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Serious infectious diseases still on the increase in New Zealand because of rising social and ethnic inequalities

February 19, 2012

Infectious diseases are still the most common cause of hospital admission in New Zealand with hospitalisations due to serious infectious diseases increasing by more than 50% over the past 20 years, according to new research published Online First in The Lancet. Moreover, despite a well established government commitment to reducing inequalities, Māori and Pacific peoples are about twice as likely to end up in hospital with an infectious disease as citizens of other ethnic groups, and the risk is also much higher for individuals living in socially deprived areas.

"The increase in admissions is equivalent to an additional 17 000 hospital admissions per year compared with the expected incidence, had the proportion of admissions caused by infectious diseases in 1989 continued to the present", explains Michael Baker from the University of Otago, Wellington, New Zealand, lead author of the study. "In 2001, the New Zealand Ministry of Health presented a broad strategic plan for reducing the incidence and burden of infectious diseases. Our findings show an urgent need to revisit these strategies."

The researchers measured the burden of infectious diseases by tracking all hospital admissions for infectious and non-infectious diseases in New Zealand between 1989 and 2008, and analysed the distribution of diseases according to age, ethnic group, and socioeconomic status.

Infectious diseases made the largest contribution to hospital admissions of any cause, with the age-standardised rate of infectious diseases increasing substantially compared with non-infectious diseases over the 20 year study period (51.3% vs 7.3%).

The findings also revealed substantial increases in ethnic and social inequalities over the last two decades. The greatest increase in admissions was noted in Pacific peoples (age-standardised rate ratio 2.35) and Māori (2.15) compared with people from European and other ethnic groups, and in the most economically disadvantaged people (2.81) compared with the least deprived.

The researchers suggest that increasing incidence and rising inequalities are most likely the result of disparities in income, housing conditions, and access to health services. Baker states: "The increase in both ethnic and socioeconomic inequalities is of great concern, especially in a country that has a longstanding government and health-sector commitment to reducing such inequalities. Our findings suggest that prevention of infectious diseases is likely to be a particularly effective way to reduce ethnic health inequalities."

In an accompanying Comment, Stephen Lim and Ali Mokdad from the University of Washington, Seattle, USA say: "These findings challenge the epidemiological transition theory, whereby development is accompanied by a shift of health burden towards chronic diseases, and have enormous implications for health and social policy in New Zealand."

They add: "The health of indigenous New Zealanders has historically been poorer than the rest of the population, and these findings suggest that a rising burden of infectious diseases might lead to a widening of this gap. Urgent action must be taken to reverse this trend."
-end-
Dr Michael Baker, University of Otago, Wellington, New Zealand. T) 64-4-918-6802 Mobile) 64-21-355-056 E) michael.baker@otago.ac.nz

For Dr Stephen Lim, Institute for Health Metrics and Evaluation, please contact William Heisel T) 206-897-2886 / 206-612-0739 E) wheisel@uw.edu or Jill Oviatt T) 206-897-2862; 206-8616684 E) oviattj@uw.edu

Lancet

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