When screening is not enough.
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Abortion, Induced↗
Biomedical subjects
B Borman
Publications and source records attributed to B Borman.
Socio-demographic characteristics of New Zealand smokers: results from the 1996 census.
AIMS: To examine the key socio-demographic characteristics of adult smokers in New Zealand based on 1996 census data. METHODS: Data were obtained from the 1996 Census of Populations and Dwellings on smoking status and key socio-demographic variables. Age standardised smoking prevalence rates were calculated. RESULTS: Of the New Zealand population aged 15 years and over, 23.7% reported that they were regular smokers. Maori have the highest smoking prevalence in New Zealand (40.5%) and the peak rate is 55% among young Maori women aged 25-29 years. Pacific Island people, particularly males, have higher smoking rates than Europeans, while among Asians, the rate for males is three to four times the rate for females. People with no qualifications, who are unemployed or earning less than $30,000 per year, and women with high parities also have relatively high smoking prevalence rates. CONCLUSION: The smoking rates of New Zealand population groups are highly heterogeneous and there is substantial scope for focusing tobacco control interventions on those groups with the highest prevalence.
Adolescent↗
An assessment of spatial clustering of leukaemias and lymphomas among young people in New Zealand.
STUDY OBJECTIVE: To assess spatial clustering of childhood leukaemias and lymphomas in New Zealand, using a national dataset from a country with no nuclear installations. DESIGN: New Zealand Map Grid coordinates, derived from the birth addresses of cases and controls were used in clustering analyses that applied Cuzick and Edwards' method. SETTING: The whole of New Zealand. PARTICIPANTS: The cases were ascertained from the New Zealand Cancer Registry. They were diagnosed with leukaemia or lymphoma at ages 0-14 years during the period 1976 to 1987. For Hodgkin's disease, the age range was extended to include those aged from 0-24 years. The cancer registrations were linked with national birth records, to obtain the birth addresses of the cases. The controls were selected at random from birth records, with matching to cases (1:1) on age and sex. The analyses included 600 cases and 600 controls. MAIN RESULTS: There was no statistically significant spatial clustering for any tumour group overall, including acute lymphoblastic leukaemia, acute nonlymphoblastic leukaemia, other leukaemias, non-Hodgkin's lymphomas, Hodgkin's disease, and all these combined. Significant clustering was found in a sub-analysis for one of three age specific subgroups of acute lymphoblastic leukaemia (ages 10-14 years, p = 0.003). CONCLUSION: The subgroup finding may have been real or a chance association, as several comparisons were made. This study found little evidence for spatial clustering of leukaemias or lymphomas in a population with no nuclear installations.
Adolescent↗
The spectrum of congenital anomalies of the VATER association: an international study.
The spectrum of the VATER association has been debated ever since its description more than two decades ago. To assess the spectrum of congenital anomalies associated with VATER while minimizing the distortions due to small samples and referral patterns typical of clinical series, we studied infants with VATER association reported to the combined registry of infants with multiple congenital anomalies from 17 birth defects registries worldwide that are part of the International Clearinghouse for Birth Defects Monitoring Systems (ICB-DMS). Among approximately 10 million infants born from 1983 through 1991, the ICB-DMS registered 2,295 infants with 3 or more of 25 unrelated major congenital anomalies of unknown cause. Of these infants, 286 had the VATER association, defined as at least three of the five VATER anomalies (vertebral defects, anal atresia, esophageal atresia, renal defects, and radial-ray limb deficiency), when we expected 219 (P<0.001). Of these 286 infants, 51 had at least four VATER anomalies, and 8 had all five anomalies. We found that preaxial but not other limb anomalies were significantly associated with any combination of the four nonlimb VATER anomalies (P<0.001). Of the 286 infants with VATER association, 214 (74.8%) had additional defects. Genital defects, cardiovascular anomalies, and small intestinal atresias were positively associated with VATER association (P<0.001). Infants with VATER association that included both renal anomalies and anorectal atresia were significantly more likely to have genital defects. Finally, a subset of infants with VATER association also had defects described in other associations, including diaphragmatic defects, oral clefts, bladder exstrophy, omphalocele, and neural tube defects. These results offer evidence for the specificity of the VATER association, suggest the existence of distinct subsets within the association, and raise the question of a common pathway for patterns of VATER and other types of defects in at least a subset of infants with multiple congenital anomalies.
