Avoiding double counting: the effect of bundling hospital events in administrative datasets for the interpretation of rural-urban differences in Aotearoa New Zealand.

Background And Objectives: All publicly funded hospital discharges in Aotearoa New Zealand are recorded in the National Minimum Dataset (NMDS). Movement of patients between hospitals (and occasionally within the same hospital) results in separate records (discharge events) within the NMDS and if these consecutive health records are not accounted for hospitalization (encounters) rates might be overestimated. The aim of this study was to determine the impact of four different methods to bundle multiple discharge events in the NMDS into encounters on the relative comparison of rural and urban Ambulatory Sensitive Hospitalization (ASH) rates.

Rural-urban variation in the utilisation of publicly funded healthcare services: an age-stratified population-level observational study.

Aim: To compare age-stratified public health service utilisation in Aotearoa New Zealand across the rural-urban spectrum.

Methods: Routinely collected hospitalisation, allied health, emergency department and specialist outpatient data (2014-2018), along with Census denominators, were used to calculate utilisation rates for residents in the two urban and three rural categories in the Geographic Classification for Health.

Results: Relative to their urban peers, rural Māori and rural non-Māori had lower all-cause, cardiovascular, mental health and ambulatory sensitive (ASH) hospitalisation rates.

Rural-urban variation in COVID-19 vaccination uptake in Aotearoa New Zealand: Examining the national roll-out.

This study aimed to understand rural-urban differences in the uptake of COVID-19 vaccinations during the peak period of the national vaccination roll-out in Aotearoa New Zealand (NZ). Using a linked national dataset of health service users aged 12+ years and COVID-19 immunization records, age-standardized rates of vaccination uptake were calculated at fortnightly intervals, between June and December 2021, by rurality, ethnicity, and region. Rate ratios were calculated for each rurality category with the most urban areas (U1) used as the reference.

Comparison of urban and rural mortality rates across the lifespan in Aotearoa/New Zealand: a population-level study.

Background: Previous studies undertaken in New Zealand using generic rurality classifications have concluded that life expectancy and age-standardised mortality rates are similar for urban and rural populations.

Methods: Administrative mortality (2014-2018) and census data (2013 and 2018) were used to estimate age-stratified sex-adjusted mortality rate ratios (aMRRs) for a range of mortality outcomes across the rural-urban spectrum (using major urban centres as the reference) for the total population and separately for Māori and non-Māori. Rural was defined according to the recently developed Geographic Classification for Health.

Unmasking hidden disparities: a comparative observational study examining the impact of different rurality classifications for health research in Aotearoa New Zealand.

Objectives: Examine the impact of two generic-urban-rural experimental profile (UREP) and urban accessibility (UA)-and one purposely built-geographic classification for health (GCH)-rurality classification systems on the identification of rural-urban health disparities in Aotearoa New Zealand (NZ).

Design: A comparative observational study.

Setting: NZ; the most recent 5 years of available data on mortality events (2013-2017), hospitalisations and non-admitted hospital patient events (both 2015-2019).

Mortality outcomes and inequities experienced by rural Māori in Aotearoa New Zealand.

Background: Previous research identified inequities in all-cause mortality between Māori and non-Māori populations. Unlike comparable jurisdictions, mortality rates in rural areas have not been shown to be higher than those in urban areas for either population. This paper uses contemporary mortality data to examine Māori and non-Māori mortality rates in rural and urban areas.

Defining rural in Aotearoa New Zealand: a novel geographic classification for health purposes.

Aim: Describe the first specifically designed and validated five-level rurality classification for health purposes in New Zealand that is both data-driven and incorporates heuristic understandings of rurality.

Method: Our approach involved: (1) defining the purpose and parameters of a proposed five-level Geographic Classification for Health (GCH); (2) developing a quantitative framework; (3) undertaking co-design with the National Rural Health Advisory Group (NRHAG), and extensive consultation with key stakeholders; (4) testing the validity of the five-level GCH and comparing it to previous Statistics New Zealand (Stats NZ) rurality classifications; and (5) describing rural populations and identifying differences in all-cause mortality using the GCH and previous Stats NZ rurality classifications.

