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Objectives Occupation is a poorly characterised risk factor for cardiovascular disease (CVD) with females and indigenous populations under-represented in most research. This study assessed associations between occupation and ischaemic heart disease (IHD) in males and females of the general and Māori (indigenous people of NZ) populations of New Zealand (NZ). Methods Two surveys of the NZ adult population (NZ Workforce Survey (NZWS); 2004–2006; n = 3003) and of the Māori population (NZWS Māori; 2009–2010; n = 2107) with detailed occupational histories were linked with routinely collected health data and followed-up until December 2018. Cox regression was used to calculate hazard ratios (HR) for IHD and “ever-worked” in any of the nine major occupational groups or 17 industries. Analyses were controlled for age, deprivation and smoking, and stratified by sex and survey. Results ‘Plant/machine operators and assemblers’ and ‘elementary occupations’ were positively associated with IHD in female Māori (HR 2.2, 95%CI 1.2–4.1 and HR 2.0, 1.1–3.8, respectively) and among NZWS males who had been employed as ‘plant/machine operators and assemblers’ for 10+ years (HR 1.7, 1.2–2.8). Working in the ‘manufacturing’ industry was also associated with IHD in NZWS females (HR 1.9, 1.1–3.7), whilst inverse associations were observed for ‘technicians and associate professionals’ (HR 0.5, 0.3–0.8) in NZWS males. For ‘clerks’, a positive association was found for NZWS males (HR 1.8, 1.2–2.7), whilst an inverse association was observed for Māori females (HR 0.4, 0.2–0.8). Conclusion Associations with IHD differed significantly across occupational groups and were not consistent across males and females or for Māori and the general population, even within the same occupational groups, suggesting that current knowledge regarding the association between occupation and IHD may not be generalisable across different population groups.

Hospitals have a pivotal role in reducing health inequities for indigenous people and other marginalised groups, argue Anna Matheson and colleagues

BackgroundHealth inequities between indigenous and non-indigenous people are well documented. However, the contribution of differential exposure to risk factors in the occupational environment remains unclear. This study assessed differences in the prevalence of self-reported exposure to disease risk factors, including dust and chemicals, physical factors and organisational factors, between Māori and non-Māori workers in New Zealand.MethodsPotential participants were sampled from the New Zealand electoral rolls and invited to take part in a telephone interview, which included questions about current workplace exposures. Logistic regression, accounting for differences in age, socioeconomic status and occupational distribution between Māori and non-Māori, was used to assess differences in exposures.ResultsIn total, 2344 Māori and 2710 non-Māori participants were included in the analyses. Māori had greater exposure to occupational risk factors than non-Māori. For dust and chemical exposures, the main differences related to Māori working in occupations where these exposures are more common. However, even within the same job, Māori were more likely to be exposed to physical factors such as heavy lifting and loud noise, and organisational factors such as carrying out repetitive tasks and working to tight deadlines compared with non-Māori.ConclusionsThis is one of the first studies internationally to compare occupational risk factors between indigenous and non-indigenous people. These findings suggest that the contribution of the occupational environment to health inequities between Māori and non-Māori has been underestimated and that work tasks may be unequally distributed according to ethnicity.

ObjectivesObesity among Pasifika people living in New Zealand is a serious health problem with prevalence rates more than twice those of the general population (67% vs 33%, respectively). Due to the high risk of developing obesity for this population, we investigated diet quality of Pacific youth and their parents and grandparents. Therefore, we examined the dietary diversity of 30 youth and their parents and grandparents (n=34) to identify whether there are generational differences in dietary patterns and investigate the relationship between acculturation and dietary patterns.MethodsThe study design of the overarching study was cross-sectional. Face-to-face interviews were conducted with Pasifika youth, parents and grandparents to investigate dietary diversity, that included both nutritious and discretionary food items and food groups over a 7 day period. Study setting was located in 2 large urban cities, New Zealand. Exploratory factor analyses were used to calculate food scores (means) from individual food items based on proportions consumed over the week, and weights were applied to calculate a standardised food score. The relationship between the level of acculturation and deprivation with dietary patterns was also assessed.ResultsThree distinctive dietary patterns across all participants were identified from our analyses. Healthy diet, processed diet and mixed diet. Mean food scores indicated statistically significant differences between the dietary patterns for older and younger generations. Older generations showed greater diversity in food items consumed, as well as eating primarily a ‘healthy diet’. The younger generation was more likely to consume a ‘processed diet’. There was significant association between acculturation and deprivation with the distinctive dietary patterns.ConclusionOur investigation highlighted generational differences in consuming a limited range of food items. Identified dietary components may, in part, be explained by specific acculturation modes (assimilation and marginalised) and high socioeconomic deprivation among this particular study population.

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. Electronic supplementary material The online version of this article (10.1007/s10689-018-0080-8) contains supplementary material, which is available to authorized users.

