To measure the association of income, education, occupational class, small area socio-economic de... more To measure the association of income, education, occupational class, small area socio-economic deprivation, car access and labour force status with mortality among 25-64 year old males and females using the 1991 census-cohort of the New Zealand Census-Mortality Study. Mortality records for 1991-94 were anonymously and probabilistically linked to 1991 census records, thereby creating a cohort study of all New Zealand census respondents. Odds ratios of mortality comparing categories of each socio-economic factor were calculated using logistic regression. For income, education and deprivation (NZDep91) a modified relative index of inequality (RII(10:90)) was calculated. The RII(10:90) estimates the relative risk of mortality for low socio-economic people (10th percentile rank) compared to high socio-economic people (90 percentile rank) allowing direct comparisons across socio-economic factors. The relative risk of all-cause mortality for 25-64 year old males with an equivalised househo...
To assess the preventability and clinical context of adverse events identified in New Zealand pub... more To assess the preventability and clinical context of adverse events identified in New Zealand public hospitals. Two-stage retrospective review of 6579 medical records randomly sampled from admissions for 1998 in 13 generalist hospitals providing acute care. Initial screening and medical review according to a standardised protocol. Eight hundred and fifty adverse events were identified, of which over one third (315) were preventable to a significant degree. Preventability of events increased with age of patient, and was more characteristic of certain diagnostic categories. Half of all events (413/850) were both preventable and occurred in hospital, giving an occurrence rate of 6.3%. This rate increased with patient age, as did impact on patients and extended stay. There were also variations by diagnostic category. Over half of the events were associated with surgery (489) and one third with medicine (303); operative incidents were predominant in the former, drug-related in the latter...
To describe the characteristics and workload of New Zealand general medical practitioners (GPs). ... more To describe the characteristics and workload of New Zealand general medical practitioners (GPs). Data were collected from a stratified random sample of GPs as part of the The National Primary Medical Care Survey carried out in 2001. Data were submitted by 244 practitioners; a 62% response rate. Women made up 63% of the GP workforce aged under 40 years, but only 19% of those aged over 50 years. New Zealand graduates made up 69% of GPs; graduates from other areas occupied particular niches in the GP workforce. Each week, GPs worked (on average) 4 days and saw 102 patients. Eighty percent undertook after-hours work, and the average on-call roster was 1-in-8. At least 8% of visits to GPs occurred after-hours. Parameters of workload were lower for women and for those working in community-owned clinics, and higher for those working outside cities. An increasing proportion of GPs are women, and more GPs are working part time. In addition, if the changes in primary healthcare add to GPs'...
OBJECTIVE. The objective of this study was to use volumetric MRI to study brain volumes in 10- to... more OBJECTIVE. The objective of this study was to use volumetric MRI to study brain volumes in 10- to 14-year-old children with and without intrauterine exposure to cocaine, alcohol, cigarettes, or marijuana.METHODS. Volumetric MRI was performed on 35 children (mean age: 12.3 years; 14 with intrauterine exposure to cocaine, 21 with no intrauterine exposure to cocaine) to determine the effect of prenatal drug exposure on volumes of cortical gray matter; white matter; subcortical gray matter; cerebrospinal fluid; and total parenchymal volume. Head circumference was also obtained. Analyses of each individual substance were adjusted for demographic characteristics and the remaining 3 prenatal substance exposures.RESULTS. Regression analyses adjusted for demographic characteristics showed that children with intrauterine exposure to cocaine had lower mean cortical gray matter and total parenchymal volumes and smaller mean head circumference than comparison children. After adjustment for other...
Australian and New Zealand Journal of Public Health, 2002
Objective: Social class mortality differences in New Zealand men aged 15-64 years have previously... more Objective: Social class mortality differences in New Zealand men aged 15-64 years have previously been examined for the periods 1975-77 and 1985-87 using the Elley-Irving social class scale. The objective was to repeat these analyses for 1995-97 in order to examine time trends, and to assess current social class patterns of mortality. Methods: Age-standardised mortality rates were calculated for each social class and a weighted estimate of the social class mortality gradient was obtained. Results: Male mortality declined 21% between 1985-87 and 1995-97, but the social class mortality differences have not diminished and may have even increased.