Results: The GCH is a technically robust and heuristically valid rurality classification for health purposes.

Factors associated with self-reported health among New Zealand military veterans: a cross-sectional study.

Objective: To identify factors associated with better or poorer self-reported health status in New Zealand military Veterans.

Design: A cross-sectional survey.

Participants: The participants of interest were the 3874 currently serving Veterans who had been deployed to a conflict zone, but all Veterans were eligible to participate.

Access to advanced-level hospital care: differences in prehospital times calculated using incident locations compared with patients' usual residence.

Studies estimate that 84% of the USA and New Zealand's (NZ) resident populations have timely access (within 60 min) to advanced-level hospital care. Our aim was to assess whether usual residence (ie, home address) is a suitable proxy for location of injury incidence. In this observational study, injury fatalities registered in NZ's Mortality Collection during 2008-2012 were linked to Coronial files.

Developing the geographic classification for health, a rural-urban classification for New Zealand health research and policy: A research protocol.

Introduction: Rural-urban health inequities, exacerbated by deprivation and ethnicity, have been clearly described in the international literature. To date, the same inequities have not been as clearly demonstrated in Aotearoa New Zealand despite the lower socioeconomic status and higher proportion of Māori living in rural towns. This is ascribed by many health practitioners, academics and other informed stakeholders to be the result of the definitions of 'rural' used to produce statistics.

Optimising base locations for New Zealand's Helicopter Emergency Medical Services.

Helicopter Emergency Medical Services (HEMS) in New Zealand (NZ) are located at hospitals or airports near the communities they serve. This may result in suboptimal response times. Timely access to advanced hospital care improves critically injured patients' chances of survival.

Access to specialist hospital care and injury survivability: identifying opportunities through an observational study of prehospital trauma fatalities.

Background: Of the five million injury deaths that occur globally each year, an estimated 70% occur before the injured person reaches hospital. Although reducing the time from injury to definitive care has been shown to achieve better outcomes for patients, the relationship between injury incident location and access to specialist care has been largely unexplored.

Objective: To determine the number and distribution of prehospital (on-scene/en route) trauma deaths without timely access to a hospital with surgical and intensive care capabilities, overall and by estimated injury survivability.

Opportunities to prevent fatalities due to injury: a cross-sectional comparison of prehospital and in-hospital fatal injury deaths in New Zealand.

Objective: There is interest in opportunities that lie in the prehospital setting to reduce the substantial burden of fatal injury. This study examines the epidemiology of prehospital and in-hospital fatal injury in New Zealand.

Methods: All deaths registered in 2008-2012 with an underlying cause of death external cause-code V01-Y36 (ICD-10-AM) were identified.

Evaluating the impact of prehospital care on mortality following major trauma in New Zealand: a retrospective cohort study.

Background: Injury is a leading cause of death and health loss in New Zealand and internationally. The potentially fatal or severe consequences of many injuries can be reduced through an optimally structured prehospital trauma care system that can provide timely and appropriate care.

Objective: To investigate the relationship between emergency medical services (EMS) care and survival to hospital for major trauma cases in New Zealand.

Work-Related Fatalities Involving Children in New Zealand, 1999-2014.

In high income countries, children under 15 years of age are exposed to workplace hazards when they visit or live on worksites or participate in formal or informal work. This study describes the causes and circumstances of unintentional child work-related fatal injuries (child WRFI) in New Zealand. Potential cases were identified from the Mortality Collection using International Classification of Disease external cause codes: these were matched to Coronial records and reviewed for work-relatedness.

Potential survivability of prehospital injury deaths in New Zealand: a cross-sectional study.

Introduction: Acknowledging a notable gap in available evidence, this study aimed to assess the survivability of prehospital injury deaths in New Zealand.

