Māori health outcomes in an intensive care unit in Aotearoa New Zealand

Abstract

Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand’s Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 ( n = 3009). Primary outcomes were in–intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation ( P < 0.001). Māori had higher admission rates for trauma and sepsis ( P < 0.001 overall) and required more renal replacement therapy ( P < 0.001). There was no difference in crude and adjusted mortality in–intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.

Mortality outcomes for Māori requiring renal replacement therapy during critical illness: a single unit audit in Aotearoa New Zealand

“…Our report has further characterised the unique aspects of the ESRD population requiring critical care support in our population. We had previously identified ethnic inequity in terms of age, comorbidity and socioeconomic deprivation affecting Māori admitted to the general ICU 14 . Our findings suggest that these ethnic disparities appear to be uniquely diminished within the ESRD population requiring an ICU admission, compared with non‐ESRD.…”

“…Multimorbidity is defined as two or more of the morbidities as characterised in the ANZICS APD data dictionary, in addition to insulin‐dependent diabetes 20 . Immunosuppression and liver disease are aggregate morbidities, respectively, characterised as previously described 14,21 …”

“…Waikato Hospital provides tertiary renal services, including intensive care, to four District Health Boards (DHB) in the region of Te Manawa Taki of NZ: Waikato, Bay of Plenty, Lakes and Tairāwhiti. Our group previously identified a greater burden of renal replacement therapy (RRT) requirement for Māori in our general intensive care unit (ICU) 14 …”

“…Our group previously identified a greater burden of renal replacement therapy (RRT) requirement for M aori in our general intensive care unit (ICU). 14 In this report, we aimed to identify if mortality inequality exists among the RRT-requiring population in our ICU.…”

Clinical outcomes of Indigenous Australians and New Zealand Māori with metabolic acidosis and acidaemia

“…9 Like Indigenous people, Mãori people are less likely to be admitted to the ICU after elective surgery and proportionately more likely to be admitted to the ICU as an emergency. 10 Sepsis and trauma are also common reasons for ICU admission for Mãori people, and unlike Indigenous people, Mãori people admitted to the ICU have higher mortality rates than their Pãkehã counterparts. 10 Decompensated metabolic acidosis is a major acidbase derangement in critically ill patients and may impair cardiac contractility, which may contribute to reduced ABSTRACT Objective: To assess the incidence and impact of metabolic acidosis in Indigenous and non-Indigenous patients.…”