Risk of stomach cancer in Aotearoa/New Zealand: A Māori population based case-control study.

Māori, the indigenous people of New Zealand, experience disproportionate rates of stomach cancer, compared to non-Māori. The overall aim of the study was to better understand the reasons for the considerable excess of stomach cancer in Māori and to identify priorities for prevention. Māori stomach cancer cases from the New Zealand Cancer Registry between 1 February 2009 and 31 October 2013 and Māori controls, randomly selected from the New Zealand electoral roll were matched by 5-year age bands to cases. Logistic regression was used to estimate odd ratios (OR) and 95% confidence intervals (CI) between exposures and stomach cancer risk. Post-stratification weighting of controls was used to account for differential non-response by deprivation category. The study comprised 165 cases and 480 controls. Nearly half (47.9%) of cases were of the diffuse subtype. There were differences in the distribution of risk factors between cases and controls. Of interest were the strong relationships seen with increased stomach risk and having >2 people sharing a bedroom in childhood (OR 3.30, 95%CI 1.95-5.59), testing for H pylori (OR 12.17, 95%CI 6.15-24.08), being an ex-smoker (OR 2.26, 95%CI 1.44-3.54) and exposure to environmental tobacco smoke in adulthood (OR 3.29, 95%CI 1.94-5.59). Some results were attenuated following post-stratification weighting. This is the first national study of stomach cancer in any indigenous population and the first Māori-only population-based study of stomach cancer undertaken in New Zealand. We emphasize caution in interpreting the findings given the possibility of selection bias. Population-level strategies to reduce the incidence of stomach cancer in Māori include expanding measures to screen and treat those infected with H pylori and a continued policy focus on reducing tobacco consumption and uptake

Germline CDH1 mutations are a significant contributor to the high frequency of early-onset diffuse gastric cancer cases in New Zealand Māori.

New Zealand Māori have a considerably higher incidence of gastric cancer compared to non-Māori, and are one of the few populations worldwide with a higher prevalence of diffuse-type disease. Pathogenic germline CDH1 mutations are causative of hereditary diffuse gastric cancer, a cancer predisposition syndrome primarily characterised by an extreme lifetime risk of developing diffuse gastric cancer. Pathogenic CDH1 mutations are well described in Māori families in New Zealand. However, the contribution of these mutations to the high incidence of gastric cancer is unknown. We have used next-generation sequencing, Sanger sequencing, and Multiplex Ligation-dependent Probe Amplification to examine germline CDH1 in an unselected series of 94 Māori gastric cancer patients and 200 healthy matched controls. Overall, 18% of all cases, 34% of cases diagnosed with diffuse-type gastric cancer, and 67% of cases diagnosed aged less than 45 years carried pathogenic CDH1 mutations. After adjusting for the effect of screening known HDGC families, we estimate that 6% of all advanced gastric cancers and 13% of all advanced diffuse-type gastric cancers would carry germline CDH1 mutations. Our results demonstrate that germline CDH1 mutations are a significant contributor to the high frequency of diffuse gastric cancer in New Zealand Māori

COVID-19 vaccine strategies for Aotearoa New Zealand:a mathematical modelling study

Summary: Background: COVID-19 elimination measures, including border closures have been applied in New Zealand. We have modelled the potential effect of vaccination programmes for opening borders.Methods: We used a deterministic age-stratified Susceptible, Exposed, Infectious, Recovered (SEIR) model. We minimised spread by varying the age-stratified vaccine allocation to find the minimum herd immunity requirements (the effective reproduction number Reff<1 with closed borders) under various vaccine effectiveness (VE) scenarios and R0 values. We ran two-year open-border simulations for two vaccine strategies: minimising Reff and targeting high-risk groups.Findings: Targeting of high-risk groups will result in lower hospitalisations and deaths in most scenarios. Reaching the herd immunity threshold (HIT) with a vaccine of 90% VE against disease and 80% VE against infection requires at least 86•5% total population uptake for R0=4•5 (with high vaccination coverage for 30–49-year-olds) and 98•1% uptake for R0=6. In a two-year open-border scenario with 10 overseas cases daily and 90% total population vaccine uptake (including 0–15 year olds) with the same vaccine, the strategy of targeting high-risk groups is close to achieving HIT, with an estimated 11,400 total hospitalisations (peak 324 active and 36 new daily cases in hospitals), and 1,030 total deaths.Interpretation: Targeting high-risk groups for vaccination will result in fewer hospitalisations and deaths with open borders compared to targeting reduced transmission. With a highly effective vaccine and a high total uptake, opening borders will result in increasing cases, hospitalisations, and deaths. Other public health and social measures will still be required as part of an effective pandemic response.Funding: This project was funded by the Health Research Council [20/1018].Research in contex

Māori linked administrative data: Te Hao Nui - A novel Indigenous data infrastructure and longitudinal study

Worldwide, large amounts of administrative data are collected within official statistics systems on Indigenous Peoples. These data are primarily used for government and state policy purposes as opposed to by Indigenous Peoples to support Indigenous agendas (Taylor &amp; Kukutai, 2017). In Aotearoa me Te Waipounamu New Zealand, Māori need high quality data to develop evidence-based policies and programs and to monitor government policies that impact on Māori. In this methodological paper, we describe uses of administrative data for Māori and current barriers to its use. We outline the development of a novel administrative data infrastructure and future longitudinal study. By explicating our Indigenous initiated, designed and controlled data project, we make a methodological contribution to Indigenous Data Sovereignty and Kaupapa Māori (Māori worldview) epidemiology