Methods: A cross-sectional review of prehospital injury death postmortems (PM) undertaken during 2009-2012. Deaths without physical injuries (eg, drownings, suffocations, poisonings), where there was an incomplete body, or insufficient information in the PM, were excluded.

Risk and protective factors for post-traumatic stress among New Zealand military personnel: A cross sectional study.

Background: Post-traumatic stress (PTS) is prevalent among military personnel. Knowledge of the risk and protective factors associated with PTS in this population may assist with identifying personnel who would benefit from increased or targeted support.

Aims: To examine factors associated with PTS among New Zealand military personnel.

Geographical and population disparities in timely access to prehospital and advanced level emergency care in New Zealand: a cross-sectional study.

Objective: Rapid access to advanced emergency medical and trauma care has been shown to significantly reduce mortality and disability. This study aims to systematically examine geographical access to prehospital care provided by emergency medical services (EMS) and advanced-level hospital care, for the smallest geographical units used in New Zealand and explores national disparities in geographical access to these services.

Design: Observational study involving geospatial analysis estimating population access to EMS and advanced-level hospital care.

New Zealanders' experiences and pathways to a diagnosis of bowel cancer: a cross-sectional descriptive study of a younger cohort.

Aims: To understand colorectal cancer (CRC) symptoms experienced by Aotearoa/New Zealand patients and to describe patient-experienced pathways and factors which may be associated with delayed diagnosis.

Methods: Ninety-eight patients diagnosed with CRC, recruited via a national charity, completed a questionnaire. Questions included demographics, symptoms, help-seeking and diagnostic pathways followed.

Empirical validation of the New Zealand serious non-fatal injury outcome indicator for 'all injury'.

Our purpose was to empirically validate the official New Zealand (NZ) serious non-fatal 'all injury' indicator. To that end, we aimed to investigate the assumption that cases selected by the indicator have a high probability of admission. Using NZ hospital in-patient records, we identified serious injury diagnoses, captured by the indicator, if their diagnosis-specific survival probability was ≤0.

Preventable injury deaths: identifying opportunities to improve timeliness and reach of emergency healthcare services in New Zealand.

Background: Traumatic injury is a leading cause of premature death and health loss in New Zealand. Outcomes following injury are very time sensitive, and timely access of critically injured patients to advanced hospital trauma care services can improve injury survival.

Objective: This cross-sectional study will investigate the epidemiology and geographic location of prehospital fatal injury deaths in relation to access to prehospital emergency services for the first time in New Zealand.

Managing distance and covariate information with point-based clustering.

Background: Geographic perspectives of disease and the human condition often involve point-based observations and questions of clustering or dispersion within a spatial context. These problems involve a finite set of point observations and are constrained by a larger, but finite, set of locations where the observations could occur. Developing a rigorous method for pattern analysis in this context requires handling spatial covariates, a method for constrained finite spatial clustering, and addressing bias in geographic distance measures.

Towards valid 'serious non-fatal injury' indicators for international comparisons based on probability of admission estimates.

Background: Governments wish to compare their performance in preventing serious injury. International comparisons based on hospital inpatient records are typically contaminated by variations in health services utilisation. To reduce these effects, a serious injury case definition has been proposed based on diagnoses with a high probability of inpatient admission (PrA).

The impact of a rural scanner in overcoming urban versus rural disparities in the utilisation of computed tomography.

Objective: In 2008, Oamaru Hospital became the second rural hospital in New Zealand to install a computed tomography (CT) scanner. This article assesses the impact of this on local CT scanning rates.

Design: Observational: review of radiology department data.

Geographic disparities in the utilisation of computed tomography scanning services in southern New Zealand.

Most secondary care health services in New Zealand, including computed tomography (CT) scanners, are concentrated in urban centres. Little is known about the access rural patients have to these services. The aim of this research was to determine whether there was geographic variation in the utilisation of CT across the southern part of the South Island and if present to measure the magnitude.