Abnormalities, Multiple↗
Breast cancer in New Zealand: trends, patterns, and data quality.
AIMS: To determine if incidence of cancer of the female breast in New Zealand is changing by age, ethnic group, and geographic region, and if there are differences in rates for stage of tumour by urban and rural residence. METHODS: Age-adjusted incidence rates for Maori and nonMaori were computed from all primary cancers of the breast registered in the National Cancer Registry, 1978-92. Analyses of time trends and geographic variations were conducted using standard statistical methods. RESULTS: There were steady, but nonsignificant, increases in the Maori and nonMaori incidence rates between 1978-92 which represents important increases in case numbers. The age-specific rates increased sharply from age 20, levelled out at age 45 and slowly increased through 85 years and older. There was a significant trend over time for the rate of "not staged" cases which was due to an artifact. No statistically significant variations in the age-adjusted rates by area (14 area health board districts, 4 regional health authorities), or by stage of tumour in three urban-rural groups were found. Maori women showed less shift in incidence rates from regional to local stage of tumour than nonMaori. The proportion of tumours reported without stage increased in the period 1988-92. A large proportion of cases had nonspecific morphology codes. CONCLUSIONS: There are small differences between rates of breast cancer in rural and urban residences in New Zealand, as compared to some other countries. The quality of the Cancer Registry as a basis for evaluating the planned breast cancer screening programme is adversely affected by the high proportion of cases found with no reported stage of tumour. The proportion of nonspecific morphologies in these data is also of concern. The recent passing of the Cancer Registry Act should ensure better reporting of morphologies.
Adult↗
Population mixing and the incidence of childhood leukaemias: retrospective comparison in rural areas of New Zealand.
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Adolescent↗
Trends in incidence rates of adenocarcinoma of the oesophagus and gastric cardia in New Zealand, 1978-1992.
BACKGROUND: Increasing incidence rates for adenocarcinomas of the oesophagus and gastric cardia have been reported from the United States, Denmark, United Kingdom, Switzerland, and Sweden. This paper reports on the incidence of adenocarcinomas of the oesophagus and gastric cardia in New Zealand in the Maori (Polynesian), and non-Maori (predominantly European) populations. METHODS: Incidence data from the National Cancer Registry for 1978 through 1992 were used to compute age-adjusted rates by sex, ethnic group, anatomic subsite, morphology, 14 area health districts, and for three periods: 1978-1982, 1983-1987 and 1988-1992. Statistical tests for significance of trends and differences in frequencies were employed. RESULTS: Incidence rates for adenocarcinoma of the oesophagus are increasing in non-Maori men and women, but at a lesser rate than that reported for the US. The rate of 2.3 per 100000 population (1988-1992) for non-Maori men is similar to the rate for US white men of 2.5 (1988-1990). Rates for adenocarcinoma of the gastric cardia in non-Maori men declined from 2.5 in 1983-1987 to 1.9 in 1988-1992, and were stable at 0.4 in non-Maori women. However, rates for cases with unspecified anatomic subsite fluctuated over the 15-year period and probably caused a deflation in rates in the most recent 5-year period. CONCLUSIONS: The incidence patterns of adenocarcinomas of the oesophagus and gastric cardia in New Zealand should be monitored over the next decade for confirmation of the trends observed here. There is need to review the quality of the data in the New Zealand registry.
Adenocarcinoma↗
Cervical cancer in New Zealand: national and regional trends.
AIMS: To assess the impact of past cervical screening on national and regional trends in mortality and incidence of cancer of the cervix uteri. METHODS: Age-specific mortality and incidence rates were calculated for the total female New Zealand population and the nonMaori populations of the regional health authorities. Analyses of the trends for different birth-cohorts and regions were conducted. RESULTS: Cervical cancer mortality rates for women born about 1919 to 1929 at older ages were lower than expected from their mortality at younger ages. Birth-cohorts born about 1939 to 1944 and 1954 to 1959 experienced some reduction in cervical cancer mortality at younger ages which may not have been sustained at older ages. No obvious effect of screening was present for generations of women born about 1949. Regional differences in trends in cervical cancer were observed. CONCLUSIONS: A reduction in cervical cancer mortality from cervical screening has occurred at different ages for some generations of New Zealand women but has not always been sustained as women age. Also, there is some evidence that the effect of screening has varied between regions within New Zealand.
