AIMS: Despite dramatic declines in coronary heart disease (CHD) incidence in Aotearoa New Zealand over more than 50 years, the burden of CHD is still inequitable, particularly for Māori and Pacific peoples. We studied re...AIMS: Despite dramatic declines in coronary heart disease (CHD) incidence in Aotearoa New Zealand over more than 50 years, the burden of CHD is still inequitable, particularly for Māori and Pacific peoples. We studied recent trends in first hospitalisations for acute coronary syndromes (ACS) by ethnicity. METHODS: All first ACS hospitalisations (2005-2019) were identified from national administrative datasets. Population denominators were constructed using multiple linked national data sources. Trends in rates of incident ACS and incidence rate ratios (IRRs) were analysed for younger (20-59 years) and older (60-84 years) patients. RESULTS: The ACS cohort (n=69,161) comprised 74.7% European, 14.2% Māori, 6.1% Pacific peoples, 2.8% Indian and 2.2% non-Indian Asian peoples. For younger patients, annual ACS incidence initially decreased in all ethnic groups but plateaued between 2013 and 2015 for Māori, non-Indian Asians and Europeans; the decline was minimal for Pacific peoples across the time period. In older patients ACS incidence initially fell for all groups, but plateaued for Māori from 2015, and slowed after 2014 for Europeans. IRRs, compared with Europeans, increased between 2005 and 2019 for younger Māori (IRR 1.5 to 2.25, p=0.017) and Pacific peoples (IRR 1.25 to 1.5, p<0.001), and for older Māori (IRR 1.35 to 1.6, p=0.006) and Pacific peoples (IRR 1.0 to 1.6, p<0.001). CONCLUSION: Rates of decline in ACS incidence have stalled or slowed for most younger ethnic groups, and for older Māori and Europeans. The differential rate of change between ethnic groups has resulted in increasing inequity for Māori and Pacific peoples across the age range.
AIM: To quantify the current state of the cardiology specialist workforce in Health New Zealand - Te Whatu Ora. METHODS: The Cardiac Society of Australia and New Zealand sent a survey to all Health New Zealand - Te Whatu...AIM: To quantify the current state of the cardiology specialist workforce in Health New Zealand - Te Whatu Ora. METHODS: The Cardiac Society of Australia and New Zealand sent a survey to all Health New Zealand - Te Whatu Ora cardiology departments in 2024, requesting information on specialist cardiac staff. Population information was obtained from Health New Zealand - Te Whatu Ora. International comparisons were obtained by website search. RESULTS: Of 154 Health New Zealand - Te Whatu Ora-employed cardiologists, 119 (77%) were male, and 113 (73%) received cardiology training in New Zealand. Over half were aged >50, 35% >55, including 18% >60 years. Time in current position was 12±9 years and the vacancy rate was 14%. The current ratio of persons per cardiologist is 35,000. In the five districts with the highest proportion of Māori and Pacific peoples, this ratio exceeds the national average: Tairāwhiti 54,000; Counties Manukau 38,000; Lakes 61,000; Northland 52,000; Hawke's Bay 47,000. For cities with cardiac surgery the ratio is 32,000 and without is 46,000. International ratios include: United States of America (USA) 15,000; Canada 25,000; United Kingdom (UK) 40,000 and Australia 25,000 persons per cardiologist. CONCLUSIONS: Health New Zealand - Te Whatu Ora has an experienced but ageing cardiologist workforce, with many vacancies. Districts with higher Māori/Pacific populations have fewer cardiologists per capita than the national average of 1:35,000, which is similar to the UK, but less than the USA, Australia and Canada.
BACKGROUND: Computed tomography colonography (CTC) is an alternative to colonoscopy for the detection of polyps and colorectal cancer (CRC). One-third of CRCs arise via the sessile serrated pathway. Evidence supports usi...BACKGROUND: Computed tomography colonography (CTC) is an alternative to colonoscopy for the detection of polyps and colorectal cancer (CRC). One-third of CRCs arise via the sessile serrated pathway. Evidence supports using CTC to detect adenomas and CRC; however, its accuracy for sessile serrated lesions (SSLs) remains uncertain. This study aimed to determine the accuracy of CTC in detecting SSLs compared with colonoscopy. METHOD: Electronic records identified all colonoscopy procedures where a histologically validated SSL was excised over a 11-month period. In those patients who had a CTC within 1 year prior to colonoscopy, the presence, size and location of SSLs were compared to determine the accuracy of CTC in SSL identification. RESULTS: A total of 4,346 procedures were performed (2,548 people, 2,082 [47.9%] male, mean age 59.6). A total of 2,204 SSLs were removed, representing 24% of all polypectomies. SSLs were predominantly located in the right colon (65.1%) and were typically (85%) <10mm in size. A total of 110 SSLs were obtained from 39 procedures with a prior CTC. Of these procedures, 12 (30.8%) had lesions identified on CTC; however, CTC only accurately identified 14.5% of the total SSLs. Five of 16 (32%) SSLs ≥10mm were correctly identified compared with 11 of 94 (11%) SSLs 1-9mm, (odds ratio 3.42, p=0.0495). CONCLUSION: This study demonstrated that CTC has poor efficacy in detecting SSLs, irrespective of polyp size and location. Based on these findings, CTC as a substitute for colonoscopy is not advisable in patients at risk of SSLs.
