Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

Abstract

Māori are the indigenous people of New Zealand (NZ), comprising approximately 15% of the national population. A major disparity exists between Māori and non-Māori in cardiovascular mortality, which remains the leading cause of premature death and disability in New Zealand.1,2 Furthermore, recent health statistics indicate that those living in rural areas are worse off than urban New Zealanders, including for prevalence of ischaemic heart disease.3 Rural Māori have a shorter life expectancy than urban Māori, with 1.2 years difference for women and 1.5 years difference for men. 3 The combination of resource accessibility and ethnic disparities may additionally disadvantage rural Māori communities with respect to health outcomes.Recent data on cardiovascular disease (CVD) and its risk factors in Māori has been obtained from mortality or hospital statistics, 1,4 from diagnoses in general practice, 5 and in urban Auckland communities, 6-10 but we lack information about the state of Māori cardiovascular health in rural communities. In addition, disease rates and risk factors in indigenous population groups may be underestimated if these groups do not have equivalent access to health care or CVD screening. This underestimation will occur in studies based on clinical databases. It will also occur in population studies that rely on self-report of doctor-diagnosed conditions, such as the New Zealand Health Survey. Results: Mean age of participants (n=252) was 45.7±0.7, 8% reported a history of cardiac disease, 43% were current smokers, 22% had a healthy BMI, 30% were overweight and 48% obese.Hypertension was previously diagnosed in 25%; an additional 22% were hypertensive at screening. Dyslipidaemia was previously diagnosed in 14% and an additional 43% were dyslipidaemic at screening. Type-2 diabetes was previously diagnosed in 11%. Glycaemic control was achieved in only 21% of those with type-2 diabetes.Blood pressure and cholesterol were above recommended targets in more than half of those with diagnosed CVD risk factors. Conclusions

Hyperuricaemia and gout in New Zealand rural and urban Māori and non‐Māori communities

“…The Hauora Manawa/Community Heart Study is a cohort study of heart disease in New Zealand, based on random selection from electoral rolls, sampled to be representative of the age and gender profiles within each participating Māori community. Full details of the methodology, sample selection, recruitment and interviewing processes are published elsewhere . In brief, a total of 751 participants aged 20 to 64 years was recruited by random selection, stratified by age and gender, from the electoral roll for Wairoa District and for Christchurch City.…”

“…Full details of the methodology, sample selection, recruitment and interviewing processes are published elsewhere. 14,15 In brief, a total of 751 participants aged 20 to 64 years was recruited by random selection, stratified by age and gender, from the electoral roll for Wairoa District and for Christchurch City. Participants for the Mā ori samples were selected from among those who identified as being of Mā ori descent on the roll and who also self-identified at interview as being of Mā ori ethnicity.…”

A cohort study comparing cardiovascular risk factors in rural Māori, urban Māori and non-Māori communities in New Zealand

“…11 No studies to date have compared cardiovascular health and risk factors between rural and urban M aori communities, and the only previous study of cardiovascular health in rural M aori was conducted 50 years ago. 12 We have recently reported high levels of both diagnosed and undiagnosed CVD risk factors, especially hypertension, dyslipidaemia and diabetes in a rural M aori community, 13 with several major risk factors at higher levels than those reported than either national statistics or for Auckland City M aori. To understand how CVD risk factors differ between diverse localities across New Zealand, we have compared the cardiovascular risk profiles of two regionally distinct rural and urban M aori communities and a matched urban comparator cohort of non-M aori to identify risk factors in common and those that differ among these communities.…”

“…13 In brief, all participants completed an interviewer-administered questionnaire providing demographic, personal and family medical history, current medications, smoking status recorded as current, ex-smoker (quit more than 12 months) or never-smoker, alcohol consumption, physical activity levels (physically active defined as 'at least 30 min of moderate or vigorous physical activity on 5 or more days of the week') and socioeconomic data. Blood pressure was recorded (two measurements, seated, at least 20 min apart), height, weight, waist and hip measurements were taken and body mass index (BMI) was calculated.…”

Racial Inequities in Cardiovascular Disease in New Zealand

“…They found that rural Māori were at greatest risk of CVD because of higher levels of; obesity, dyslipidaemia, hypertension, smoking, type 2 diabetes and hyperuricaemia, than urban Māori, and urban nonMāori ( Figure 6) [54]. A number of researchers have concluded that the development of an integrated healthcare programme is required to address the increased risks of CVD in rural and urban Māori that is sensitive to their cultural perspective of health [54][55][56]. While interventions that focus upon such risk factors are important they will fail to fully address the ethnic inequities that exist in New Zealand healthcare unless the socioeconomic inequities such as poverty are addressed first [33].…”