Prioritizing risk factors to identify preventive interventions for economic assessment.

Objective: To explore a risk factor approach for identifying preventive interventions that require more in-depth economic assessment, including cost-effectiveness analyses.

Methods: A three-step approach was employed to: (i) identify the risk factors that contribute most substantially to disability-adjusted life years (DALYs); (ii) re-rank these risk factors based on the availability of effective preventive interventions warranting further cost-effectiveness analysis (and in some instances on evidence from existing cost-effectiveness analyses); and (iii) re-rank these risk factors in accordance with their relative contribution to health inequalities. Health inequalities between the Māori and non-Māori populations in New Zealand were used by way of illustration.

Bias in relative survival methods when using incorrect life-tables: lung and bladder cancer by smoking status and ethnicity in New Zealand.

Relative survival and excess mortality approaches are commonly used to estimate and compare net survival from cancer. These approaches are based on the assumption that the underlying (non-cancer) mortality rate of cancer patients is the same as that of the general population. This assumption is likely to be violated particularly in the context of smoking-related cancers.

Linkage of data in the study of ethnic inequalities and inequities in health outcomes in Scotland, New Zealand and The Netherlands: insights for global study of ethnicity and health.

Reducing inequalities in health is a global priority. An essential tool in achieving this reduction is the ability to provide valid measurements of inequalities, which are comparable over time and ultimately across countries and continents. With valid data a true understanding of inequalities can be ascertained, which can begin to inform effective legislation and policy.

Comparing self-rated health and self-assessed change in health in a longitudinal survey: which is more valid?

Self-rated health (SRH) is commonly used in longitudinal analyses as a repeated outcome measure. This assumes that computed changes in SRH over time truly represent within-individual changes in underlying health. The longitudinal validity of SRH, however, is threatened by ceiling effects (where people reporting the highest level of SRH cannot report subsequent improved health), insensitivity to small changes within SRH categories, reference group effects (where individuals assess their health changes relative to their peers) and stability in SRH even when change in underlying health is occurring.

What are the elements of the tobacco endgame?

The available literature on tobacco endgames tends to be limited to discussing means, targets and difficulties. This article offers additional ideas on the key elements of endgame strategies and the circumstances in which these are likely to be adopted and implemented. We suggest such strategies will include explicit plans, will define the nature of `the end of tobacco use/sale' and have target dates within 20 years.

Comorbidity among patients with colon cancer in New Zealand.

Aims: To identify patient factors that are associated with a higher risk of comorbidity, and to assess the impact of comorbidity on risk of in-hospital death, length of stay and 5-year all-cause survival among a large cohort of patients with colon cancer in New Zealand.

Methods: Comorbidity data were collected from patients who were diagnosed with colon cancer and admitted to public hospitals during 1996-2003. The comorbidity measures included all conditions listed in the Charlson Comorbidity Index, as well as a predetermined list of additional conditions.

Mortality among the working age population receiving incapacity benefits in New Zealand, 1981-2004.

Like many OECD countries New Zealand has experienced a large increase in the number of working-age people receiving incapacity benefits in the last 3 decades, despite apparent improvements in population health. This paper examines trends in mortality rates of people receiving sickness benefit or invalid's benefit (SBIB) between 1981 and 2004 using repeated cohort studies (linking the 1981, 1986, 1991, 1996, and 2001 censuses to mortality data). Mortality rates, standardised for age and ethnicity, were calculated for each census cohort for 25-64 year olds by benefit receipt status.

Social inequalities or inequities in cancer incidence? Repeated census-cancer cohort studies, New Zealand 1981-1986 to 2001-2004.

Background: We examine incidence trends for 18 adult cancers, by ethnicity and socioeconomic position in New Zealand.

Methods: The 1981 to 2001 censuses were linked to subsequent cancer registrations, giving 47.5 million person-years of follow-up.

The relationship between income and health using longitudinal data from New Zealand.

Background: Evidence for a cross-sectional relationship between income and health is strong but is probably biased by substantial confounding. Longitudinal data with repeated income and health measures on the same individuals can be analysed to control completely for time-invariant confounding, giving a more accurate estimate of the impact of short-term changes in income on health.

Methods: 4 years of annual data (2002--2005) from the New Zealand longitudinal Survey of Family, Income and Employment were used to investigate the relationship between annual household income and self-rated health (SRH) using a fixed-effects ordinal logistic regression model.

When does neighbourhood matter? Multilevel relationships between neighbourhood social fragmentation and mental health.

Studies investigating relationships between mental health and residential areas suggest that certain characteristics of neighbourhood environments matter. After developing a conceptual model of neighbourhood social fragmentation and health we examine this relationship (using the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag)) with self-reported mental health (using SF-36). We used the nationally representative 2002/3 New Zealand Health Survey dataset of urban adults, employing multilevel methods.

Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position?

Background: Adult socioeconomic position (SEP) is one of the most frequently hypothesised indirect pathways between childhood SEP and adult health. However, few studies that explore the indirect associations between childhood SEP and adult health systematically investigate the mediating role of multiple individual measures of adult SEP for different health outcomes. We examine the potential mediating role of individual measures of adult SEP in the associations of childhood SEP with self-rated health, self-reported mental health, current smoking status and binge drinking in adulthood.

The association of food security with psychological distress in New Zealand and any gender differences.

Food security (access to safe, nutritious, affordable food) is intrinsically linked to feelings of stress or distress and it is strongly associated with socioeconomic factors. However, the impact of food insecurity on mental health, independent of confounding socioeconomic factors, is not clear. We investigated the association of food insecurity with psychological distress in New Zealand, controlling for socioeconomic factors.

Health status and epidemiological capacity and prospects: WHO Western Pacific Region.

Background: This article on the state of epidemiology in the WHO Western Pacific Region (WPR) is the first in a series of eight articles commissioned by the International Epidemiological Association (IEA) to identify global opportunities to promote the development of epidemiology.

Methods: Global mortality and disease data were used to summarize the burden of mortality, disease, risk factor and patterns of inequalities in the region. Medline bibliometrics were used to estimate epidemiological publication output by country.

Do effects of price discounts and nutrition education on food purchases vary by ethnicity, income and education? Results from a randomised, controlled trial.

Background: Reducing health inequalities requires interventions that work as well, if not better, among disadvantaged populations. The aim of this study was to determine if the effects of price discounts and tailored nutrition education on supermarket food purchases (percentage energy from saturated fat and healthy foods purchased) vary by ethnicity, household income and education.

Method: A 2×2 factorial trial of 1104 New Zealand shoppers randomised to receive a 12.

Attachment as a function of the case manager-client relationship.

This article reports an exploratory study of the relationship between case manager's attachment styles and outcomes of client services. The primary purpose of this study was to discover whether a measure of attachment could be used as part of a preemployment screening process for potential case managers. Two attachment measures were completed by a group of randomly selected staff.

Change in income and change in self-rated health: Systematic review of studies using repeated measures to control for confounding bias.

It is generally assumed that income is strongly and positively associated with health. However, much of the evidence supporting this assumption comes from cross-sectional data or analyses that have not fully accounted for biases from confounding and health selection (the reverse pathway from health to income). This paper reports results of a systematic review of panel and longitudinal studies investigating whether changes in income led to changes in self-rated health (SRH) in adults.