AIM: This study aims to investigate the perceptions of Māori, Pacific, and non-Māori/Pacific breast cancer patients' treatment experience in Wellington, Aotearoa New Zealand. It will also explore the support they receive...AIM: This study aims to investigate the perceptions of Māori, Pacific, and non-Māori/Pacific breast cancer patients' treatment experience in Wellington, Aotearoa New Zealand. It will also explore the support they received throughout their treatment journey and the information provided to them over the course of their care. METHOD: Qualitative semi-structured focus groups were carried out including breast cancer patients who had completed treatment within the past 2 years. Participants were recruited through breast cancer clinics. Data were analysed using reflexive thematic analysis. RESULTS: Participants reported a need for more tailored information from health professionals. Many participants reported barriers accessing services and follow-up appointments. Additionally, many participants, especially Māori and Pacific participants, emphasised the importance of ongoing support from healthcare professionals and their personal networks. CONCLUSION: The findings highlight the need for improving patient-centred communication, recognising the important role of patient support systems and providing more tailored information and resources throughout breast cancer treatment. Addressing these factors could improve different patient groups' experiences and outcomes by fostering a more informed and supported treatment journey.
AIMS: To discuss the regulatory scope of Medicines Act 1981 related to point-of-care testing (POCT) in vitro diagnostic (IVD) devices, the implications of the now repealed Therapeutic Products Act 2023 and the regulatory...AIMS: To discuss the regulatory scope of Medicines Act 1981 related to point-of-care testing (POCT) in vitro diagnostic (IVD) devices, the implications of the now repealed Therapeutic Products Act 2023 and the regulatory requirements which will be needed in the proposed Medical Products Bill. METHODS: This review includes the relevant sections on regulation of IVD devices under the Medicines Act 1981, the role of Medsafe, the relevant sections of the Therapeutic Products Act 2023, the cabinet papers on the proposed Medical Products Bill and published literature on regulation for POCT devices in New Zealand and overseas. RESULTS: IVD devices are not regulated under the Medicines Act 1981. Faulty devices have been supplied to health services and direct to the public. New Zealand is currently behind international regulatory standards. Cabinet papers and the proposed Medical Products Bill state that IVD devices should be regulated and subject to a risk classification system. CONCLUSION: A comprehensive regulatory framework for POCT IVD devices is required to ensure the supply of high-quality devices to health services and consumers. The proposed Medical Products Bill must include a regulatory framework for POCT IVD devices in the interests of patient safety. Implemented wisely, the advantages of regulation outweigh disadvantages.
AIM: We aimed to examine barriers and enablers to mental health support for transgender and gender-diverse individuals in rural Aotearoa New Zealand, drawing on research conducted in the Whanganui Region. METHOD: Finding...AIM: We aimed to examine barriers and enablers to mental health support for transgender and gender-diverse individuals in rural Aotearoa New Zealand, drawing on research conducted in the Whanganui Region. METHOD: Findings were drawn from a qualitative study involving interviews with transgender and gender-diverse participants in Whanganui, where mental health concerns consistently arose despite not being the study's primary focus. RESULTS: Participants reported high levels of psychological distress, shaped by intersecting factors such as gender dysphoria, neurodivergence, financial hardship and social isolation. Major barriers to accessing support included a lack of affirming and knowledgeable mental health providers, limited service availability and experiences of discrimination-both systemic and interpersonal. Some participants described additional difficulty related to provider biases or the ineligibility of publicly funded therapy for gender-related issues. At the same time, protective factors included access to gender-affirming care, culturally safe counselling and peer or community-based support. For neurodivergent participants, inflexible service design and diagnostic barriers further impacted mental health access. CONCLUSION: Strengthening culturally safe, affirming and accessible mental health services is essential for improving outcomes for transgender and gender-diverse communities in rural Aotearoa. Strategies such as increasing provider training, supporting community-led initiatives, expanding telehealth and creating clearer care pathways may help address persistent inequities.