Summary Introduction Indigenous people have disproportionally worse health and lower life expectancy than their non-indigenous counterparts in high-income countries. Cancer data for indigenous people are scarce and incidence has not previously been collectively reported in Australia, New Zealand, Canada, and the USA. We aimed to investigate and compare, for the first time, the cancer burden in indigenous populations in these countries. Methods We derived incidence data from population-based cancer registries in three states of Australia (Queensland, Western Australia, and the Northern Territory), New Zealand, the province of Alberta in Canada, and the Contract Health Service Delivery Areas of the USA. Summary rates for First Nations and Inuit in Alberta, Canada, were provided directly by Alberta Health Services. We compared age-standardised rates by registry, sex, cancer site, and ethnicity for all incident cancer cases, excluding non-melanoma skin cancers, diagnosed between 2002 and 2006. Standardised rate ratios (SRRs) and 95% CIs were computed to compare the indigenous and non-indigenous populations of each jurisdiction, except for the Alaska Native population, which was compared with the white population from the USA. Findings We included 24 815 cases of cancer in indigenous people and 5 685 264 in non-indigenous people from all jurisdictions, not including Alberta, Canada. The overall cancer burden in indigenous populations was substantially lower in the USA except in Alaska, similar or slightly lower in Australia and Canada, and higher in New Zealand compared with their non-indigenous counterparts. Among the most commonly occurring cancers in indigenous men were lung, prostate, and colorectal cancer. In most jurisdictions, breast cancer was the most common cancer in women followed by lung and colorectal cancer. The incidence of lung cancer was higher in indigenous men in all Australian regions, in Alberta, and in US Alaska Natives than in their non-indigenous counterparts. For breast cancer, rates in women were lower in all indigenous populations except in New Zealand (SRR 1·23, CI 95% 1·16–1·32) and Alaska (1·14, 1·01–1·30). Incidence of cervical cancer was higher in indigenous women than in non-indigenous women in most jurisdictions, although the difference was not always statistically significant. Interpretation There are clear differences in the scale and profile of cancer in indigenous and non-indigenous populations in Australia, New Zealand, Canada, and the USA. Our findings highlight the need for much-improved, targeted programmes of screening, vaccination, and smoking cessation, among other prevention strategies. Governments and researchers need to work in partnership with indigenous communities to improve cancer surveillance in all jurisdictions and facilitate access to cancer data. Funding International Agency for Research on Cancer–Australia Fellowship.

Background In New Zealand, the burden of childhood obesity is greatest in Māori and Pacific children. Methods In 687 infants from an internet-based birth cohort in New Zealand, we investigated ethnic differences in early life risk factors for later obesity, the degree to which these were explained by sociodemographic factors, and the extent to which ethnic differences in weight at age 3 months were explained by measured risk factors. Results The risk of having an obese mother was double in Māori and Pacific infants compared with NZ European infants (prevalence 24% and 14%, respectively; OR 2.23, 95% CI 1.23 to 4.04). Māori and Pacific infants had higher weights in the first week of life and at 3 months (mean difference 0.19 kg, 95% CI 0.01 to 0.38), and their mothers had higher scores on a ‘snacks’ dietary pattern and lower scores on ‘healthy’ and ‘sweet’ dietary patterns. These inequalities were not explained by maternal education, maternal age or area-based deprivation. No ethnic differences were observed for maternal pre-pregnancy physical activity, hypertension or diabetes in pregnancy, exclusive breastfeeding or early introduction of solid foods. Ethnic inequalities in infant weight at 3 months were not explained by sociodemographic variables, maternal pre-pregnancy body mass index or dietary pattern scores or by other measured risk factors. Conclusions This study shows excess prevalence of early life risk factors for obesity in Māori and Pacific infants in New Zealand and suggests an urgent need for early interventions for these groups.

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.

Exposure to workplace hazards, such as dust, solvents, and fumes, has the potential to adversely affect the health of people. However, the effects of workplace hazards on health may differ when exposure occurs at different times in the circadian cycle, and among people who work longer hours or who do not obtain adequate sleep. The aim of the present study was to document exposures to workplace hazards across a national sample of New Zealanders, comparing people who work a standard 08:00 -17:00 h Monday-to-Friday working week (Std hours) and those who do not (N-Std hours). New Zealanders (n = 10 000) aged 20-64 yrs were randomly selected from the Electoral Roll to take part in a nationwide survey of workplace exposures. Telephone interviews were conducted between 2004 and 2006, using a six-part questionnaire addressing demographics, detailed information on the current or most recent job (including exposures to a range of workplace hazards), sleep, sleepiness, and health status. N-Std hours were categorised on the basis of: being required to start work prior to 07:00 h or finish work after 21:00 h and/or; having a regular on-call commitment (at least once per week) and/or; working rotating shifts and/or; working night shift(s) in the last month. The response rate was 37% (n = 3003), with 22.2% of participants (n = 656) categorised as working N-Std hours. Industry sectors with the highest numbers of participants working N-Std hours were manufacturing, health and community services, and agriculture, fishing, and forestry. Response rate was 37% (n = 3003) with 22.2% (n = 656) categorised as working N-Std hours. Participants working N-Std hours were more likely to be exposed to all identified hazards, including multiple hazards (OR = 2.45, 95% CI = 2.01-3.0) compared to those working Std hours. Participants working N-Std hours were also more likely to report 'never/rarely' getting enough sleep (OR = 1.38, 95% CI = 1.15-1.65), 'never/rarely' waking refreshed (OR = 1.23, 95% CI = 1.04-1.47), and excessive sleepiness (OR = 1.77, 95% CI = 1.29-2.42). New Zealanders working N-Std hours are more likely to be exposed to hazards in the workplace, to be exposed to multiple hazards, and to report inadequate sleep and excessive sleepiness than their colleagues working a standard 08:00-17:00 h Monday-to-Friday working week. More research is needed on the effects of exposure to hazardous substances outside the usual waking day, on the effects of exposure to multiple hazards, and on the combination of hazard exposure and sleep restriction as a result of shift work.

