Epidemiology Service, with all of the indicators in the Chronic Conditions and Disabilities stream being updated in this year s edition. These indicators have been grouped into four sections, as outlined below, with an in-depth topic on the children of parents with mental health issues and alcohol and other addictions (COPMIA) forming the fifth and final section. Section 1: Conditions Arising in the Perinatal Period This section is divided into two parts, with the first reviewing two key perinatal outcomes: fetal deaths and preterm births. The second part begins with a brief overview of antenatal and newborn screening, before using hospital birth data to review the prevalence of congenital anomalies in newborn babies. This review is spread across four chapters, with the first exploring the range of anomalies (from minor to severe) identified in hospital born babies. Subsequent chapters provide additional detail on three anomalies which are usually identifiable at birth, and which may lead to significant health and/or disability support service utilisation. These are cardiovascular anomalies, chromosomal anomalies including Down syndrome, and spina bifida and other neural tube defects. Section 2: Other Disabilities This section begins with a review of children and young people with permanent hearing loss using NZ Deafness Notification Database and Newborn Hearing Screening data. Then, as a result of a paucity of other routinely collected data sources, it uses hospital admission data to explore access to secondary health services in children and young people aged 0 24 years with any mention of cerebral palsy or autism spectrum disorder in any of their first 15 diagnoses. For each condition, the main reasons for hospital admission are explored, along with their distribution by age, ethnicity and gender. Introduction and Overview - 20
Section 3: Chronic Medical Conditions This section reviews hospital admissions for children aged 0 14 years with eczema and dermatitis, as well as hospital admissions and mortality for children and young people aged 0 24 years with inflammatory bowel disease, cystic fibrosis, Type 1 diabetes, and epilepsy. Again the main reasons for hospital admission are described, along with their distribution by age, ethnicity and gender. Cancer incidence and mortality in children and young people aged 0 24 years is then explored using data from the NZ Cancer Registry and the National Mortality Collection. Section 4: Obesity, Nutrition and Physical Activity This section is divided into two parts, with the first reviewing overweight and obesity in children and young people and the second reviewing breastfeeding, nutrition and physical activity. Part 1 begins with an in-depth topic which explores the determinants and consequences of obesity in children and young people, before reviewing the distribution of overweight and obesity and its complications using 2011/12 NZ Health Survey, Youth 12 Survey and hospital admission data. Part 1 concludes with a second in-depth topic, which explores the treatment of obesity in children and young people. Part 2 then begins with a review of breastfeeding and the early introduction of solids using Plunket and 2011/12 NZ Health Survey data, before exploring a range of nutrition and physical activity indicators using 2011/12 NZ Health Survey and Youth 12 Survey data. Section 5: Children of Parents with Mental Illness and Alcohol and Other Addictions (COPMIA) This in-depth topic considers the current issues experienced by the children of parents with mental health issues and alcohol and other addictions in New Zealand and identifies evidence-based effective programmes that could be implemented to reduce risk and enhance resilience in these children. Reviews of Evidence Based Interventions Each of the chapters in this report concludes with a brief overview of local policy documents and evidence-based reviews which consider population level approaches to prevention or management. Appendix 1 provides an overview of the methodology used to develop these reviews. As previously, the quality and depth of evidence available varied from indicator to indicator (e.g. a large number of reviews were available on the medical management of those with cystic fibrosis, but few (with the exception of foliate for neural tube defects) were available on the primary prevention of congenital anomalies). Notes on Data Quality and the Signalling of Statistical Significance One of the main purposes of this report is to inform health needs assessment. Thus, as previously, where high quality data was not available, yet an issue was deemed to be of public health importance, bookmark indicators have been included (e.g. hospital admissions for those with autism spectrum disorders) so that the needs of these children and young people do not fall below the public health radar. In such cases, the reader is urged to read the cautions on interpretation which accompany these indicators, in order to gain a better understanding of the strengths and weaknesses of the data used. Further, Appendix 2 outlines the rationale for the use of statistical significance testing in this report and Appendix 3 Appendix 5 contain information on the data sources used to develop each indicator. Readers are urged to be aware of the contents of these Appendices when interpreting the information in this report. In particular (as outlined in Appendix 2), in order to assist the reader to determine whether tests of statistical significance have been used in a particular section, the statistical significance of the associations presented has been signalled in the text with the words significant, or not significant in italics. Where the words significant or not significant do not appear in the text, then the associations described do not imply statistical significance or non-significance. Introduction and Overview - 21