Māori Linked Administrative Data : Te Hao Nui - A novel Indigenous Data Infrastructure and Longitudinal Study

Worldwide, large amounts of administrative data are collected within official statistics systems on Indigenous Peoples. These data are primarily used for government and state policy purposes as opposed to by Indigenous Peoples to support Indigenous agendas (Taylor & Kukutai, 2017). In Aotearoa me Te Waipounamu New Zealand, Māori need high quality data to develop evidence-based policies and programs and to monitor government policies that impact on Māori. In this methodological paper, we describe uses of administrative data for Māori and current barriers to its use. We outline the development of a novel administrative data infrastructure and future longitudinal study. By explicating our Indigenous initiated, designed and controlled data project, we make a methodological contribution to Indigenous Data Sovereignty and Kaupapa Māori (Māori worldview) epidemiology

Social class mortality differences in Maori and non-Maori men aged 15-64 during the last two decades.

AIMS: This investigation uses data from 1996-97 to update previous studies of social class mortality differences in Maori and non-Maori New Zealand men aged 15-64 years. METHODS: Numerator data were obtained from the national death registrations and denominator data were from the 1976, 1986 and 1996 censi. For each social class, age standardised death rates in Maori and non-Maori men were calculated for amenable, non-amenable and all causes of mortality. RESULTS: Maori male mortality was significantly higher than non-Maori mortality in each social class and for the total population for amenable (overall RR = 5.3(CI = 4.0-6.9)), non-amenable (overall RR = 2.4(2.2-2.6)) and all causes of mortality (overall RR = 2.4(2.3-2.6)). The social class mortality differences within Maori (relative index of inequality was 3.3) were markedly greater than non-Maori class differences (RII = 1.5). CONCLUSIONS: The persistently high Maori mortality rates, when controlled for social class, indicate that the poor state of Maori health cannot be explained solely by relative socioeconomic disadvantage. The high Maori rate of potentially preventable deaths indicates that the health sector is still not meeting the serious health needs of many Maori. The social class mortality gradient within Maori underlines the need to address disparities within Maori

Genetics, race, ethnicity, and health

Genetics plays only a small part in ethnic differences in health, and other factors are often more amenable to chang

Compression, expansion, or dynamic equilibrium? The evolution of health expectancy in New Zealand.

STUDY OBJECTIVE: To evaluate the New Zealand evidence for three theories of population health change: compression of morbidity, expansion of morbidity, and dynamic equilibrium. DESIGN: Using the Sullivan method, repeated cross sectional survey information on functional limitation prevalence was combined with population mortality data and census information on the utilisation of institutional care to produce health expectancy indices for 1981 and 1996. SETTING: The adult population of New Zealand in 1981 and 1996. PARTICIPANTS: 6891 respondents to the 1981 social indicators survey; 8262 respondents to the 1996 household disability survey. MAIN RESULTS: As a proportion of overall life expectancy at age 15 the expectation of non-institutionalised mobility limitations increased from 3.5% to 6% for men, and from 4.5% to 8% for women; the expectation of agility limitation increased from 3% to 7.5% for men and from 4.5% to 8.5% for women, and the expectation of self care limitations increased from 2.0% to 4.5% for men and from 3.0% to 6.0% for women. These changes were primarily attributable to increases in the expectation of moderate functional limitation. CONCLUSION: The dynamic equilibrium scenario provides the best fit to current New Zealand evidence on changes in population health. Although an aging population is likely to lead to an increase in demand for disability support services, the fiscal impact of this increase may be partially offset by a shift from major to moderate limitations, with a consequential reduction in the average levels of support required

Māori and Linked Administrative Data: A Critical Review of the Literature and Suggestions to Realise Māori Data Aspirations.

Linked data presents different social and ethical issues for different contexts and communities. The Statistics New Zealand Integrated Data Infrastructure (IDI) is a collection of de-identified whole-population administrative datasets that researchers are increasingly using to answer pressing social and policy research questions. Our work seeks to provide an overview of the IDI, associated issues for Māori (the Indigenous peoples of New Zealand), and steps to realise Māori data aspirations. In this paper, we first introduce the IDI including what it is and how it developed. We then move to an overview of Māori Data Sovereignty. Our paper then turns to examples of organisations, agreements, and frameworks which seek to make the IDI and data better for Māori communities. We then discuss the main issues with the IDI for Māori including technical issues, deficit-framed work, involvement from communities, consent, social license, further data linkage, and barriers to access for Māori. We finish with a set of recommendations around how to improve the IDI for Māori, making sure that Māori can get the most out of administrative data for our communities. These include the need to build data researcher capacity and capability for Māori, Māori data co-governance and accountability, reducing practical and skill barriers for access by Māori and Māori organisations, providing robust, consistent and transparent practice exemplars for best practice, and potentially even abolishing the IDI and starting again. These issues are being worked through via Indigenous engagement and co-governance processes that could provide useful exemplars for Indigenous and community engagement with linked data resources