In New Zealand, the burden of obesity is greatest among Pacific people, especially in children and adolescents. We investigated the factors of the obesogenic environment that were indigenous to Pasifika youths' social-cultural context, their food purchasing behaviours, and associated anthropometric measures.An exploratory study of 30 Pasifika youth aged 16-24 years in Wellington and Auckland, New Zealand.A large proportion of the participants were obese (mean body mass index: 31.0kg/m2; waistto-hip ratio: 0.84; waist-to-height ratio: 0.6), suggesting that the future health and wellbeing trajectory of the studied Pasifika youth is poor. Purchasing behaviours of food and snacks over a 7-day period provided meaningful insights that could be a useful future research tool to examine the role of their physical environment on food access and availability.From this exploratory study, we highlight the following: (i) the future health trajectory of Pasifika youth is poor. Developing the youths' healthy lifestyle knowledge may lend itself to developing culturally relevant intervention programmes; (ii) identifying the enablers and barriers within the Pasifika ontext of an obesogenic environment can provide very useful information; (iii) use of spatial analysis using purchased food receipts adds to the current knowledge base of obesity-related research, although this was an exploratory investigation. We need to address these highlights if we are to reverse the trend of obesity for this population.

This study investigated the role that demographic and tumour factors play in explaining ethnic inequalities in breast cancer survival.Breast cancer cases notified to the New Zealand Cancer Registry (NZCR) from April 2005 to April 2007 were followed up to April 2009. Māori, Pacific and non-Māori/non-Pacific women were categorised according to ethnicity on the NZCR. Deprivation was analysed as quintiles of the New Zealand area-based index of socio-economic position. Relative survival rates were estimated using ethnic-specific life tables. Missing values were imputed and excess mortality modelling was used to estimate the contribution of demographic and tumour factors to ethnic inequalities in survival.There were 2968 breast cancer cases (76.5% non-Māori/non-Pacific, 17% Māori, and 6.5% Pacific) included and 433 recorded deaths. Relative survival rates at 4 years were 91.5% (95% confidence interval (CI) 89.7 to 92.9) for non-Māori/non-Pacific, 86.2% (CI 80.3 to 90.4) for Māori, and 79.6% (CI 68.2 to 87.2) for Pacific women. Using non-Māori/non-Pacific as the reference group, the age-adjusted hazard ratio (HR) dropped for Māori from 1.76 (CI 1.22 to 2.48) to 1.43 (CI 0.97 to 2.10) when further adjusted by deprivation. For Pacific the HR dropped from 2.49 (CI 1.57 to 3.94) to 1.94 (CI 1.20 to 3.13). Inequalities persisted after adjustment for subtype variables (ER/PR/HER2), but adjusting for access to care variables (extent/size) eliminated the ethnic inequalities in excess mortality.Ethnic disparities in breast cancer survival in New Zealand can be attributed to deprivation and differential access to health care rather than differences in breast cancer subtypes.

Objectives: The authors conducted a population-based\ud survey to examine gender differences in occupational\ud exposure patterns and to investigate whether any\ud observed differences are due to: (a) gender differences\ud in occupational distribution; and/or (b) gender differences\ud in tasks within occupations.\ud Methods: Men and women aged 20e64 years were\ud randomly selected from the Electoral Roll and invited to\ud take part in a telephone interview, which collected\ud information on self-reported occupational exposure to\ud specific dusts and chemicals, physical exposures and\ud organisational factors. The authors used logistic regression\ud to calculate prevalence ORs and 95% CIs comparing the\ud exposure prevalence of males (n¼1431) and females\ud (n¼1572), adjusting for age. To investigate whether men\ud and women in the same occupation were equally exposed,\ud the authors also matched males to females on current\ud occupation using the five-digit code (n¼1208) and\ud conducted conditional logistic regression adjusting for age.\ud Results: Overall, male workers were two to four times\ud more likely to report exposure to dust and chemical\ud substances, loud noise, irregular hours, night shifts and\ud vibrating tools. Women were 30% more likely to report\ud repetitive tasks and working at high speed, and more\ud likely to report exposure to disinfectants, hair dyes and\ud textile dust. When men were compared with women\ud with the same occupation, gender differences were\ud attenuated. However, males remained significantly more\ud likely to report exposure to welding fumes, herbicides,\ud wood dust, solvents, tools that vibrate, irregular hours\ud and night-shift work. Women remained more likely to\ud report repetitive tasks and working at high speed, and in\ud addition were more likely to report awkward or tiring\ud positions compared with men with the same occupation.\ud Conclusion: This population-based study showed\ud substantial differences in occupational exposure patterns\ud between men and women, even within the same\ud occupation. Thus, the influence of gender should not be\ud overlooked in occupational health research.

Objectives To investigate the differences in occupational exposure between Māori (New Zealand's indigenous people) and non-Māori. Methods Participants were randomly selected from the Electoral Roll. Exposure to occupational risk factors was assessed through telephone interviews and exposure prevalences of Māori (n = 273) and non-Māori (n = 2,724) were compared. Subsequently, Māori were matched with non-Māori on current occupation (n = 482) to assess whether ethnic differences also exist within occupations. Results Māori were more likely to report exposure to physical strain (e.g., lifting, standing). Part of these differences remained when Māori were compared with non-Māori in the same job. In addition, Māori women were twice as likely to categorize their job as very or extremely stressful than non-Māori women in the same job, while Māori men were twice as likely to report exposure to dust. Conclusion Marked ethnic differences exist in risk factors for occupational ill-health, due to both occupational distribution and the distribution of tasks within occupations. Am. J. Ind. Med. 54:410–418, 2011. © 2011 Wiley-Liss, Inc.