AIM: No previous research has assessed the epidemiology or treatment of narcolepsy in New Zealand. This study aimed to estimate its national incidence and prevalence and examine demographic trends in the prescribing of n...AIM: No previous research has assessed the epidemiology or treatment of narcolepsy in New Zealand. This study aimed to estimate its national incidence and prevalence and examine demographic trends in the prescribing of narcolepsy-related medications. METHOD: From 2021 to 2023, diagnostic data from all centres conducting multiple sleep latency tests (MSLTs) were analysed to estimate incidence and prevalence. Concurrently, data on all special authority (SA) approvals for narcolepsy medications were obtained from Pharmac and analysed by medication type, region, age, gender and ethnicity. RESULTS: Among 342 MSLTs, 57 cases of narcolepsy were identified, giving an incidence of 0.36 per 100,000 person-years and a prevalence of 21.9 per 100,000 people. Over the same period, 223 new and 762 total SA applications were approved. The average number of new approvals (74.3 per year) was 3.9 times higher than the number of new diagnoses (19 per year). Demographic variations were observed in the SA data. Generally, methylphenidate hydrochloride was prescribed more than modafinil. CONCLUSIONS: This is the first national estimate of the incidence and prevalence of narcolepsy in New Zealand. The mismatch between diagnosis and treatment data likely reflects limited diagnostic access, multiple medication use, the existence of imported cases with established diagnoses and the treatment of idiopathic hypersomnolence (IH) under the guise of narcolepsy. Policy and funding changes are needed to improve care access and reporting accuracy.
AIM: We investigated Māori and Pacific adults with type 2 diabetes (T2D) to determine the prevalence of latent autoimmune diabetes in adults (LADA), assess the type 1 diabetes (T1D) genetic risk score (GRS) distribution...AIM: We investigated Māori and Pacific adults with type 2 diabetes (T2D) to determine the prevalence of latent autoimmune diabetes in adults (LADA), assess the type 1 diabetes (T1D) genetic risk score (GRS) distribution in those with and without autoantibodies and investigate differences in clinical diabetes characteristics based on autoantibody presence or a high T1D GRS. METHOD: A total of 2,538 Māori and Pacific participants from the Genetics of Gout, Diabetes, and Kidney Disease study in Aotearoa New Zealand were included (830 with T2D, 1,708 without). LADA was defined as age of diabetes onset >30 years, presence of autoantibodies and no insulin treatment within the first 6 months. Clinical characteristics were extracted from medical records. T1D-associated autoantibodies (glutamic acid decarboxylase, islet antigen 2, zinc transporter 8) were measured from stored blood samples from 293 participants (262 T2D, 31 without). A T1D GRS consisting of 30 single-nucleotide polymorphisms was calculated for all participants. RESULTS: Autoantibodies were detected in 8.8% (23/262) of individuals with T2D, with 5.3% (14/262) meeting the criteria for LADA. No significant difference in T1D GRS or clinical characteristics was observed between T2D cases with and without autoantibodies. Autoantibodies were also detected in 3.2% (1/31) of participants without diabetes. CONCLUSION: LADA is present in a subset of Māori and Pacific individuals with T2D. Autoantibody presence was not associated with differences in T1D GRS or clinical features. Further research is needed to assess whether C-peptide monitoring could guide treatment decisions in those with LADA.
AIM: This study aims to investigate the cancer incidence and mortality among patients with systemic lupus erythematosus (SLE) in New Zealand. METHODS: SLE patients were linked to the New Zealand Cancer Registry to identi...AIM: This study aims to investigate the cancer incidence and mortality among patients with systemic lupus erythematosus (SLE) in New Zealand. METHODS: SLE patients were linked to the New Zealand Cancer Registry to identify cancer cases. The cancer incidence rate and cancer mortality rate among SLE patients in 2010-2021 were age-standardised to the general population. The estimations were stratified by cancer site, sex, ethnicity and age group. RESULTS: Among 2,656 SLE patients, 240 new cancer cases were identified, including 187 women and 53 men. Haematologic cancers accounted for 20% of cancer cases identified. The relative risk of cancer incidence for SLE patients compared to the general population was 1.48 (95% confidence interval [CI] 1.28-1.71) for women and 2.08 (95% CI 1.59-2.73) for men. The relative risk of cancer death for SLE patients compared to the general population was 1.75 (95% CI 1.40-2.19) for women and 2.27 (95% CI 1.49-3.44) for men. Younger patients had greater relative risks of cancer incidence and cancer mortality than older patients. CONCLUSIONS: Patients with SLE in New Zealand experience a higher cancer burden compared to the general population, with greater disparity among younger patients and male patients. Haematologic cancers were especially prevalent among SLE patients.
