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Biomedical subjects

T Blakely

Publications and source records attributed to T Blakely.

At least 19 recordsLinked to original sources
PubMed2007

Cancer is overtaking cardiovascular disease as the main driver of socioeconomic inequalities in mortality: New Zealand (1981-99).

BACKGROUND: Relative socioeconomic disparities in cardiovascular mortality have increased in New Zealand, as in many Western countries in Northern Europe, the US and Australia during the late 20th century. However, substantial declines in cardiovascular mortality mean that its absolute contribution to overall mortality has decreased. RESEARCH QUESTIONS: How did the absolute contribution of major causes of death to socioeconomic inequalities in New Zealand change during the 1980s and 90s? METHODS: Linked census-mortality cohorts were used to calculate the contribution of different causes of death to inequalities in mortality, measured with the slope index of inequality, by household income. RESULTS: Between 1981-4 and 1996-9, the contribution of cardiovascular disease (CVD) to total inequality declined from 55% to 28% among women, whereas at the same time the contribution of cancers increased from 14% to 37%. Among men, the contribution of CVD to total inequality peaked at 47% in 1986-9, then declined to 38% in 1996-9. The contribution of cancer increased from 19% to 26% in men. CONCLUSION: CVD mortality has declined at all income levels and so too has the contribution of CVD to mortality inequalities. Concurrently, the contribution of cancer to inequalities in mortality by income has increased and, in women at least, is now greater than the contribution of CVD. It is hypothesised that a similar crossover is occurring in other populations where CVD mortality has declined, although socioeconomic differences in the distribution and effect of the obesity epidemic for CVD may ensure its continuing importance. Prevention efforts aimed at reducing socioeconomic inequalities in mortality will need to increasingly focus on socioeconomic inequalities in cancer mortality.

Adult↗
PubMed2005

Retrofitting houses with insulation to reduce health inequalities: aims and methods of a clustered, randomised community-based trial.

This paper describes the purpose and methods of a single-blinded, clustered and randomised trial of the health impacts of insulating existing houses. The key research question was whether this intervention increased the indoor temperature and lowered the relative humidity, energy consumption and mould growth in the houses, as well as improved the health and well-being of the occupants and thereby lowered their utilisation of health care. Households in which at least one person had symptoms of respiratory disease were recruited from seven predominantly low-income communities in New Zealand. These households were then randomised within communities to receive retrofitted insulation either during or after the study. Measures at baseline (2001) and follow-up (2002) included subjective measures of health, comfort and well-being and objective measures of house condition, temperature, relative humidity, mould (speciation and mass), endotoxin, beta glucans, house dust mite allergens, general practitioner and hospital visits, and energy or fuel usage. All measurements referred to the three coldest winter months, June, July and August. From the 1352 households that were initially recruited, baseline information was obtained from 1310 households and 4413 people. At follow-up, 3312 people and 1110 households remained, an 84% household retention rate and a 75% individual retention rate. Final outcome results will be reported in a subsequent paper. The study showed that large trials of complex environmental interventions can be conducted in a robust manner with high participation rates. Critical success factors are effective community involvement and an intervention that is valued by the participants.

Adolescent↗
PubMed2004

A multilevel analysis of socioeconomic (small area) differences in household food purchasing behaviour.

STUDY OBJECTIVE: To examine the association between area and individual level socioeconomic status (SES) and food purchasing behaviour. DESIGN: The sample comprised 1000 households and 50 small areas. Data were collected by face to face interview (66.4% response rate). SES was measured using a composite area index of disadvantage (mean 1026.8, SD = 95.2) and household income. Purchasing behaviour was scored as continuous indices ranging from 0 to 100 for three food types: fruits (mean 50.5, SD = 17.8), vegetables (61.8, 15.2), and grocery items (51.4, 17.6), with higher scores indicating purchasing patterns more consistent with dietary guideline recommendations. SETTING: Brisbane, Australia, 2000. PARTICIPANTS: Persons responsible for their household's food purchasing. MAIN RESULTS: Controlling for age, gender, and household income, a two standard deviation increase on the area SES measure was associated with a 2.01 unit increase on the fruit purchasing index (95% CI -0.49 to 4.50). The corresponding associations for vegetables and grocery foods were 0.60 (-1.36 to 2.56) and 0.94 (-1.35 to 3.23). Before controlling for household income, significant area level differences were found for each food, suggesting that clustering of household income within areas (a composition effect) accounted for the purchasing variability between them. CONCLUSIONS: Living in a socioeconomically advantaged area was associated with a tendency to purchase healthier food, however, the association was small in magnitude and the 95% CI for area SES included the null. Although urban areas in Brisbane are differentiated on the basis of their socioeconomic characteristics, it seems unlikely that where you live shapes your procurement of food over and above your personal characteristics.