Background : This study investigated the role that demographic and tumour factors play in explaining socioeconomic inequalities in breast cancer survival. Methods : Breast cancer cases notified to the New Zealand Cancer Registry (NZCR) from April 2005 to April 2007 were followed up to April 2009. The New Zealand area-based deprivation index (NZDep) was used as a measure of socioeconomic position. Relative survival rates were estimated using sex-, deprivation- and ethnic-specific life tables. Multiple imputation was used to impute missing data. Excess mortality modelling was used to estimate the contribution of demographic and tumour factors to inequalities in survival. Results : There were 2968 breast cancer cases included and 433 recorded deaths. Relative survival rates at 4 years varied across deprivation groups. Using NZDep deciles 1–4 (least deprived) as the reference group, the age- and ethnicity-adjusted hazard ratio (HR) for NZDep deciles 7–8 was 2.03 (CI 1.36–3.04) and for NZDep deciles 9–10 was 1.93 (CI 1.28–2.92). In the fully adjusted model there remained 50% excess mortality for the two most deprived groups compared to the most affluent. Variables which measured timely access to care (extent/size) accounted for more of the survival disparity than breast cancer subtype variables (ER/PR/HER2). Conclusion : Women from deprived areas in New Zealand who are diagnosed with breast cancer are less likely to survive as long as those from affluent areas. A substantial proportion of these socioeconomic disparities can be attributed to differential access to health care although other factors, currently unknown, are also likely to play an important role.

Background There are ethnic disparities in cervical cancer survival in New Zealand. The objectives of this study were to assess the associations of screening history, ethnicity, socio-economic status (SES) and rural residence with stage at diagnosis in women diagnosed with cervical cancer in New Zealand during 1994-2005. Methods The 2323 cases were categorized as 'ever screened' if they had had at least one smear prior to 6 months before diagnosis, and as 'regular screening' if they had had no more than 36 months between any two smears in the period 6-114 months before diagnosis. Logistic regression was used to estimate the associations of screening history, ethnicity, SES and urban/rural residence with stage at diagnosis. Results The percentages 'ever screened' were 43.3% overall, 24.8% in Pacific, 30.5% in Asian, 40.6% in M (a) over bar ori and 46.1% in 'Other' women. The corresponding estimates for 'regular screening' were 14.0, 5.7, 7.8, 12.5 and 15.3%. Women with 'regular screening' had a lower risk of late stage diagnosis [odds ratio (OR) 0.16, 95% confidence interval (CI) 0.10-0.26], and the effect was greater for squamous cell carcinoma (OR 0.12, 95% CI 0.07-0.23) than for adenocarcinoma (OR 0.32, 95% CI 0.13-0.82). The increased risk of late-stage diagnosis (OR 2.72, 95% CI 1.99-3.72) in M (a) over bar ori (compared with 'Other') women decreased only slightly when adjusted for screening history (OR 2.45, 95% CI 1.77-3.39). Conclusions Over half of cases had not been 'ever screened'. Regular screening substantially lowered the risk of being diagnosed at a late stage. However, screening history does not appear to explain the ethnic differences in stage at diagnosis.

OBJECTIVE: To investigate ethnic, socioeconomic, and urban/rural differences in stage at diagnosis and cervical cancer survival in New Zealand. METHODS: The study involved 1594 cervical cancer cases registered during 1994-2005. Cox regression was used to estimate adjusted cervical cancer mortality hazard ratios (HRs). RESULTS: Māori and Pacific women had higher death rates than Other (predominantly European) women, with age and year of diagnosis adjusted HRs of 2.15 (95% CI 1.68-2.75) and 1.98 (95% CI 1.25-3.13), respectively, whereas Asian women had a lower (nonstatistically significant) risk (0.81, 95% CI 0.47-1.42). Adjustment for stage reduced the HR in Māori to 1.62 (95% CI 1.25-2.09), but there was little change for Pacific or Asian women. These patterns varied over time: for cases diagnosed during 1994-1997, the HR for Māori women was 2.34 (95% CI 1.68-3.27), which reduced to 1.83 (95% CI 1.29-2.60) when adjusted for stage; for cases diagnosed during 2002-2005, the corresponding estimates were 1.54 (95% CI 0.75-3.13) and 0.90 (95% CI 0.43-1.89). Socioeconomic status and urban/rural residence had only marginal effects. CONCLUSIONS: There were major ethnic differences in cervical cancer survival in New Zealand that were only partly explained by stage at diagnosis. These patterns varied over time, with postdiagnostic factors playing an important role in the high Māori mortality rates in the 1990s, but in more recent years, the excess mortality in Māori women appeared to be almost entirely due to stage at diagnosis, indicating that ethnic differences in access to and uptake of screening and treatment of premalignant lesions may have been playing a major role.

Background: Few studies have compared ovarian cancer rates between different ethnic groups in the same country. The aim of this study was to describe ethnic patterns in the incidence and mortality of ovarian cancer in New Zealand, and to investigate ethnic and socioeconomic differences in the grade and stage of ovarian cancer. Methods: Data on all women registered with ovarian cancer on the New Zealand Cancer Registry (1993-2004) were analysed. Population data were taken from the 1996 and 2001 census. Logistic regression was used to estimate associations between ethnicity, deprivation and tumour characteristics. Results: Age-standardised incidence rates were highest in Pacific women, intermediate in Māori women, and lowest in non-Māori, non-Pacific women. Age-standardised mortality rates showed the same pattern. Ovarian cancer subtypes differed by ethnic group. There was no significant association between socioeconomic deprivation and tumour grade or stage. Age-adjusted models showed that Māori women were more likely to have well-differentiated tumours and less likely to present at a later stage compared to non-Māori, non-Pacific women. These patterns were partly explained by socioeconomic deprivation, and were not apparent for Pacific women. Conclusions: Pacific and Māori women experience higher incidence of ovarian cancer and mortality, compared to non-Māori, non-Pacific women. Māori women seemed to have better prognostic factors (local stage and well-differentiated tumours) than non-Māori, non-Pacific women. More work is needed to improve current cancer prevention strategies, particularly in Pacific women.

