Rural and Ethnic Disparities in Out-of-hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand.

Introduction: The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care.

Methods: This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients <85 years in age who were injured in a road traffic crash (RTC).

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.

Comparison of injury severity scores derived from ICD-10-AM codes with trauma registry derived scores: A study from New Zealand.

Introduction: Various attempts at automation have been made to reduce the administrative burden of manually assigning Abbreviated Injury Severity (AIS) codes to derive Injury Severity Scores (ISS) in trauma registry data. The accuracy of the resulting measures remains unclear, especially in the New Zealand (NZ) context. The aim of this study was to compare ISS derived from hospital discharge International Classification of Diseases Australian Modification (ICD-10-AM) codes with ISS recorded in the NZ Trauma Registry (NZTR).

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).

Predictors of hospital readmission after trauma: A retrospective cohort study in New Zealand.

Introduction: Understanding predictors of hospital readmission following major trauma is important as readmissions are costly and some are potentially avoidable. This study describes the incidence of, and sociodemographic, injury-related and treatment-related factors predictive of, hospital readmission related to: a) all-causes, b) the index trauma injury, and c) subsequent injury events in the 30 days and 12 months following discharge for major trauma patients nationally in New Zealand.

Methods: Data from the New Zealand Trauma Registry (NZTR) was linked with Ministry of Health hospital discharge data.

Societal burden of work on injury deaths in New Zealand, 2005-14: An observational study.

Background: Work poses increased risk of injury not only for workers but also for the public, yet the broader impact of work-related injury is not quantified. This study, utilising population data from New Zealand, estimates the societal burden of work-related fatal injury (WRFI) by including bystanders and commuters.

Methods: This observational study selected deaths due to unintentional injury, in persons aged 0-84 years using International Classification of Disease external cause codes, matched to coronial records, and reviewed for work-relatedness.

Does support received for subsequent injuries differ between Māori and non-Māori? Findings from a cohort study of injured New Zealanders.

Aims: To examine if differences exist between injured Māori and non-Māori in accessing and receiving support from the Accident Compensation Corporation (ACC) for treatment and rehabilitation of subsequent injuries.

Methods: This cohort study utilised participants' self-reported data from the Prospective Outcomes of Injury Study, and ACC claims data.

Results: Approximately one-third of Māori (32%) and non-Māori (35%) who self-reported a subsequent injury had no associated ACC claim.

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.

The role of religious diversity in social progress.

This article brings together the notions of religious diversity and social progress and argues, against the sceptics, that the former can - and indeed must - contribute positively to the latter. To do this, it builds on to a major initiative in which the author had co-responsibility for the material on religion. This was the International Panel on Social Progress (IPSP) which assessed state-of-the-art knowledge that bears on social progress across a wide range of economic, political and cultural questions.

Epidemiology of major trauma in New Zealand: a systematic review.

Aim: To describe the incidence and characteristics of major trauma in New Zealand.

Methods: A systematic review based on a MEDLINE search strategy was performed using the databases PubMed, EMBASE, CINAHL and Scopus. Search terms included: "Wounds and Injuries," "Fatal Injuries," "Injury Severity Score," "Major Trauma," "Severe Trauma," "Injury Scale," "Epidemiology," "Incidence," "Prevalence" and "Mortality.

Participation in paid and unpaid work one year after injury and the impact of subsequent injuries for Māori: Results from a longitudinal cohort study in New Zealand.

Introduction: Indigenous populations experience greater injury burdens than non-indigenous groups. This paper investigated, for injured Māori (New Zealand's indigenous population): 1) participation in paid and unpaid work 12 months after injury, 2) whether subsequent injuries are predictive of reduced participation, and 3) if particular characteristics of subsequent injuries predict reduced participation.

Methods: The Subsequent Injury Study utilised data from the earlier Prospective Outcomes of Injury Study, a study of 2856 injured New Zealanders (including 566 Māori; 20%) who had an Accident Compensation Corporation (ACC; New Zealand's no-fault injury insurer) entitlement claim (sentinel injury).

Impact of legislative reform on worker fatalities in New Zealand workplaces: a 30-year retrospective population-level analysis.

Objectives: To determine the impact of major legislative changes to New Zealand's Occupational Health and Safety (OHS) legislation with the adoption of the Robens model as a means to control occupational risks on the burden and risk of work-related fatal injury (WRFI).

Methods: Population-based comparison of WRFI to workers aged 15-84 years occurring during three periods: before (pre:1985-1992), after legislative reform (post-1:1993-2002) and after subsequent amendment (post-2:2003-2014). Annual age-industry standardised rates were calculated with 95% CI.

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.

Prevalence and predictors of post-traumatic stress symptoms in 2200 hospitalised and non-hospitalised injured New Zealanders.

Objective: Post-traumatic stress disorder following injuries unrelated to mass casualty events has received little research attention in New Zealand. Internationally, most studies investigating predictors of post-injury post-traumatic stress disorder focus on hospitalised patients although most survivors are not hospitalised. We compared the prevalence and predictors of symptoms suggestive of post-traumatic stress disorder 12 months following injury among hospitalised and non-hospitalised entitlement claimants in New Zealand's Accident Compensation Corporation.

Missing cases of injury death: use of quantitative methods and case reviews to inform future improvements in case definition.

Background: Knowledge of fatal injuries is required to inform prevention activities. Where hospital patients with an injury principal diagnosis (PDx) died and were certified to a medical underlying cause of death (UCoD), there is the potential to underestimate injury mortality. We sought to characterise injury/non-injury (NI) mismatches between PDx and UCoD by identifying which subgroups had small/large mismatches, and to understand why mismatches had occurred using informative examples.

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.

Predictors of subsequent injury for Māori in New Zealand.

Introduction: This paper identifies predictors of subsequent injury (SI) in a cohort of injured Māori. Interventions to reduce SI among indigenous populations would help overcome the disproportionate burden of subsequent injury experienced, thereby reducing inequities in injury outcomes and the overall burden of injury.

Methods: Interview data from the Prospective Outcomes of Injury Study (POIS) were combined with Accident Compensation Corporation (ACC; New Zealand's universal no-fault injury insurer) and hospital discharge datasets.

Prospective Outcomes of Injury Study 10 Years on (POIS-10): An Observational Cohort Study.

Injury is a leading cause of disability and is costly. This prospective cohort study extension aims to improve disability, health, and wellbeing outcomes for injured New Zealanders, including for Māori. We will identify predictors and modifiable risk factors of long-term outcomes (positive and negative), and develop an Injury Early Care Tool (INJECT) to inform the implementation of effective interventions to improve outcomes.

POIS-10 Māori: Outcomes and Experiences in the Decade Following Injury.

Injury-related disability burden extends well beyond two years post-injury, especially for Māori (Indigenous) New Zealanders. Māori also experience greater difficulty accessing health services. This prospective cohort study extension uses mixed-methods and aims to understand and identify factors contributing to long-term experiences and outcomes (positive and negative) at 12 years post-injury for injured Māori and their whānau (families), and explore the barriers and facilitators to whānau flourishing, and access to health and rehabilitation services.