AIM: The B4 School Check includes hearing screening of four-year-old children in Aotearoa New Zealand. This study describes the prevalence and distribution of hearing loss, likely due to otitis media with effusion (OME),...AIM: The B4 School Check includes hearing screening of four-year-old children in Aotearoa New Zealand. This study describes the prevalence and distribution of hearing loss, likely due to otitis media with effusion (OME), to determine if there is inequity in access to screening and primary healthcare, and to inform programme design and delivery. METHOD: Hearing data over a five-year period were linked with demographic data and interrogated using regression analyses for differences in disease burden, access to screening and to primary healthcare. RESULTS: Māori and Pacific children and those living with higher deprivation were less likely to be screened. When screened these children had higher rates of disease, were less likely to be referred immediately and had poorer access to primary healthcare to enable appropriate management. CONCLUSION: The current delivery of hearing screening is inequitable, missing those that need it most and exacerbating an uneven distribution of disease burden. A redeveloped programme to enable identification and screening of all eligible children, differential delivery according to need and a more holistic provision of care is required. This includes support for speech and language concerns, ear health promotion and linkage with primary care and healthy housing programmes.
AIM: Cardiovascular disease (CVD) inequities in Aotearoa New Zealand disproportionately affect Māori and Pacific peoples, who experience higher risk factors, hospitalisations and mortality than NZ Europeans. These dispar...AIM: Cardiovascular disease (CVD) inequities in Aotearoa New Zealand disproportionately affect Māori and Pacific peoples, who experience higher risk factors, hospitalisations and mortality than NZ Europeans. These disparities stem from the historical and contemporary effects of colonisation, including institutional racism, impacting access to healthcare and socio-economic resources. Despite guidelines for earlier CVD risk assessments (CVDRA), gaps in identification and management persist. METHOD: The Manawataki Fatu Fatu (MFF) for Māori and Pacific Hearts in Unison for Achieving Cardiovascular Care in Equity Studies (ACCESS) is a Māori and Pacific-led research programme examining CVD inequities in Aotearoa New Zealand. This study presents phase three, focussing on qualitative co-design hui (meetings) across Aotearoa New Zealand to gather insights from Māori and Pacific patients, whānau (family/supports) and kaimahi (healthcare workers) engaged with CVD services spanning primary to secondary care. RESULTS: A total of 105 participants attended four regional hui focussed on the heart healthcare experiences of Māori and Pacific peoples in Aotearoa New Zealand. Template analysis revealed four key themes for achieving equitable healthcare: the importance of the whānau/community, the need for providers to engage with patients at their level, the persistent barriers faced and a strong commitment to protecting Māori and Pacific communities and kaimahi. CONCLUSION: This study is a comprehensive qualitative investigation into heart healthcare for Māori and Pacific peoples in Aotearoa New Zealand. The findings reiterate that care must align with the realities of Māori and Pacific peoples and that interventions must address long-standing systemic barriers to care.
Pseudoaneurysms of the brachial artery have been reported in the literature, with aetiologies including iatrogenic causes, trauma and intravenous drug use. Among traumatic causes, blunt trauma is the most common, and the...Pseudoaneurysms of the brachial artery have been reported in the literature, with aetiologies including iatrogenic causes, trauma and intravenous drug use. Among traumatic causes, blunt trauma is the most common, and the incidence of brachial artery pseudoaneurysms due to penetrating injuries is approximately 0.04%. The presentations are usually late, mainly after months or years, but the presentation within a week is rare. The management includes computed tomography (CT) angiography as the modality for diagnosis and endovascular or surgical approaches-the surgery is either graft or end-to-end repair. However, well-defined protocol-based management, as well as the keen suspicion of such a rare entity, is necessary for trauma or vascular surgeons to prevent further morbidities or mortality.
AIM: With the phase one Royal Commission COVID-19 report published, it is an opportune time to reflect on the various public health interventions used to consider if they were effective and how they could be improved. As...AIM: With the phase one Royal Commission COVID-19 report published, it is an opportune time to reflect on the various public health interventions used to consider if they were effective and how they could be improved. As we look to the future, it is important to understand if digital contact tracing (DCT) was an effective public health intervention during the COVID-19 pandemic and how it could be improved. METHOD: We summarise a series of articles detailing the population and public uptake of the various DCT technologies implemented in Aotearoa New Zealand during the COVID-19 pandemic. RESULTS: New Zealand had one of the highest population uptakes of DCT in the developed world. However, there were additional barriers to the full implementation of these tools that likely reduced their efficacy. CONCLUSION: DCT was just one of many interventions aiming to eliminate, and then suppress, COVID-19. This context makes it difficult to isolate and conclude that the efficacy of DCT during this pandemic would translate to future pandemic conditions, especially if there is improved design and implementation. However, this research shows that the self-service survey approach worked better than expected, and that there is some promise in automating notification processes.