Background From 1950 to 1990 pentachlorophenol (PCP) was used widely in the New Zealand sawmill industry, and persistent claims of long-term health effects have been made. Methods We surveyed surviving members of a cohort enumerated to study mortality in sawmill workers employed from 1970 to 1990. Estimates of historical exposure were based on job titles held, using the results of a PCP biomonitoring survey conducted in the 1980s. The survey involved interviews and clinical examinations, with interviewers and examiners blinded to exposure status. Results Of the 293 participants 177 had not been exposed, and of the 116 exposed all but 10% had low or short-term PCP exposure. Nevertheless, a number of significant associations between PCP exposure and the prevalence of various symptoms were observed including associations between: (i) exposure levels and self-reported tuberculosis, pleurisy or pneumonia (P

Epidemiologic studies have shown an inverse association between atopy and malignant lymphoma, but results are inconsistent. We investigated levels of IgE, before and after commencement of treatment, and evaluated lymphoma risk in relation to total and specific IgE levels. Serum levels of IgM, IgA, and IgG were also measured. We enrolled 467 newly diagnosed lymphoma cases and 544 hospital controls, matched for age, sex, and hospital. Lymphomas were histologically confirmed and categorized according to the WHO classification. Subjects provided blood for analysis of total and specific IgE levels, and total IgM, IgA, and IgG levels. Additional information was collected by interviewer-administered questionnaire. Controlling for age, sex, center, smoking status, and any treated asthma or eczema, we found that the overall risk of lymphoma was significantly lower in the high [odds ratio (OR), 0.39; 95% confidence interval (95% CI), 0.28-0.54] and middle (OR, 0.55; 95% CI, 0.40-0.74) tertiles for total serum IgE compared with the low tertile. Specific IgE to common aeroallergens (defined as ≥0.35 kU/L) was also inversely associated with risk of lymphoma (OR, 0.67; 95% CI, 0.45-1.00). Lymphoma was associated with IgA and IgM but not IgG. Mean levels of all immunoglobulins were decreased with more advanced malignancy, and total serum IgE levels were lower before treatment. The data suggest that the low levels of immunoglobulins seen in a wide range of lymphoma cases is likely to be linked to a lymphogenesis process rather than resulting from a selective protection due to an atopic process. Long-term cohort studies may be fundamental to fully evaluate these associations. (Cancer Epidemiol Biomarkers Prev 2007;16(7):1492–8)

The present study investigated the relationship between socioeconomic status, using measures of occupational class and education level, and the prevalence and incidence of asthma (with and without atopy) and chronic bronchitis using data from the European Community Respiratory Health Survey (ECRHS). Asthma and chronic bronchitis were studied prospectively within the ECRHS (n = 9,023). Incidence analyses comprised subjects with no history of asthma or bronchitis at baseline. Asthma symptoms were also assessed as a continuous score. Bronchitis risk was associated with low educational level (prevalence odds ratio (POR) 1.9; 95% confidence interval (CI) 1.4-2.8) and occupational class (1.8; 1.2-2.7). Incident bronchitis also increased with low educational level (risk ratio (RR) 2.8; 95%CI 1.5-5.4). Prevalent and incident asthma with no atopy were associated with low educational level. Subjects in the low occupational class (incident risk ratio (IRR) 1.4; 95%CI 1.2-1.7) and education group (IRR 1.3; 95% CI 1.1-1.6) had higher mean asthma scores than those in higher socioeconomic groups. Lower educational level was associated with increased risk of prevalent and incident chronic bronchitis and asthma with no atopy. Lower socioeconomic groups tended to have a higher prevalence and incidence of asthma, particularly higher mean asthma scores. Adjustment for variables associated with asthma and bronchitis explained little of the observed health differences by socioeconomic status.

We explored the contribution of stage at diagnosis to ethnic disparities in cancer survival in New Zealand. We linked 115811 adult patients with invasive cancer registered on the cancer registry (1994 to 2002) to mortality data. Age-standardized, 5-year relative survival rates were lowest for Maori, intermediate for Pacific people (otherwise known as Pacific Islanders), and highest for non-Maori/non-Pacific people for many cancers. Stage at diagnosis accounted for only part of these differences. Possible factors responsible for ethnic inequalities might include access to specialized cancer services and the quality of care received.

