Socio-Economic Inequity: Diabetes in New Zealand

Holder-Pearson, Lui; Chase, J. Geoffrey

doi:10.3389/fmed.2022.756223

Cited by 19 publications

(15 citation statements)

References 26 publications

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“…Furthermore, there is increasing evidence for the role of biochemical markers to measure the multiple pathogenic mechanisms of DKD, which include tubulointerstitial injury due to hyper-reabsorption stress, chronic endothelial damage, disruption of the endothelial glycocalyx, and hyperfiltration-induced podocytopathy 35–37. There is also an increasing need to explore the social determinants of the unexplained differences in DKD outcomes, which include issues such as healthcare access, differential treatment, adherence to treatments, food security, health literacy, systemic racism, and more specific socioeconomic factors 20 3839…”

Section: Discussionmentioning

confidence: 99%

Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand

Wang

Cai

et al. 2022

BMJ Open Diab Res Care

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IntroductionInsights into ethnic differences in the natural history of chronic kidney disease (CKD) among people with type 2 diabetes mellitus (T2DM) might inform clinical strategies to address disparities in hospitalization and mortality. Risks of CKD II–V stages over a 25-year period between New Zealand Europeans (NZEs), Māori and Pasifika, and with T2DM in Auckland, New Zealand (NZ) were compared.Research design and methodsAs a primary care audit program in Auckland, the Diabetes Care Support Service was linked with national registration databases. People with existing CKD II–V were ruled out. To balance potential confounders, we applied a tapered matching method . ‘Quasi-trial’-matched cohorts were set up separately between Māori and NZE and between Pasifika and NZE. Ethnic population differences in risk of any and each stage of CKD over 1994–2018 were examined by weighted Cox regression model.ResultsThe HRs for developing any CKD, CKD stages II–V for Māori (n=2215) versus NZE (n=2028) were 1.18 (95% CI 0.99 to 1.41), 1.10 (95% CI 0.91 to 1.32), 1.70 (95% CI 1.19 to 2.43), 3.93 (95% CI 2.16 to 7.14), and 3.74 (95% CI 1.74 to 8.05), respectively. Compared with NZE (n=2474), the HRs for developing any CKD, CKD stages II–V for Pasifika (n=3101) were 1.31 (95% CI 1.09 to 1.57), 1.26 (95% CI 1.05 to 1.52), 1.71 (95% CI 1.14 to 2.57), 3.75 (95% CI 1.40 to 10.05), and 4.96 (95% CI 1.56 to 15.75), respectively.ConclusionsAmong people with T2DM in NZ, significant ethnic differences exist in the risk of progressing to each stage of CKD (stage V in particular). Mechanism studies underlying these differences, as well as the need for identification of biomarkers to predict the early onset renal lesion, are warranted.

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Section: Discussionmentioning

confidence: 99%

Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand

Wang

Cai

et al. 2022

BMJ Open Diab Res Care

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“…• Inadequate government policies to address the drivers of T2DM -SDOH, such as food insecurity, poverty, and unemployment. These issues cannot be addressed through the health system 28,29 • Cross-party agreements and implemented strategies to address the SDOH • Intersectoral policies and actions required • Failure to adopt evidence-based population health measures to support diabetes prevention…”

Section: Policy and Resourcingmentioning

confidence: 99%

It is time for a more targeted approach to prediabetes in primary care in Aotearoa New Zealand

Barthow

Pullon

McKinlay

et al. 2022

J. Prim. Health Care

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Type 2 diabetes (T2DM), its related morbidities and entrenched diabetes-related inequities pose significant challenges for health care delivery systems in Aotearoa New Zealand (NZ). Primary care services undertake the majority of diabetes prevention work by initially detecting and managing those with prediabetes. In this viewpoint, we present available NZ data to highlight NZ trends in prediabetes and consider the current NZ clinical guidelines and the prediabetes care pathway. Multiple areas for improvement are identified to optimise diabetes prevention, potentially reduce T2DM inequities, and sustain more effective prediabetes management in primary care in NZ.

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“…[12][13][14][15][16] In Aotearoa New Zealand, hospital admissions for gallbladder disease and cholecystectomy increased by 5.8% and 6.6% respectively between 2004 and 2019. 17 Further, it is known that risk factors for acute cholecystitis (such as obesity 18 and type 2 diabetes mellitus 19 ) are more prevalent among M aori, and some data suggest that acute cholecystitis likely disproportionately affects M aori patients. 20 Ethnic inequities in aetiologies of benign biliary disease remain understudied.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID‐19 pandemic on outcomes of cholecystectomy for acute cholecystitis: a national cohort study

2024

ANZ Journal of Surgery

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BackgroundThe COVID‐19 pandemic was associated with significant disruptions to healthcare provision globally and in Aotearoa New Zealand. It remains unclear how this disruption affected the surgical management of acute cholecystitis and whether there are ongoing impacts.MethodsWe conducted a secondary analysis of two multicentre cohort studies (CHOLECOVID and CHOLENZ) on patients who underwent cholecystectomy for acute cholecystitis. Participants were categorized into pre‐pandemic (September–November 2019), pandemic (March–May 2020), and late‐pandemic (August–October 2021) phases. Baseline demographics, clinical management, and 30‐day postoperative complications were assessed between phases. Multivariable logistic regression was used to explore the impact of timing of operation on rates of hospital readmission and postoperative complications.Results517 participants were included, of whom 85 (16%) were in the pre‐pandemic‐phase, 52 (10%) were in the pandemic phase, and 380 (73%) were in the late‐pandemic phase. Pandemic and late‐pandemic phase participants were more comorbid and had higher rates of obesity and deranged blood results than pre‐pandemic. After multivariable adjustment, there were no differences in rates of hospital readmission or postoperative complications at 30‐day follow‐up across phases.ConclusionThe COVID‐19 pandemic had minimal impacts on the provision of cholecystectomy for acute cholecystitis in Aotearoa New Zealand. However, patients managed during the COVID‐19 pandemic were more comorbid and had higher rates of obesity and elevated inflammatory markers.

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Socio-Economic Inequity: Diabetes in New Zealand

Cited by 19 publications

References 26 publications

Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand

Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand

It is time for a more targeted approach to prediabetes in primary care in Aotearoa New Zealand

Impact of the COVID‐19 pandemic on outcomes of cholecystectomy for acute cholecystitis: a national cohort study

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