5th October 2018, Volume 131 Number 1483

Nina Scott, Helen Clark, Bridget Kool, Shanthi Ameratunga, Grant Christey, Donna Cormack

Injury, as a leading cause of morbidity and mortality, contributes to health inequity in New Zealand and is a major socio-economic burden.1,2 Health inequities are defined as “differences which are…

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Summary

Eliminating unfair differences in life expectancy between Māori and non-Māori is something the New Zealand government has signed up to. Part of this involves fixing unwarranted variations in healthcare that exist across a range of pathways. For this, we need good-quality ethnicity data to figure out where healthcare needs improving. We found that one-quarter (24%) of trauma patients who self-identified as Māori were misclassified as New Zealand European. We did this by asking patients to self-identify their ethnicity using the census ethnicity question. This is important because hospital data is used for national planning and budgeting and we need good-quality ethnicity data to guide efforts to implement the necessary steps for achieving equity.

Abstract

Māori are disproportionately impacted by injury in New Zealand, therefore reliable ethnicity data are essential for measuring and addressing inequities in trauma incidence, care and outcomes.

Aim

To audit the quality of ethnicity data captured by the Waikato Hospital Trauma Registry and Waikato Hospital patient management system against self-identified ethnicity.

Method

Self-identified ethnicity using the New Zealand Census ethnicity question was gathered from 100 consecutive trauma patients and compared with ethnicity recorded in their Trauma Registry record and in the hospital’s patient management database.

Results

Twenty-nine (29%) participants self-identified as Māori, of whom six were classified as New Zealand European (NZE) only in the Trauma Registry and five as NZE on the hospital patient management database. Over half of Māori (n=18/29) reported more than one ethnicity compared with 4% (n=3/71) of non-Māori. Self-identified ethnicity matched Trauma Registry ethnicity for one quarter (n=7/29) of Māori versus 9% of non-Māori.

Conclusion

The degree of misclassification of Māori ethnicity data among patients in the Waikato Trauma Registry and the Waikato Hospital patient management system highlights a need for improvements to how ethnicity data is captured within these databases and potentially many other similar entities collecting ethnicity data in New Zealand. The release of revised standardised protocols for the collection of ethnicity data is timely given the recent establishment of a national trauma registry. Without quality data, the opportunity to investigate and address ethnic inequities in trauma incidence and management is greatly compromised.

Author Information

Nina Scott, Public Health Physician, Waikato District Health Board Hamilton;
Helen Clark, Medical Education Officer, Clinical Education and Training Unit; Waikato District Health Board, Hamilton; Bridget Kool, Senior Lecturer (Epidemiology and Biostatics), School of Population Health, The University of Auckland, Auckland; Shanthi Ameratunga, Professor of Epidemiology, School of Population Health, The University of Auckland, Auckland; Grant Christey, Trauma Director, Waikato District Health Board Hamilton; Donna Cormack, Senior Lecturer, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland. 

Correspondence

Nina Scott, Waikato Hospital, Pembroke Street, Private Bag 3200, Hamilton 3240.

Correspondence Email

nina.scott@waikatodhb.health.nz

Competing Interests

Dr Cormack reports grants from the Ministry of Health during the conduct of the study.

References

  1. Creamer G, Civil I, Ng A, Adams D, Cacala S, Koelmeyer T, et al. Ethnicity of severe trauma patients: results of a population based study, Auckland, New Zealand 2004. New Zealand Medical Journal 2010; 123(1316):1–7.
  2. Gulliver P, JC Simpson J. Fact Sheet 38: Injury as a leading cause of death and hospitalisation. Dunedin: Injury Prevention Research Unit, 2007.
  3. Whitehead M. The concepts and principles of equity and health. International Journal of Health Services 1992; 22(3):429–45.
  4. Robson B, Harris R. Hauora: Maori Standards of Health IV. A study of the years 2000–2005. Wellington: Te Ropu Rangahau a eru Pomare, 2007.
  5. Ameratunga S, Abel S, Tin Tin S, Asiasiga L, Milne S, Crengle S. Children admitted to hospital following unintentional injury: perspectives of health service providers in Aotearoa/New Zealand. BMC Health Services Research 2010; 10(333):1–9.
  6. Arlidge B, Abel S, Asiasiga L, Milne S, Crengle S, Ameratunga S. Experiences of whānau/families when injured children are admitted to hospital: a multi-ethnic qualitative study from Aotearoa/New Zealand. Ethnicity & Health. 2009; 14(2):169–83.
  7. Hosking J, Ameratunga S, Bramley D, Crengle S. Reducing ethnic disparities in the quality of trauma care: an important research gap. Annals of Surgery. 2011; 253(2):233–37.
  8. McNaughton H, McRae A, Green G, Abernethy G, Gommans J. Stroke rehabilitation services in New Zealand: a survey of service configuration, capacity and guideline adherence. New Zealand Medical Journal 2014; 127(1402).
  9. Scott N, Lawrenson R. Potential for health gain equity. New Zealand Medical Journal. 2015; 128(1415):10.
  10. Statistics New Zealand. Statistical Standard for Ethnicity 2005. Wellington: Statistics New Zealand, 2005.
  11. Ministry of Health. Ethnicity data protocols for the health and disability sector. Wellington: Ministry of Health, 2004.
  12. Ministry of Health. HISO 10001:2017 Ethnicity Data Protocols. Wellington, New Zealand: Ministry of Health, 2017.
  13. Cormack D, McLeod M. Improving and Maintaining Quality in Ethnicity Data Collection: Issues for the Health and Disability Sector. Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare, 2010.
  14. Kilgour R, Keefe V. Kia piki te ora: the collection of Māori health statistics. Wellington: Department of Health, 1992.
  15. Sandiford P, Salvetto M, Bramley D, Wong S, Johnson L. The effect of Māori ethnicity misclassification on cervical screening coverage. New Zealand Medical Journal 2013; 126(1372):55–65.
  16. Ministry of Health. Primary Care Ethnicity Data Audit Toolkit: A toolkit for assessing ethnicity data quality. Wellington: Ministry of Health, 2013.
  17. Midland Regional Trauma System. Midland Regional Trauma System Annual Report. 2013–2014. ISBN. 1-877296-25-2. Waikato: Waikato District Health Board, 2014.
  18. Robson B, Purdie G, Simmonds S, Waa A, Brownlee G, Rameka R. Waikato District Health Board Māori Health Profile 2015. Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare, 2015.
  19. Harris R, Curtis E, Robson B, et al. Disparities by Deprivation: understanding the relationship. A review of Maori:non-Maori disparities in caesarean sections. Wellington: Te Ropu Rangahau Hauora a Eru Pomare, 2003.
  20. Gulliver PJ, Cryer C, Langley JD, Davie DS. Identifying Māori ethnicity for estimating trends in fatal and serious non-fatal injury. Australian and New Zealand Journal of Public Health 2011; 35(4):352–56.
  21. Cormack D, Harris R. Issues in monitoring Māori health and ethnic disparities: an update. Wellington, New Zealand: Te Rōpū Rangahau Hauora a Eru Pōmare, 2009.
  22. Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health Equity: A Guide for Health Care Organizations. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement, 2016.

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