Bridget Robson

Bio: Bridget Robson is an academic researcher from University of Otago. The author has contributed to research in topics: Indigenous & Aotearoa. The author has an hindex of 23, co-authored 62 publications receiving 2274 citations.

Decades of disparity: widening ethnic mortality gaps from 1980 to 1999.

Abstract: Background Maori and Pacific deaths were severely undercounted in the mid-1980s and first half of 1990s, resulting in numerator-denominator bias when calculating mortality rates by ethnicity. We used the New Zealand Census-Mortality Study to adjust for this bias and calculate corrected ethnic-specific mortality rates from 1980 to 1999. Methods Age-specific adjusters were calculated for the period 1980–99. They were applied to mortality data to obtain a corrected number of deaths. Mortality rates (by age and gender) were calculated by dividing the total number of adjusted deaths by the respective census counts. Results Contrary to unadjusted rates, corrected Maori and Pacific mortality rates were clearly higher than non- Maori non-Pacific rates during the 1980s and early 1990s. From 1980–84 (1361 per 100,000 for males and 965 per 100,000 for females) to 1996–99 (1258 and 894), there was only a modest decrease in Maori 1 to 74 year old mortality rates. Pacific mortality rates changed little from 1980–84 (1264 and 672) to 1996–99 (1144 and 696 per 100,000 for males and females respectively). Non-Maori non-Pacific mortality rates, however, decreased by about 30% from 1980–84 (919 and 553) to 1996–99 (641 and 407 per 100,000 for males and females, respectively). Cancer (lung, prostate, breast, colorectal) mortality rates tended to increase over time among Maori compared to steadily decreasing among non-Maori non-Pacific. Of note, Pacific colorectal cancer mortality rates have increased by about ten-fold during the 1980s and 1990s. All ethnic groups experienced falls in cardiovascular disease mortality rates, but the decreases were much greater among non-Maori non-Pacific. Conclusion The gaps between Maori and non-Maori non-Pacific mortality widened over the 1980s and 1990s mainly due to steadily declining non-Maori non-Pacific mortality rates and stagnant Maori mortality rates. Likewise, the gaps between Pacific and non-Maori non-Pacific mortality also widened during that period. This paper presents Maori, Pacific, and non-Maori non-Pacific mortality rate trends during the 1980s and 1990s. The results presented in this paper, for the first time, correct for ‘undercounting of Maori and Pacific deaths’ and ‘modest overcounting of non-Maori non-Pacific deaths’ that occurred during that period. This so-called numerator-denominator bias for ethnicity recording between census and mortality data has been known about for some time. 1–4 However, it is only with the recent record linkage of census and mortality data in the New Zealand Census-Mortality Study (NZCMS) 5,6 that we can now accurately determine ethnic mortality trends.

Survival Disparities in Indigenous and Non-Indigenous New Zealanders with Colon Cancer: The Role of Patient Comorbidity, Treatment and Health Service Factors

Abstract: Background Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori (Indigenous) and nonMaori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed. Methods Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using KaplaneMeier survival curves and Cox hazards modelling with multivariable adjustment. Results 301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori (hazard ratio (HR)¼1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients (HR¼1.07, 95% CI 0.77 to 1.47). Conclusion Higher patient comorbidity and poorer access and quality of cancer care are both important explanations for worse survival in Maori compared with non-Maori New Zealanders with colon cancer.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Abstract: www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.