 A study charting trends in mortality since 1981 shows that while there has been an encouraging reduction in mortality rates for Europeans and Maori, the same gains are not evident among Pacific peoples.
The New Zealand Census-Mortality Study (NZCMS) is currently funded by the Ministry of Health (previously the Health Research Council) and is a joint project between the Ministry and the University of Otago. It links census and mortality records for the three years following each census back to 1981. The project is lead by researchers in the Department of Public Health at the Wellington School of Medicine and Health Sciences. Professor Tony Blakely, Director of the Health Inequalities Research Programme, is one of the researchers and authors of Tracking Disparity, the fourth report to be published as part of the study. Tony says the study plays an important monitoring role in the health sector. Standardised mortality rates are calculated for males and females aged from 1 to 74 and then analysed by specific ethnic groups, various indicators of socio-economic position and specific causes of death. “The study has been monitoring mortality trends by ethnicity and socio-economic status over a 25 year period. It’s the largest study of its kind in the English-speaking world and the main vehicle for the Ministry of Health to see if there are changes over time in inequalities in mortality between social groups,” says Tony. The overall picture is encouraging for New Zealand and shows that the inequalities between ethnic groups which were widening in the 1980s and 90s, may have stopped widening now and have even started to narrow. However, mortality rates for Pacific people are not declining as fast as for their European or Maori counterparts, as the graphs on the next page illustrate. Between 1981–84 and 2001–04, Pacific mortality rates dropped 14 percent for males and 10 percent for females compared to reductions of 42 percent and 35 percent for male and female Europeans and 25 percent and 22 percent for male and female Maori. “What’s happened over 25 years is that European and Maori mortality rates have dropped nicely and the Pacific mortality rate which used to be closer to the European rate is now closer to the Maori rate. So the Maori rate has come down ok, the European rate has been coming down nicely and the Pacific rate has stayed much the same. It is not improving as much as the other ethnic groups,” explains Tony. The study also shows that disparities in mortality rates between Pacific and other groups, which widened dramatically in the 80s and 90s, are still significant. The mortality rate for Pacific males compared to European/Other males was 21 percent higher in the 1980s, 84 percent higher in the 1990s and 79 percent higher in the 2001 to 2004 period. For females, the disparity climbed from 32 percent in the 1980s to 86 percent in the 1990s and dropped slightly (but not statistically significantly) to 84 percent in the most recent analysis. The study also looks at causes of mortality and Tony notes that the incidence of cardiovascular disease is a key driver behind these mortality trends. “About 50 percent of the gap between Pacific and European/Other is attributable to cardiovascular disease, which includes heart attacks and strokes. The European mortality rate for cardiovascular disease has dropped by 65 percent since 1981, which is absolutely outstanding. The Maori and Pacific rates have come down too, but the drops aren’t nearly as pronounced. So the gap between European and Pacific cardiovascular mortality has widened profoundly.” Tony says although another 15 to 20 percent of the gap is attributable to cancer rates, the most interesting finding is that 40 percent of the gap is driven by causes other than cardiovascular disease, cancer, chronic lung disease or suicide. “This is not the case for other ethnic groups and is probably due to diabetes, which is notoriously difficult to code on death certificates.” What are the implications of the report for policymakers and people working in the Pacific health sector? “At the highest level we tend to focus on inequalities between European/Other and Maori, but what this report shows is that Pacific mortality rates haven’t fallen as much as other groups and that this inequality is becoming more prominent. I guess if you were to project out into the future you would be concerned that the Pacific mortality rate might overtake the Maori mortality rate,” says Tony. “It also tells us that addressing cardiovascular disease is critical. Ensuring large reductions for Pacific people, not just Europeans, is essential to help close mortality gaps between Pacific and Europeans.” Tracking Disparity: Trends in ethnic and socioeconomic inequalities in mortality, 1981–2004 is available from the Ministry of Health website and the New Zealand Census-Mortality website www.wnmeds.ac.nz/nzcms-info.html . 
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