Adult↗
PubMed2004

How much downside? Quantifying the relative harm from tobacco taxation.

OBJECTIVE: To estimate the loss of life expectancy attributable to tobacco taxation (via financial hardship and flow-on health effect) in New Zealand. DESIGN: Data were used on the gradients in life expectancy and smoking by neighbourhood socioeconomic deprivation and survey data on tobacco expenditure. Three estimates were modelled of the percentage of the crude association of neighbourhood deprivation with life expectancy that might be mediated via financial hardship: 100%, 50%, and 25% (best estimate). From this information the impact of tobacco taxation on life expectancy was estimated. MAIN RESULTS: For the total population, the estimated loss of life expectancy due to tobacco tax ranged from 0.005 years to 0.027 years. For people living in the most deprived 30% of neighbourhoods, the range was 0.009 to 0.044 years (that is, 3 to 16 days of lost life expectancy). For the total population the loss of life expectancy attributable to tobacco tax ranged from 119 to 460 times less than that attributable to deprivation. The loss of life expectancy attributable to tobacco tax was 42 to 257 times less than that attributable to smoking. CONCLUSIONS: The estimated harm to life expectancy from tobacco taxation (via financial hardship) is orders of magnitude smaller than the harm from smoking. Although the analyses involve a number of simplistic assumptions, this conclusion is likely to be robust. Policy makers should be reassured that tobacco taxation is likely to be achieving far more benefit than harm in the general population and in socioeconomically deprived populations.

Aged↗
PubMed2003

No association of income inequality with adult mortality within New Zealand: a multi-level study of 1.4 million 25-64 year olds.

STUDY OBJECTIVE: To determine the association of regional income inequality within New Zealand with mortality among 25-64 year olds. DESIGN: Individual census and mortality records were linked over the 1991-94 period. Income inequality (Gini coefficients) and average household income variables were calculated for 35 regions. "Individual level" variables were sex, age, ethnicity, household income, rurality, and small area socioeconomic deprivation. Logistic regression was used for the analyses. Sensitivity analyses for the level of regional aggregation were conducted. PARTICIPANTS: 1.4 million New Zealand census respondents aged 25-64 years followed up for mortality for three years. MAIN RESULTS: Controlling for age, ethnicity, rurality, household income, and regional mean income, there was no association of income inequality with all cause mortality for either men (OR=1.007 for a 0.01 increase in the Gini, 95% confidence intervals 0.989 to 1.024) or women (OR=1.004, 0. 983 to 1.026). By cause of death (cancer, cardiovascular disease, unintentional injury, and suicide) there was some suggestion of a positive association for female unintentional injury (OR=1.068, 0.952 to 1.198) and suicide (OR=1.087, 0.957 to 1.234) but the 95% confidence intervals all included 1.0. Failure to control for ethnicity at the individual level resulted in some association of increasing regional income inequality with increasing mortality risk. Using fewer (n=14) or more (n=73) regional divisions did not substantially change the findings. CONCLUSION: There is no convincing evidence of an association of income inequality within New Zealand with adult mortality. Previous ecological analyses within New Zealand suggesting an association of income inequality with mortality were confounded by ethnicity at the individual level. However, this study does not refute the possibility that income inequality at the national level affects health.

Adult↗
PubMed2001

What is chronic fatigue syndrome? Heterogeneity within an international multicentre study.

OBJECTIVE: We sought to compare the characteristics of patients presenting with chronic fatigue (CF) and related syndromes in eight international centres and to subclassify these subjects based on symptom profiles. The validity of the subclasses was then tested against clinical data. METHOD: Subjects with a clinical diagnosis of CF completed a 119-item self-report questionnaire to provide clinical symptom data and other information such as illness course and functional impairment. Subclasses were generated using a principal components-like analysis followed by latent profile analysis (LPA). RESULTS: 744 subjects returned complete data sets (mean age 40.8 years, mean length of illness 7.9 years, female to male ratio 3:1). Overall, the subjects had a high rate of reporting typical CF symptoms (fatigue, neuropsychological dysfunction, sleep disturbance). Using LPA, two subclasses were generated. Class one (68% sample) was characterized by: younger age, lower female to male ratio; shorter episode duration; less premorbid, current and familial psychiatric morbidity; and, less functional disability. Class two subjects (32%) had features more consistent with a somatoform illness. There was substantial variation in subclass prevalences between the study centres (Class two range 6-48%). CONCLUSIONS: Criteria-based approaches to the diagnosis of CF and related syndromes do not select a homogeneous patient group. While substratification of patients is essential for further aetiological and treatment research, the basis for allocating such subcategories remains controversial.