The assessment of patient encounters with general practitioners (GPs) at both rural and urban set... more The assessment of patient encounters with general practitioners (GPs) at both rural and urban settings is a remarkably under-researched area in New Zealand. Despite the importance of this information for the planning, funding and delivery of local health services and both undergraduate and postgraduate medical education, only a handful of studies have attempted to describe the nature and frequency of visits to general practices based in either urban or country areas.
Australian and New Zealand Journal of Public Health, 2004
W ith the growing international in terest in health inequalities, the issue of the measurement of... more W ith the growing international in terest in health inequalities, the issue of the measurement of socioeconomic position has become more salient. 1 While a range of indices is available, frequently the most practical measure in health settings is one based on occupation. One common approach is to view occupations as social groupings exhibiting both the material and non-material dimensions of socioeconomic stratification. A way of capturing this is to score occupations according to the educational and income characteristics of their incumbents. 2,3 On this model, the labour market is seen as central to socioeconomic inequality, with gender and ethnicity as important, but analytically independent, determinants of entry and progress. Hence, occupations are viewed as building blocks to broader socioeconomic strata characterised by distinct material and non-material profiles. An Australasian version of such an approach is the New Zealand Socioeconomic Index of Occupational Status (NZSEI). 4 The NZSEI-91 was developed from 1991 Census data on the
Though there is much agreement on the importance of the social determinants of health, debate con... more Though there is much agreement on the importance of the social determinants of health, debate continues on suitable empirically-based models to underpin efforts to tackle health and health care disparities. We demonstrate an approach that uses a dynamic micro-simulation model of the early life course, based on longitudinal data from a New Zealand cohort of children born in 1977, and counterfactual reasoning applied to a range of outcomes. The focus is on health service use with a comparison to outcomes in non-health domains, namely educational attainment and antisocial behaviour. We show an application of the model to test scenarios based on modifying key determinants and assessing the impact on putative outcomes. We found that appreciable improvement was only effected by modifying multiple determinants; structural determinants were relatively more important than intermediary ones as potential policy levers; there was a social gradient of effect; and interventions bestowed the greatest benefit to the most disadvantaged groups with a corresponding reduction in disparities between the worst-off and the best-off. Our findings provide evidence on how public policy initiatives might be more effective acting broadly across sectors and across social groups, and thus make a real difference to the most disadvantaged.
To measure the association of income, education, occupational class, small area socio-economic de... more To measure the association of income, education, occupational class, small area socio-economic deprivation, car access and labour force status with mortality among 25-64 year old males and females using the 1991 census-cohort of the New Zealand Census-Mortality Study. Mortality records for 1991-94 were anonymously and probabilistically linked to 1991 census records, thereby creating a cohort study of all New Zealand census respondents. Odds ratios of mortality comparing categories of each socio-economic factor were calculated using logistic regression. For income, education and deprivation (NZDep91) a modified relative index of inequality (RII(10:90)) was calculated. The RII(10:90) estimates the relative risk of mortality for low socio-economic people (10th percentile rank) compared to high socio-economic people (90 percentile rank) allowing direct comparisons across socio-economic factors. The relative risk of all-cause mortality for 25-64 year old males with an equivalised househo...
To assess the preventability and clinical context of adverse events identified in New Zealand pub... more To assess the preventability and clinical context of adverse events identified in New Zealand public hospitals. Two-stage retrospective review of 6579 medical records randomly sampled from admissions for 1998 in 13 generalist hospitals providing acute care. Initial screening and medical review according to a standardised protocol. Eight hundred and fifty adverse events were identified, of which over one third (315) were preventable to a significant degree. Preventability of events increased with age of patient, and was more characteristic of certain diagnostic categories. Half of all events (413/850) were both preventable and occurred in hospital, giving an occurrence rate of 6.3%. This rate increased with patient age, as did impact on patients and extended stay. There were also variations by diagnostic category. Over half of the events were associated with surgery (489) and one third with medicine (303); operative incidents were predominant in the former, drug-related in the latter...
To describe the characteristics and workload of New Zealand general medical practitioners (GPs). ... more To describe the characteristics and workload of New Zealand general medical practitioners (GPs). Data were collected from a stratified random sample of GPs as part of the The National Primary Medical Care Survey carried out in 2001. Data were submitted by 244 practitioners; a 62% response rate. Women made up 63% of the GP workforce aged under 40 years, but only 19% of those aged over 50 years. New Zealand graduates made up 69% of GPs; graduates from other areas occupied particular niches in the GP workforce. Each week, GPs worked (on average) 4 days and saw 102 patients. Eighty percent undertook after-hours work, and the average on-call roster was 1-in-8. At least 8% of visits to GPs occurred after-hours. Parameters of workload were lower for women and for those working in community-owned clinics, and higher for those working outside cities. An increasing proportion of GPs are women, and more GPs are working part time. In addition, if the changes in primary healthcare add to GPs'...
