Ethnic differences in stroke outcomes in Aotearoa New Zealand: A national linkage study

Abstract

Background: Ethnic differences in post-stroke outcomes have been largely attributed to biological and socioeconomic characteristics resulting in differential risk factor profiles and stroke sub-types, but evidence is mixed. Aims: This study assessed ethnic differences in stroke outcome and service access in New Zealand (NZ) and explored underlying causes in addition to traditional risk factors. Methods: This national cohort study used routinely collected health and social data to compare post-stroke outcomes between NZ Europeans, Māori, Pacific Peoples, and Asians, adjusting for differences in baseline characteristics, socioeconomic deprivation, and stroke characteristics. First and principal stroke public hospital admissions during November 2017-October 2018 were included (N=6,879). Post-stroke unfavourable outcome was defined as being dead, change in residence, or unemployed if working pre-stroke. Results: In total, 5,394 NZ Europeans, 762 Māori, 369 Pacific Peoples and 354 Asians experienced a stroke during the study period. Median age was 65 years for Māori and Pacific Peoples, and 71 and 79 years for Asians and NZ Europeans, respectively. Compared with NZ Europeans, Māori were more likely to have an unfavourable outcome at all three time-points (OR=1.6 (95%CI=1.3–1.9); 1.4 (1.2–1.7); 1.4 (1.2–1.7), respectively). Māori also had increased odds of death at all time-points (1.7 (1.3–2.1); 1.5 (1.2–1.9); 1.7 (1.3–2.1)) and unemployment at twelve months (2.5 (1.2–5.2). There was evidence of differences in post-stroke secondary prevention medication by ethnicity. Conclusions: We found ethnic disparities in care and outcomes following stroke, independent of traditional risk factors raising concern for potential unconscious bias and institutional racism in stroke services.

Stroke among Māori in Aotearoa New Zealand and solutions to address persistent inequities

“…76 (1.07-1.89)]. The substudy, using health administrative data, increased the study power and controlled for socioeconomic factors (Denison et al, 2023). Among 762 Māori and 6,117 non-Māori stroke patients Māori were more likely to have an increased odds of death at 3,6, and 12 months with ORs 1.5-1.7 (1.2-2.1) and these findings persisted after controlling for socioeconomic deprivation.…”

The global burden of stroke

“…While there do appear to be some geographical differences, for example, increased intracranial stenosis in Far Eastern populations, 7 differences in access to services are likely to be more important in determining stroke outcome. This is highlighted in a study by Denison et al 8 from New Zealand in which they showed worse stroke outcomes in Maori, compared with European, New Zealanders. Importantly, they report that disparities in care and outcomes following stroke were independent of traditional risk factors, suggesting they may be attributable to differences in stroke service delivery rather than patient factors.…”

Self-Identified Fat Peoples Experiences of COVID-19 Vaccination Centre's in Aotearoa NZ

“…This configuration excludes or inadequately addresses the diverse health needs of minority populations, including fat communities. In Aotearoa NZ, the healthcare system reflects the colonial roots from which it was developed (Denison et al, 2023;Moewaka Barnes & McCreanor, 2019). The health system that was introduced by colonisers to mirror their own system in Britain, completely disregarded any indigenous knowledge, practices and beliefs, rather prioritising patriarchal and colonial values Graham & Masters-Awatere, 2020;Moewaka Barnes & McCreanor, 2019;Warbrick et al, 2019).…”