Adult↗
PubMed2000

Anonymous linkage of New Zealand mortality and Census data.

BACKGROUND: The New Zealand Census-Mortality Study (NZCMS) aims to investigate socio-economic mortality gradients in New Zealand, by anonymously linking Census and mortality records. OBJECTIVES: To describe the record linkage method, and to estimate the magnitude of bias in that linkage by demographic and socio-economic factors. METHODS: Anonymous 1991 Census records, and mortality records for decedents aged 0-74 years on Census night and dying in the three-year period 1991-94, were probabilistically linked using Automatch. Bias in the record linkage was determined by comparing the demographic and socio-economic profile of linked mortality records to unlinked mortality records. RESULTS: 31,635 of 41,310 (76.6%) mortality records were linked to one of 3,373,896 Census records. The percentage of mortality records linked to a Census record was lowest for 20-24 year old decedents (49.0%) and highest for 65-69 year old decedents (81.0%). By ethnic group, 63.4%, 57.7%, and 78.6% of Maori, Pacific, and decedents of other ethnic groups, respectively, were linked. Controlling for demographic factors, decedents from the most deprived decile of small areas were 8% less likely to be linked than decedents from the least deprived decile, and male decedents from the lowest occupational class were 6% less likely to be linked than decedents from the highest occupational class. CONCLUSION: The proportion and accuracy of mortality records linked was satisfactorily high. Future estimates of the relative risk of mortality by socio-economic status will be modestly under-estimated by 5-10%.

Adolescent↗
PubMed2000

Socioeconomic inequalities in health: how big is the problem and what can be done?

Socioeconomic factors shape the working day for many doctors in New Zealand. The occurrence and severity of most common conditions confronting doctors in day-to-day practice are linked to the socioeconomic conditions in which patients live and work. Poorer people are likely to have worse health than wealthier people; but it is also becoming clearer that it is not just the absolute level of poverty that affects people's health, but also the distribution of material resources in society. This article highlights important aspects of our current knowledge concerning the effects of socioeconomic factors on health, and makes practical suggestions for day-to-day practice. An essential first step is to identify and characterise the socioeconomic characteristics of patients. Information routinely collected by many general practitioners can be used to characterise the socioeconomic circumstances of individual patients and the practice population as a whole. Doctors can then take action at three levels to mitigate the risks associated with these socioeconomic factors: at a broad social level; at a community and practice level; and at an individual level.

Adolescent↗
PubMed1999

The 1996 pertussis epidemic in New Zealand: descriptive epidemiology.

AIM: To describe the 1996 pertussis epidemic. METHODS: Hospitalisation, notification and laboratory data were used to describe the 1996 pertussis epidemic and compare it with previous epidemics. RESULTS: The 1996 epidemic spanned 24 months. The crude hospitalisation rate from 1 June 1995 to 31 May 1997, was 10.1 per 100,000 person years, being highest for children aged six weeks to two months (42 to 90 days old inclusive; 1402 per 100,000). The 1996 epidemic involved more hospitalisations than the 1991 and 1986 epidemics, and a greater proportion for children under the age of one year (77%), compared to previous epidemics (60-70%). There were no deaths. Pertussis only became notifiable from 1 June 1996. The crude notification rate for the following twelve months was 19.8 per 100,000 (equivalent hospitalisation rate 6.7 per 100,000); children aged six weeks to two months of age had the highest notification rate (531 per 100,000; equivalent hospitalisation rate 1021 per 100,000). In 1996-97, children aged under 15 months accounted for 21% of notifications, but 82% of hospitalisations. Europeans tended to have higher rates of notifications than non-Europeans, but lower rates of hospitalisation. CONCLUSIONS: New Zealand continues to experience high rates of pertussis as a result of inadequate immunisation coverage. The increase in hospitalisations during the 1996 epidemic may reflect a real increase in the population-based incidence, or other changes (e.g. hospitalisation practice, increase in vulnerable children with poor access to primary care). Improved rates, accuracy and completeness of pertussis notifications will improve the ability of notification data to accurately describe future epidemics and estimate vaccine effectiveness. Further debate is required regarding the aims of pertussis immunisation; accelerating the timing of the first three doses and adding further doses of pertussis vaccine on the national immunisation schedule; and the role of acellular pertussis vaccines. In the meantime, the priority must be increasing on-time immunisation coverage.