Adult↗
Sex specific birthweight percentiles by gestational age for New Zealand.
AIM: To produce sex specific percentiles by gestational age for New Zealand infants. METHODS: Gestational age (completed weeks) and birthweight (10 g multiples) was obtained for all births in New Zealand in 1990 and 1991. Outliers were identified and removed, the data was normalised at each gestational age and percentiles produced. RESULTS: The percentile charts were produced for gestational ages 24 to 44 weeks by sex of infant. There was an approximate difference of 100 g between male and female birthweight at all gestational ages. DISCUSSION: These are the first national birthweight percentile charts for New Zealand. As they may vary over time we recommend they be updated every 5 years.
Biometry↗
Mortality and social class in Maori and nonMaori New Zealand men: changes between 1975-7 and 1985-7.
AIMS: Social class mortality differences in Maori and nonMaori New Zealand men aged 15-64 years have previously been examined for the period 1975-7. The analysis has now been repeated for the period 1985-7 in order to examine changes over time. METHODS: Numerator data were obtained from national death registrations and denominator data were obtained from the 1976 and 1986 censuses. These were used to calculate age-standardized death rates in Maori and nonMaori. RESULTS: Mortality declined by 28% in Maori and 14% in nonMaori between 1975-7 and 1985-7. The death rate for diseases amenable to medical intervention fell by 54% in Maori and 23% in nonMaori, but the Maori death rate was still 2.8 times the nonMaori death rate, whereas the relative risk for nonamenable causes was only 1.4. CONCLUSIONS: Some progress has been achieved in reducing ethnic differences in mortality in New Zealand men, but substantial differences remain for diseases which are amenable to medical intervention (including chronic rheumatic heart disease, hypertensive heart disease, and tuberculosis). It is likely that these differences reflect poor access to culturally safe and appropriate health care in Maori people.
Adolescent↗
Descriptive epidemiology of primary cancer of the brain, cranial nerves, and cranial meninges in New Zealand, 1948-88.
We used New Zealand data on occurrence of different types of brain cancer to investigate: (i) a possible secular increase which has been seen worldwide and has generated considerable debate; (ii) possibly higher rates among Maori; and (iii) possibly higher risks related to social class and occupation. Data from the NZ Cancer Registry on the 5,684 brain cancers diagnosed among NZ residents from 1948-88 were used to study the pattern of occurrence by gender, age, race, calendar year, social class, occupation, and histology. Age-standardized brain-cancer incidence rates per 100,000 more than doubled over the 41-year period (from 2.9 to 6.9 in males and from 2.1 to 5.1 in females). A strong trend of increasing incidence with increasing social class is seen in males (Ptrend = 0.01). Among Maori, the proportion of all brain cancer that is medulloblastoma is four times that among non-Maori, and the proportion of all brain cancers that lack histologic confirmation is about 40 percent higher. Elevated risks are seen among: dairy farmers (odds ratio [OR] = 3.4, 95 percent confidence interval [CI] = 1.9-6.0); sheep handlers (OR = 2.7, CI = 1.4-5.3); livestock workers (OR = 3.8, CI = 1.7-8.4); and farm managers (OR = 3.2, CI = 1.4-7.2); as well as among electrical engineers (OR = 8.2, CI = 20-34.7); electricians (OR = 4.6, CI = 1.7-12.2); and other electrical workers. Brain cancer rates in NZ have increased steadily since 1948, but this increase has leveled off in the most recent five-year period. Although brain cancer rates are likely to be underestimated among the Maori, an excess of medulloblastoma is evident in this group.
Adolescent↗
Social class differences in mortality from diseases amenable to medical intervention in New Zealand.