OVERVIEW OF REPORT S KEY FINDINGS Previous reports in this series have focused on infectious and respiratory diseases, where hospital admissions and mortality have tended to track in a manner consistent with the region s demographic profile (e.g. with rates being much higher for DHBs with a high proportion of children living in the most deprived (NZDep deciles 9 10) areas). However, for chronic conditions and disabilities the picture is more complex, as the prevalence of many of these conditions is not influenced by socioeconomic factors. Rather factors such as genetics (e.g. cystic fibrosis) and maternal age (e.g. some congenital anomalies) play a much greater role. Further for many chronic conditions (e.g. autism spectrum disorder, cancer), the underlying cause is unknown in the vast majority of cases. Further adding to the complexity is the role that local health services play, with the majority of care for children and young people with chronic conditions and disabilities being delivered in primary care or the outpatients setting. In this context, local service delivery configurations (e.g. which children are admitted vs. managed in outpatients for various procedures or conditions) may also heavily influence hospital admission rates. Thus when considering Table 1, which provides an overview of the indicators in this year s report, and the key findings as they relate to the Hutt Valley and Capital & Coast, it is difficult to make any overall generalisations about the way the DHB s health outcomes are tracking with respect to national rates. Rather what is presented is a mixed picture, with rates in the Hutt Valley and Capital & Coast being higher than the New Zealand rate for some conditions, and lower for others, but with no consistent pattern emerging across the region. Thus for this year s report, it will be necessary to review Table 1 on a condition by condition basis, in order to obtain an broad overview of what is occurring within the region. Concluding Comments This report reviews the prevalence of conditions arising in the perinatal period that may increase the demand for health and disability support services, as well as the secondary health service utilisation patterns of children and young people with chronic conditions and disabilities. Further, it aims to provide some insights into the consequences and management of overweight and obesity in children and young people, as well as the needs of children with parents with mental health issues and alcohol and other addictions. While the data presented are at times imperfect, and at best only provide a glimpse of the health needs of these diverse groups of children and young people, the current paucity of data should not preclude DHBs reviewing the health and disability support services available locally (including those with a health promotion focus), with a view to considering whether further improvements are required within the region. Further, while high quality evidence (e.g. from randomised control trials) is often lacking, there is nevertheless sufficient information to direct future initiatives in many areas. These include the development of integrated services for the children of parents with mental health issues and alcohol and other addictions, and interventions for the prevention and management of overweight and obesity in children and young people. Introduction and Overview - 22
Table 1. Overview of the Health of Children and Young People with Chronic Conditions and Disabilities in Hutt Valley and Capital & Coast Stream Indicator New Zealand Distribution Hutt Valley and Capital & Coast Distribution Conditions Arising in the Perinatal Period Perinatal Conditions Fetal Deaths Preterm Birth in Singletons During 2006 2010, unspecified cause was the most frequent fetal cause of intermediate fetal deaths (IFD), followed by prematurity/lbw and congenital and chromosomal anomalies. Unspecified cause was the most frequent fetal cause of late fetal deaths (LFD) followed by malnutrition/slow fetal growth. Congenital anomalies still made a significant contribution. Fetal deaths exhibited a J-shaped distribution with gestational age, with a peak at <25 weeks, and rates increasing again after 37 weeks. Fetal deaths from congenital anomalies and prematurity/lbw were highest in babies <25 weeks, while unspecified fetal deaths increased rapidly after 37 weeks. During 2006 2010, there were no significant gender, ethnic, or NZDep06 differences in IFD rates. Mortality was significantly higher for the babies of younger (<25 years) and older (35+ years) women, than for those 30 34 years. During 2006 2010, LFDs were significantly higher for Pacific > Māori > European/Other babies, and babies from average to deprived (NZDep deciles 5 10) areas. Rates were significantly higher for babies of teenage women, than those 30 34 years. During 2000 2012, singleton preterm birth rates at 20 27, 28 31, and 32 36 weeks were static. The actual number of preterm babies born increased however, as the result of a rising birth rate. The largest increases were in those born at 32 36 weeks. During 2008 2012, preterm birth rates (20 36 weeks) were significantly higher for males and for Māori babies. Rates were also significantly higher for those in more deprived (NZDep deciles 7 10) areas, and for the babies of younger (<25 years) and older (35+ years) mothers, than for those aged 25 29 years. When broken down by gestational age, the excess risk of preterm birth seen for Māori, Pacific and Asian/Indian babies, the babies of teenage mothers, and those from the more deprived areas, was greatest in births at lower gestations. In the Hutt Valley during 2006-2010, unspecified cause was the most frequent fetal cause of IFD, followed by congenital and chromosomal anomalies. Similarly in Capital & Coast, chromosomal anomalies, followed by unspecified cause, were the leading causes of IFD. In the Hutt Valley, unspecified cause was also the most frequent fetal cause of LFD, followed by malnutrition/slow fetal growth. Similarly in Capital & Coast, unspecified cause, followed by malnutrition/slow fetal growth, and congenital anomalies were the leading causes of LFD In both Hutt Valley and Capital & Coast during 2006-2010, IFD and LFD rates were not significantly different from the NZ rate. In the Hutt Valley during 2008 2012, on average 128.2 babies per year were born <37 weeks gestation, with the majority being in the 32 36 weeks category. Preterm birth rates at 20 27, 28 31 and 32 36 weeks were not significantly different from the NZ rates. In Capital & Coast during 2008 2012, on average 241.4 babies per year were born <37 weeks gestation, with the majority of births also being in the 32 36 weeks category. Preterm birth rates at 20 27, 28 31 and 32 36 weeks were also not significantly different from the NZ rates. In the Hutt Valley and Capital & Coast during 2000 2012, preterm birth rates were generally higher for Māori than for European/Other babies. Introduction and Overview - 23