Adolescent↗
PubMed1998

A measles epidemic controlled by immunisation.

AIM: In 1997, an immunisation campaign, using measles-mumps-rubella vaccine, was planned for children aged 2-10 years to prevent a measles epidemic predicted by mathematical modelling. The epidemic started before the campaign and is described here. METHOD: Measles hospitalisation, notification and laboratory data were combined. RESULTS: The epidemic started in April 1997 and was largely over by January 1998. No deaths were identified and only one hospitalisation was coded as measles encephalitis, compared to seven deaths and ten cases of measles encephalitis in the 1991 epidemic. For the 12 months from 1 March 1997 there were 2,169 (60 per 100,000) measles cases identified, 314 (9 per 100,000) of whom were hospitalised. Two-thirds of hospitalised cases were notified. The age-standardised measles incidence rates were 33, 34, and 174 per 100,000 for Europeans, Maori and Pacific people, respectively. The respective age-standardised hospitalisation rates were 4, 9 and 32 per 100,000. Measles incidence was highest for under one-year-olds (904 per 100,000) and low for 11-16 year-olds (27 per 100,000)--the cohort previously offered a second vaccine dose. Most cases were aged 10 years and under, and this group were the main drivers of virus transmission. CONCLUSIONS: The immunisation campaign prevented 90-95% of predicted cases. The campaign was appropriately targeted at children aged 10 years and under.

Adult↗
PubMed1998

The incidence of hepatocellular carcinoma in New Zealand.

AIM: To measure the incidence rate of hepatocellular carcinoma (HCC) in New Zealand, by ethnicity, sex, region and age. METHODS: Cancer Registry data for 1983-94 were used to calculate rates of primary liver cancer (ICD code 155.0) and HCC (both ICD code 155.0 and ICD-O morphology code 8170) directly standardised to Segi's world population and standardised for region. RESULTS: Rates of HCC per 100,000 person years 6.6 and 1.3 for Maori males and females, 14.7 and 4.6 for Pacific people, and 0.8 and 0.3 for Other (inclusive of Chinese). The rates for Chinese for 1989-94 were 19.9 and 5.8. These rates are likely to be underestimates due to imperfect sensitivity of ICD-O code 8170 registrations for HCC. The rates of HCC for Maori and Pacific people (sexes combined) were 7.3 and 18.0 times that for other for 1983-94; the HCC rate for Chinese was 25.8 times greater than Europeans for 1989-94. Rates of HCC tended to be higher in the north of New Zealand, compared to the south, for Maori and Other/Europeans, but there was no apparent regional gradient for Pacific people and Chinese. CONCLUSIONS: Non-Europeans have higher rates of HCC than Europeans due to variations in hepatitis B carriage. Males have higher rates than females, and Maori and Europeans living in the north of New Zealand have higher rates of HCC than those living in the south. It is estimated that any hepatitis B screening and follow-up programme will detect one incident case of HCC per year per 2000 hepatitis B carriers in the target population, or one incident case per 1000 carriers actually participating in regular follow-up.

Carcinoma, Hepatocellular↗
PubMed1998

Hepatitis B virus carrier prevalence in New Zealand: population estimates using the 1987 police and customs personnel survey.

AIM: To estimate the population hepatitis B surface antigen (HBsAg) carrier prevalence for adults in New Zealand. METHOD: Data for 1987 from the New Zealand Police Department and New Zealand Customs Department hepatitis B sero-marker survey were further analysed. The sample size was 5510 staff who had completed a questionnaire, had blood sera taken and were not already immunised against hepatitis B. RESULTS: Maori adults had a HBsAg carrier prevalence of 5.43% (95% confidence interval 3.07-8.81), Pacific adults 4.44% (1.65-9.42), and European adults 0.42% (0.26-0.65). Other ethnic minorities and people with two or more self-assigned ethnic identities had a carrier prevalence of 3.85% (1.06-9.56). There were non-significant differences in this study for carrier prevalence by sex, age and region. CONCLUSIONS: Policy formation on screening programmes for hepatitis B carriers should assume a HBsAg carrier prevalence of about 5% for Maori, Pacific people and ethnic minorities, and about 0.5% for New Zealanders of European extraction.

Adult↗