BACKGROUND: The reasons for the increasing breast cancer incidence in indigenous Māori compared to non-Māori New Zealand women are unknown. The aim of this study was to assess the association of an index of combined healthy lifestyle behaviours with the risk of breast cancer in Māori and non-Māori women. METHODS: A population-based case-control study was conducted, including breast cancer cases registered in New Zealand from 2005-2007. Controls were matched by ethnicity and 5-year age bands. A healthy lifestyle index score (HLIS) was generated for 1093 cases and 2118 controls, based on public health and cancer prevention recommendations. The HLIS was constructed from eleven factors (limiting red meat, cream, and cheese; consuming more white meat, fish, fruit and vegetables; lower alcohol consumption; not smoking; higher exercise levels; lower body mass index; and longer cumulative duration of breastfeeding). Equal weight was given to each factor. Logistic regression was used to estimate the associations between breast cancer and the HLIS for each ethnic group stratified by menopausal status. RESULTS: Among Māori, the mean HLIS was 5.00 (range 1-9); among non-Māori the mean was 5.43 (range 1.5-10.5). There was little evidence of an association between the HLIS and breast cancer for non-Māori women. Among postmenopausal Māori, those in the top HLIS tertile had a significantly lower odds of breast cancer (Odds Ratio 0.47, 95% confidence interval 0.23-0.94) compared to those in the bottom tertile. CONCLUSION: These findings suggest that healthy lifestyle recommendations could be important for reducing breast cancer risk in postmenopausal Māori women.

Breast cancer incidence differs by ethnicity in New Zealand (NZ) with Māori (the indigenous people) women having the highest rates followed by Pakeha (people primarily of British/European descent), Pacific and Asian women, who experience the lowest rates. The reasons for these differences are unclear. Breast density, an important risk factor for breast cancer, has not previously been studied here. We used an automated system, Volpara™, to measure breast density volume from the medio-lateral oblique view of digital mammograms, by age (≤50 years and >50 years) and ethnicity (Pakeha/Māori/Pacific/Asian) using routine data from the national screening programme: age; x-ray system and mammography details for 3,091 Pakeha, 716 Māori, 170 Pacific and 662 Asian (total n = 4,239) women. Linear regression of the natural logarithm of absolute and percent density values was used, back-transformed and expressed as the ratio of the geometric means. Covariates were age, x-ray system and, for absolute density, the natural log of the volume of non-dense tissue (a proxy for body mass index). Median age for Pakeha women was 55 years; Māori 53 years; and Pacific and Asian women, 52 years. Compared to Pakeha women (reference), Māori had higher absolute volumetric density (1.09; 95% confidence interval [95% CI] 1.03-1.15) which remained following adjustment (1.06; 95% CI 1.01-1.12) and was stronger for older compared to younger Māori women. Asian women had the greatest risk of high percentage breast density (1.35; 95% CI 1.27-1.43) while Pacific women in both the ≤50 and >50 year age groups (0.78; 95% CI 0.66-0.92 and 0.81; 95% CI 0.71-0.93 respectively) had the lowest percentage breast density compared to Pakeha. As well as expected age differences, we found differential patterns of breast density by ethnicity consistent with ethnic differences seen in breast cancer risk. Breast density may be a contributing factor to NZ's well-known, but poorly explained, inequalities in breast cancer incidence.

Objectives Little is known about the ethnic differences in disease presentation of uterine cancer in New Zealand women. The objectives of this study were two-fold: (1) to estimate the incidence and mortality of uterine cancer among women in New Zealand and (2) to examine the association of ethnicity and socioeconomic status with tumour stage and grade, at presentation of uterine cancer. Methods Retrospective survey of cancer cases identified from the New Zealand Cancer Registry. The authors analysed all 3203 uterine cancer cases registered with the New Zealand Cancer Registry during the period 1 January 1997 to 31 December 2006. Ethnic groups were defined based on the self-identified ethnicity recorded on the cancer registry: Ma–ori, Pacific and non-M–aori non-Pacific women. Socioeconomic status was categorised as quintiles of the New Zealand Deprivation Index 2006. The mortality to incidence ratio was used as a measure of prognosis. Logistic regression was used to estimate age, ethnic and deprivation adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results Pacific and M–aori women have higher incidence (32.4 and 17.7 per 100 000 women, respectively) and mortality rates of uterine cancer (12.1 and 7.4 per 100 000 women, respectively). Women in the most deprived areas are more likely to present with an advanced stage of uterine cancer (OR 1.64, 95% CI 1.09–2.48). M–aori and Pacific women are less likely to present with well-differentiated tumours (OR 0.69, 95% CI 0.52–0.92 and OR 0.72, 95% CI 0.52–0.99, respectively). Conclusions M–aori and Pacific women, and those from lower socioeconomic areas, are more likely to present with advanced uterine cancer.

The aims of this study were to gain an understanding of pregnant women's oral health care practices, access to information, and dental care usage in New Zealand, and to investigate whether these differed between sociodemographic groups.One researcher visited 69 antenatal classes in the Wellington region to explain the study. Women self-completed the questionnaire and returned it by post.A total of 405 women (55% response rate) took part. 79.2% of participants identified as New Zealand European and most were of high income and education levels, 32% visited the dentist during pregnancy and more than 60% reported bleeding gums. Women with a household income under NZ$70,000 per year were significantly less likely to report access to oral health information (OR 0.27, 95%CI 0.10-0.76) and more likely to report the need to see a dentist (OR 2.55, 95%CI 1.08-5.99) compared to women with an income over NZ$100,000 per year.Visits to the dentist and access to oral health information were more common among New Zealand European women with higher education achievements and higher socioeconomic backgrounds with only a third of women went seeing a dentist during pregnancy. Improving the oral health of pregnant women will have follow-on benefits of improved oral health outcomes for their children.

