Equity of access to pathological diagnosis and bronchoscopy for lung cancer in Aotearoa New Zealand.

Background: Māori are less likely to survive their lung cancer once diagnosed, but it remains unclear whether this is partially driven by poorer access to best-practice diagnostic services.

Methods: We examined all lung cancer registrations in Aotearoa New Zealand between 2007-2019 (n=27,869) linked to national administrative health datasets and further stratified by ethnicity, tumour type and stage of disease. Using descriptive and regression analyses, we compared ethnic groups in terms of the basis of diagnosis (e.

Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence.

Background: Lung cancer is a deadly cancer. Early diagnosis and access to timely treatment are essential to maximizing the likelihood of survival. Indigenous peoples experience enduring disparities in lung cancer survival, and disparities in access to and through lung cancer services is one of the important drivers of these disparities.

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.

Equity of travel to access surgery and radiation therapy for lung cancer in New Zealand.

Purpose: Centralisation of lung cancer treatment can improve outcomes, but may result in differential access to care for those who do not reside within treatment centres.

Methods: We used national-level cancer registration and health care access data and used Geographic Information Systems (GIS) methods to determine the distance and time to access first relevant surgery and first radiation therapy among all New Zealanders diagnosed with lung cancer (2007-2019; N = 27,869), and compared these outcomes between ethnic groups. We also explored the likelihood of being treated at a high-, medium-, or low-volume hospital.

Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context.

Purpose: Lung cancer is the biggest cancer killer of indigenous peoples worldwide, including Māori people in New Zealand. There is some evidence of disparities in access to lung cancer treatment between Māori and non-Māori patients, but an examination of the depth and breadth of these disparities is needed. Here, we use national-level data to examine disparities in access to surgery, radiation therapy and systemic therapy between Māori and European patients, as well as timing of treatment relative to diagnosis.

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.

Inequities in COVID-19 Omicron infections and hospitalisations for Māori and Pacific people in Te Manawa Taki Midland region, New Zealand.

COVID-19 impacts population health equity. While mRNA vaccines protect against serious illness and death, little New Zealand (NZ) data exist about the impact of Omicron - and the effectiveness of vaccination - on different population groups. We aim to examine the impact of Omicron on Māori, Pacific, and Other ethnicities and how this interacts with age and vaccination status in the Te Manawa Taki Midland region of NZ.

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).

Defining catchment boundaries and their populations for Aotearoa New Zealand's rural hospitals.

Introduction There is considerable variation in the structure and resources of New Zealand (NZ) rural hospitals; however, these have not been recently quantified and their effects on healthcare outcomes are poorly understood. Importantly, there is no standardised description of each rural hospital's catchment boundary and the characteristics of the population living within this area. Aim To define and describe a catchment population for each of New Zealand's rural hospitals.

Emergency presentation prior to lung cancer diagnosis: A national-level examination of disparities and survival outcomes.

Objectives: A recent multinational investigation of emergency presentation within 30 days of cancer diagnosis, conducted within the International Cancer Benchmarking Programme (ICBP), observed that New Zealand had the highest rate of emergency presentation prior to lung cancer diagnosis compared to other similar countries. Here we use national-level health data to further investigate these trends, focussing on ethnic disparities in emergency presentation prior to lung cancer diagnosis. We have also compared survival outcomes between those who had an emergency presentation in the preceding 30 days to those who did not.

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.

Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand.

In New Zealand, there are known disparities between the Indigenous Māori and the majority non-Indigenous European populations in access to cancer treatment, with resulting disparities in cancer survival. There is international evidence of ethnic disparities in the distance travelled to access cancer treatment; and as such, the aim of this paper was to examine the distance and time travelled to access surgical care between Māori and European liver and stomach cancer patients. We used national-level data and Geographic Information Systems (GIS) analysis to describe the distance travelled by patients to receive their first primary surgery for liver or stomach cancer, as well as the estimated time to travel this distance by road, and the surgical volume of hospitals performing these procedures.

Structural disadvantage for priority populations: the spatial inequity of COVID-19 vaccination services in Aotearoa.

Aim: To examine the spatial equity, and associated health equity implications, of the geographic distribution of COVID-19 vaccination services in Aotearoa New Zealand.

Method: The distribution of Aotearoa's population was mapped, and the enhanced two-step floating catchment method (E2SFCA) applied to estimate spatial access to vaccination services. The Gini coefficient and spatial autocorrelation measures assessed the spatial equity of vaccination services.

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.

Improving spatial data in health geographics: a practical approach for testing data to measure children's physical activity and food environments using Google Street View.

Background: Geographic information systems (GIS) are often used to examine the association between both physical activity and nutrition environments, and children's health. It is often assumed that geospatial datasets are accurate and complete. Furthermore, GIS datasets regularly lack metadata on the temporal specificity.

Will access to COVID-19 vaccine in Aotearoa be equitable for priority populations?

Aim: This research examines the equity implications of the geographic distribution of COVID-19 vaccine delivery locations in Aotearoa New Zealand under five potential scenarios: (1) stadium mega-clinics; (2) Community Based Assessment Centres; (3) GP clinics; (4) community pharmacies; and (5) schools.

Method: We mapped the distribution of Aotearoa New Zealand's population and the location of potential vaccine delivery facilities under each scenario. Geostatistical techniques identified population clusters for Māori, Pacific peoples and people aged 65 years and over.

Selecting Health Need Indicators for Spatial Equity Analysis in the New Zealand Primary Care Context.

Purpose: To examine potential indicators of health need for primary care in spatial equity research, and evidence of the Inverse Care Law in the Waikato region of New Zealand.

Methods: A cross-sectional analysis of 7 health need indicators (ambulatory sensitive hospitalizations; cancer rate; mortality rate; New Zealand index of multiple deprivation-health domain; age; New Zealand index of deprivation; smoking rate) that were identified through a systematic review was carried out. Values of indicators were mapped and analyzed using geographic information systems (GIS).

Spatial equity and realised access to healthcare - a geospatial analysis of general practitioner enrolments in Waikato, New Zealand.

Introduction: Geographic measures of accessibility can quantify inequitable distributions of health care. Although closest distance measures are often used in Aotearoa New Zealand these may not reflect patient use of health care. This research examines patterns of patient enrolment in general practitioner (GP) services from a geospatial perspective.

Framework for examining the spatial equity and sustainability of general practitioner services.

Objective: To propose a framework for examining both the spatial equity and sustainability of GP services.

Design: A conceptual discussion based on a systematic literature review of spatial equity definitions and methods.

Setting: Improving the spatial equity of health services is a key step in achieving health equity.

Monitoring pre-hospital transport of severely injured patients in the Midland Region of New Zealand.

Aim: Pre-hospital triage strategies aim to identify the type and extent of patient injuries and ensure that they are transferred to the most appropriate trauma centres. Despite the importance of appropriate pre-hospital transport, there is little evidence base to assist medical staff on optimal destination policy for emergent pre-hospital transport. This paper explores the spatial relationship of patient transfers prior to the implementation of the Midland Pre-Hospital Trauma Destination Matrix in New Zealand, and is a retrospective view of practice against a destination policy that was applied after the study period.