OBJECTIVE. The objective of this study was to use volumetric MRI to study brain volumes in 10- to... more OBJECTIVE. The objective of this study was to use volumetric MRI to study brain volumes in 10- to 14-year-old children with and without intrauterine exposure to cocaine, alcohol, cigarettes, or marijuana.METHODS. Volumetric MRI was performed on 35 children (mean age: 12.3 years; 14 with intrauterine exposure to cocaine, 21 with no intrauterine exposure to cocaine) to determine the effect of prenatal drug exposure on volumes of cortical gray matter; white matter; subcortical gray matter; cerebrospinal fluid; and total parenchymal volume. Head circumference was also obtained. Analyses of each individual substance were adjusted for demographic characteristics and the remaining 3 prenatal substance exposures.RESULTS. Regression analyses adjusted for demographic characteristics showed that children with intrauterine exposure to cocaine had lower mean cortical gray matter and total parenchymal volumes and smaller mean head circumference than comparison children. After adjustment for other...
Australian and New Zealand Journal of Public Health, 2002
Objective: Social class mortality differences in New Zealand men aged 15-64 years have previously... more Objective: Social class mortality differences in New Zealand men aged 15-64 years have previously been examined for the periods 1975-77 and 1985-87 using the Elley-Irving social class scale. The objective was to repeat these analyses for 1995-97 in order to examine time trends, and to assess current social class patterns of mortality. Methods: Age-standardised mortality rates were calculated for each social class and a weighted estimate of the social class mortality gradient was obtained. Results: Male mortality declined 21% between 1985-87 and 1995-97, but the social class mortality differences have not diminished and may have even increased.
The assessment of patient encounters with general practitioners (GPs) at both rural and urban set... more The assessment of patient encounters with general practitioners (GPs) at both rural and urban settings is a remarkably under-researched area in New Zealand. Despite the importance of this information for the planning, funding and delivery of local health services and both undergraduate and postgraduate medical education, only a handful of studies have attempted to describe the nature and frequency of visits to general practices based in either urban or country areas.
Australian and New Zealand Journal of Public Health, 2004
W ith the growing international in terest in health inequalities, the issue of the measurement of... more W ith the growing international in terest in health inequalities, the issue of the measurement of socioeconomic position has become more salient. 1 While a range of indices is available, frequently the most practical measure in health settings is one based on occupation. One common approach is to view occupations as social groupings exhibiting both the material and non-material dimensions of socioeconomic stratification. A way of capturing this is to score occupations according to the educational and income characteristics of their incumbents. 2,3 On this model, the labour market is seen as central to socioeconomic inequality, with gender and ethnicity as important, but analytically independent, determinants of entry and progress. Hence, occupations are viewed as building blocks to broader socioeconomic strata characterised by distinct material and non-material profiles. An Australasian version of such an approach is the New Zealand Socioeconomic Index of Occupational Status (NZSEI). 4 The NZSEI-91 was developed from 1991 Census data on the
Though there is much agreement on the importance of the social determinants of health, debate con... more Though there is much agreement on the importance of the social determinants of health, debate continues on suitable empirically-based models to underpin efforts to tackle health and health care disparities. We demonstrate an approach that uses a dynamic micro-simulation model of the early life course, based on longitudinal data from a New Zealand cohort of children born in 1977, and counterfactual reasoning applied to a range of outcomes. The focus is on health service use with a comparison to outcomes in non-health domains, namely educational attainment and antisocial behaviour. We show an application of the model to test scenarios based on modifying key determinants and assessing the impact on putative outcomes. We found that appreciable improvement was only effected by modifying multiple determinants; structural determinants were relatively more important than intermediary ones as potential policy levers; there was a social gradient of effect; and interventions bestowed the greatest benefit to the most disadvantaged groups with a corresponding reduction in disparities between the worst-off and the best-off. Our findings provide evidence on how public policy initiatives might be more effective acting broadly across sectors and across social groups, and thus make a real difference to the most disadvantaged.
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Papers by Peter Davis