Objective: Study the determinants of non-response and the potential for non-response bias in a New Zealand survey of occupational exposures and health. Methods: A random sample of 10,000 New Zealanders aged 20–64 years were invited by mail to take part in a telephone survey. Multiple logistic regression was used to study the determinants of non-response. Whether occupational exposure, lifestyle and health indicators were associated with non-response was studied by standardising their prevalence towards the demographic distribution of the source population, and comparing early with late responders. Results: The response rate was 37%. Younger age, Māori descent, highest and lowest deprivation groups and being a student, unemployed, or retired were determinants of non-contact. Refusal was associated with older age and being a housewife. Prevalence of key survey variables were unchanged after standardising to the demographic distribution of the source population. Conclusions: Following up the non-responders to the mailed invitations with telephone calls more than doubled the response rate and improved the representativeness of the sample. Although the response rate was low, we found no evidence of major non-response bias. Implications: Judgement regarding the validity of a survey should not be based on its response rate.

The 2009 Cancer Care Survey aimed to gather information from patients about their experiences receiving outpatient cancer care.In mid-2009, Cancer Control New Zealand sent an NRC+Picker postal survey to a stratified sample of 3251 eligible adults, who had received outpatient cancer care between October 2008 and March 2009. Eight cancer treatment facilities across New Zealand provided patient lists from which potential respondents were selected.The final response rate to the survey was 68%. Most of the patients surveyed responded very positively to questions related to specialist care coordination (91% positive response; 95%CI: 90-93), the level of privacy (87% positive response; 95%CI: 85-89), and the dignity and respect provided by healthcare professionals (86% positive response; 95%CI: 85-88). However, patients tended to be much less positive about the level of information they received on the effects of cancer treatment on their day-to-day life (responses ranging between 30% and 40% positive) and the level of emotional support provided (36% positive response; 95%CI: 33-39). Responses from different cancer services tended to follow similar patterns, although for twelve questions there was at least a 20% difference in response between services.Overall, patients rated their outpatient cancer care experiences as positive, but important gaps exist in the provision of information, emotional support, and treating patients within the context of their living situation. Cancer patient experience surveys can achieve high response rates and generate useful information on patient perceptions of their care. This data can be used to inform quality improvement efforts at both national and cancer treatment service levels.

Introduction: This study examines the prevalence of a range of occupational risk factors reported by a random sample of the New Zealand working population. Methods: Men and women aged 20–64 were selected from the New Zealand Electoral Roll and invited to take part in a telephone interview, which collected information on lifetime work history, current workplace exposures and organizational factors, and various health conditions. The prevalences of occupational risk factors in each occupational and industry group are reported. Results: Three thousand and three interviews were completed (37% of the eligible sample and 55% of those that could be contacted). Trades workers reported the highest prevalences of exposure to dust (75%) and oils and solvents (59%). Agriculture and fishery workers reported the highest prevalences of exposure to pesticides (63%) and acids or alkalis (25%). Plant and machine operators and assemblers reported the highest prevalences of exposure to smoke/fume/gas (43%), working night shift in the previous 4 weeks (18%), and working irregular hours (33%). In the high exposure occupational and industry groups, males reported a higher prevalence of exposure than females. Lifting, exposure to loud noise, and the use of personal protective equipment were reported by >50% of the manual occupational groups. Conclusions: This study indicates that occupational exposure to risk factors for workrelated disease and injury remains common in the New Zealand working population. While these occupational exposures are disproportionately experienced by workers in certain industries, they also occur in occupational groups not traditionally associated with hazardous exposures or occupational disease.

The International Study of Asthma and Allergies in Childhood (ISAAC) demonstrated that the highest prevalence of asthma in the world is in English-speaking countries, including New Zealand. In this paper, we compare asthma symptom prevalence in the three major ethnic groups (Maori, Pacific, and European) in the six participating centers in New Zealand. Hospital admission rates for asthma are higher among Maori and Pacific children compared to European children. The working hypothesis was that there were important differences in prevalence of asthma symptoms or diagnosis between ethnic groups which might explain these observed differences in asthma morbidity. In each center in 1992-1993, we sampled approximately 3000 children at each of the age brackets 6-7 years and 13-14 years. There were 37592 participants. Maori children had higher rates of diagnosed asthma and reported asthma symptoms than Pacific children in both age groups (diagnosed asthma in 6-7-year-olds: Maori, 31.7%; Pacific, 21.2%; 95% confidence interval on difference (CID), 7.2, 13.8; P < 0.001; 13-14-year-olds: Maori, 24.7%; Pacific, 19.2%; CID 2.5, 8.5; P < 0.001; recent wheeze in 6-7-year-olds: Maori, 27.6%; Pacific, 22.0%; CID, 2.6, 8.6; P < 0.001; 13-14-year-olds: Maori, 30.8%; Pacific, 21.1%; CID, 4.8, 14.5; P < 0.001;). European children had rates intermediate between those of Maori and Pacific children (6-7-year-olds) or similar to those of Maori children (13-14-year-olds), but had the lowest prevalence of night waking with wheeze in both age groups (e.g., 6-7-year-olds: European, 2.6%; Maori, 5.8%; Pacific, 5.7%; European-Maori CID: -4.2, -2.2, P < 0.001; European-Pacific CID: -4.7, -1.7, P < 0.001; Maori-Pacific CID: -1.7, 1.8, P = 1.0). The pattern of differences closely resembled that in a 1985 Auckland study, despite a 1.5-1.7-fold overall increase in prevalence. In conclusion, there are important differences in asthma prevalence among Maori, Pacific, and European children. These differences are small compared to worldwide variation, but their pattern is stable over time. The higher rate of severe asthma symptoms that Maori and Pacific children report may be one reason for the increased asthma morbidity in these groups. Further studies are needed to determine the reasons for these apparent differences in asthma severity.