Social class differences in mortality from causes of death amenable to medical intervention were examined. All deaths in New Zealand males aged 15-64 years during the periods 1975-1977 and 1985-1987 were identified. Strong social class gradients in mortality from causes of death amenable to medical intervention were observed during both periods. Furthermore, social class inequalities were more pronounced for amenable causes of mortality than for non-amenable causes. However, a marked decline in the age-standardized mortality rate from amenable causes was observed, with the rate falling by 30% over the 10-year study period. This decline was twice as large as the drop in the non-amenable mortality rate. Despite the fall in the death rate from amenable causes, social class inequalities in mortality persisted among New Zealand men, with the lowest socioeconomic group experiencing a death rate from amenable causes of mortality that was 3.5 times higher than men in the highest socioeconomic group.
Adolescent↗
The prevalence of anencephalus and spina bifida in New Zealand.
Despite the plethora of epidemiological research conducted on anencephalus and spina bifida, few of the studies have used multiple source case ascertainment and controlled for the effect of possible confounding factors. This paper reports the results from a study of the relationships between various risk factors and the prevalence of anencephalus and spina bifida in New Zealand during 1978-82, using case data obtained from multiple sources and a national cohort of births as the denominator. The rates of anencephalus and spina bifida in New Zealand were 0.78/1000 and 0.94/1000 total births, respectively. The rate of a neural tube defect (NTD) birth for Maori parents was less than for their non-Maori counterparts. Paternal ethnic origin and maternal ethnic origin made similar contributions to the model of anencephalus rates, but the results suggest that paternal ethnic origin is a less important risk factor in the prevalence of spina bifida. The rate of both NTD was high among female infants and low among births to women born in countries other than the British Isles and New Zealand. The rate of anencephalus showed a distinct north-south gradient, but there was no evidence of effects for maternal or paternal age, parity, urban-rural place of residence, nuptiality, social class or season of birth in the prevalence of either NTD in New Zealand.
Adult↗
An area analysis of child injury morbidity in Auckland.
The geographical distribution of child injury morbidity in Auckland between 1982 and 1987 was examined. Analysis of total injury, pedestrian injury and vehicle occupant injury, with the census area unit as the basic spatial entity revealed distinct variations in child injury morbidity by census area unit. Morbidity rates were above average in parts of the central urban area and South Auckland and below average on the North Shore. Total injury morbidity and pedestrian injury morbidity rates were strongly correlated with census area unit unemployment rates, which were used as a measure of socio-economic deprivation. Geographical areas with high rates of child injury morbidity, to which injury prevention resources can be directed, were identified. In particular, the results suggest that injury prevention programmes should be targeted at socio-economically disadvantaged communities.
Accidents, Traffic↗
No association between fluoridation of water supplies and sudden infant death syndrome.
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Databases, Bibliographic↗
Undiminished social class mortality differences in New Zealand men.
Social class mortality differences in New Zealand men aged 15-64 years have previously been examined for the period 1975-7. It was found that the lower social classes had mortality rates higher than the upper social classes with the mortality rate of the lowest class being approximately twice that of the highest class on a six category scale. The greatest relative social class differences were in men aged less than 35 years. The analysis has now been repeated for the period 1985-7. Mortality declined by 15% between 1975-7 and 1985-7, but the social class mortality differences were undiminished, and the mortality slope was actually slightly greater in the more recent time period. The primary significance of social class analyses is that they identify groups in the community which have an excess mortality that is potentially preventable. The findings of this study indicate that this potential has not been fully realised in New Zealand, since social class differences are undiminished despite the continuing decline in overall mortality.
Adolescent↗
Domestic unintentional injuries presenting to the accident and emergency departments in the Wellington region.
A prospective descriptive study of domestic unintentional injuries attending accident and emergency (A & E) departments in the Wellington region is presented. In a three month period there were 2207 such attendances. There was no difference in the proportion of males and females seen. A disproportionate number of the very young (under five years of age) and the elderly (65 years and over) attended A & E departments for these injuries. Approximately one-quarter of the attendances were for cuts or lacerations (26.6%) and one-fifth were for fractures (18.0%). Crude estimates of distance indicate that, on average, people travel greater distances for fractures than for other injuries. General practitioners referred one-tenth (10.6%) of all the attendances. Outcomes from the A & E attendances were: 70.4% were discharged, 7.7% were admitted to hospital, 14.6% were referred to outpatient clinics, and 7.2% were referred back to their general practitioners. There were no deaths in A & E departments.
Accidents, Home↗