BackgroundThe association between breast cancer and tobacco smoke is currently unclear. The aim of this study was to assess the effect of smoking behaviours on the risk of breast cancer among three ethnic groups of New Zealand women.MethodsA population-based case-control study was conducted including breast cancer cases registered on the New Zealand Cancer Registry between 2005 and 2007. Controls were matched by ethnicity and 5-year age-group. Logistic regression was used to estimate the association between breast cancer and smoking at different time points across the lifecourse, for each ethnic group. Estimated odds ratios (OR) were adjusted for established risk factors.ResultsThe study comprised 1,799 cases (302 Māori, 70 Pacific, 1,427 non-Māori/non-Pacific) and 2,540 controls (746 Māori, 191 Pacific, 1,603 non-Māori/non-Pacific). There was no clear association between smoking and breast cancer for non-Māori/non-Pacific women, although non-Māori/non-Pacific ex-smokers had statistically significant increased risk of breast cancer when smoking duration was 20 years or more, and this remained significant in the fully adjusted model (OR 1.31, 95% CI 1.03 to 1.66). Māori showed more consistent increased risk of breast cancer with increasing duration among current smokers (ConclusionThere was no clear pattern for cigarette smoking and breast cancer incidence in non-Māori/non-Pacific women, but increased risks were observed for Māori and Pacific women. These findings suggest that lowering the prevalence of smoking, especially among Māori and Pacific women, could be important for reducing breast cancer incidence.

INTRODUCTION: There are unacceptable ethnic differences in cancer survival in Aotearoa/New Zealand. For people with cancer, quality of life and survival are shaped by access to care, but research on Maori access to, and through, cancer care is limited. Internationally, research has shown that primary care plays an important role in providing patient-centred, holistic care and information throughout the cancer care journey. Additionally, Maori health providers provide practical support and facilitate access to all levels of health care. Here we describe the cancer journeys of Maori patients and whanau and identify factors that may facilitate or inhibit access to and through cancer care services. METHODS: Twelve Maori patients affected by cancer and their whanau (family) in the lower North Island took part in face-to-face semi-structured interviews exploring their experiences of cancer screening, diagnosis, treatment, survival and palliative care. FINDINGS: Three key areas were identified that impacted upon the cancer care journey: the experience of support; continuity of care; and the impact of financial and geographic determinants. CONCLUSION: Primary care plays a key role in support and continuity of care across the cancer journey. Alongside interpersonal rapport, a long-term relationship with a primary health provider facilitated a more positive experience of the cancer care journey, suggesting that patients with a ‘medical home’ are happier with their care and report less problems with coordination between services. Positive, longstanding relationships with general practitioners and Maori health providers assisted patients and whanau with the provision and understanding of information, alongside practical support. KEYWORDS: Cancer; family; health services, indigenous; Maori health; primary health care cancer

PURPOSE: To investigate whether the relationships between established risk factors and breast cancer risk differ between three ethnic groups in New Zealand, namely Māori, Pacific, and non-Māori/non-Pacific women. METHODS: The study is a multi-ethnic, age-, and ethnicity-matched population-based case-control study of breast cancer in women. Women with a primary, invasive breast cancer registered on the New Zealand Cancer Registry between 1 April 2005 and 30 April 2006, and Māori or Pacific women diagnosed to 30 April 2007 were eligible. Control women were identified from the New Zealand Electoral Roll, stratified by ethnicity, then frequency matched on age to the cases. Logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI) between exposures and breast cancer risk in three ethnic groups separately. Likelihood ratio tests were used to test for modification of the effects by ethnicity. Post-stratification weighting of the controls was used to account for differential non-response by deprivation category. RESULTS: The study comprised 1,799 cases (302 Māori, 70 Pacific, 1,427 non-Māori/non-Pacific) and 2,543 controls (746 Māori, 194 Pacific, 1,603 non-Māori/non-Pacific), based on self-identified ethnicity. Māori women were more likely to have ER and PR positive breast cancer compared to other ethnicities. There were marked differences in exposure prevalence between ethnicities and some differing patterns of risk factors for breast cancer between the three main ethnic groups. Of interest was the strong relationship between number of children and lower breast cancer risk in Pacific women (OR for 4 or more vs. 1 child OR 0.13, 95 % CI 0.05-0.35) and a higher risk of breast cancer associated with smoking (OR 1.76, 95 % CI 1.25-2.48) and binge drinking (5 or more vs. 1-2 drinks per occasion, OR 1.55, 95 % CI 1.07-2.26) in Māori women. Some of the documented results were attenuated following post-stratification weighting. CONCLUSIONS: The findings of this study need to be interpreted with caution, given the possibility of selection bias due to low response rates among some groups of women. Reducing the burden of breast cancer in New Zealand is likely to require different approaches for different ethnic groups.

Background Unequal access to health care contributes to disparities in cancer outcomes. We examined the ethnic disparity in barriers to accessing primary and specialist health care experienced by New Zealand women with breast cancer. Methods Women diagnosed with a primary invasive breast cancer between 2005 and 2007 were eligible. There were 1,799 respondents, n = 302 Māori (the indigenous population of NZ), n = 70 Pacific and n = 1,427 non-Māori/non-Pacific women. Participants completed a questionnaire listing 12 barriers grouped into three domains for analysis: personal; practical; and health care process factors, and reported the number of days between seeing a primary and a specialist care provider. Chi-squared, Fisher exact tests and logistic regression were used to assess uni- and multivariable differences in prevalence between ethnic groupings. Results The prevalence of reporting three or more barriers was 18 % among Pacific, 10 % among Māori and 3 % among non-Māori/non-Pacific women (P