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Public Health IntelligenceMonitoring Report No. 4
Ministry of Health. 2006. Asian Health Chart Book 2006. Wellington: Ministry of Health.
Published in July 2006 by theMinistry of HealthPO Box 5013, Wellington, New Zealand
ISBN 0-478-29961-3 (Book)ISBN 0-478-29962-1 (Internet)HP 4250
This document is available on the Ministry of Healths website: HYPERLINK "http://www.moh.govt.nz" http://www.moh.govt.nz
Foreword
Asian peoples currently make up more than 6% of the New Zealand population, and this proportion is expected to increase to approximately 12% by 2021. It is therefore vitally important that the health of Asian New Zealanders is carefully monitored and the changing health needs of this population accurately assessed.
This Asian Health Chart Book 2006 is the first comprehensive review of Asian health, and the first to systematically examine inequalities between Asian ethnic groups and between migrant and established Asian communities.
The report adopts an indicator approach in order to focus attention on specific health issues of particular importance to Asian peoples. Information is presented on more than 80 indicators covering four domains: health status, health risk profile, social determinants of health, and patterns of health service utilisation.
Although trend information is not presented in this report (due to lack of reliable historical data), it will provide a baseline for periodic updating. Over time it will become possible to examine trends, assess progress in Asian health, and take corrective action as required.
Reducing inequalities in health whether between ethnic groups, social classes, genders or generations is a key goal of the New Zealand Health Strategy, released by the Minister of Health in December 2000. The information provided by this report and its future updates will contribute to the achievement of this goal.
Dr Don Matheson Professor Alistair Woodward
Deputy Director-General School of Population Health
Ministry of Health University of Auckland
Acknowledgements
This report is a joint collaboration between Public Health Intelligence (Ministry of Health), Auckland Regional Public Health Service, the Centre for Asian Health Research and Evaluation (University of Auckland), and the Asian Network Incorporated.
The report was written by Juthika Badkar, Martin Tobias and Jane Wang (Public Health Intelligence, Ministry of Health) with assistance from Kumanan Rasanathan (Auckland Regional Public Health Service), Samson Tse (University of Auckland), Janet Chen (Auckland Regional Public Health Service) and Vivian Cheung (the Asian Network Incorporated). The authors are grateful to Li-Chia Yeh, Kylie Mason, Ken Huang and Craig Wright (Public Health Intelligence, Ministry of Health) for statistical assistance, and to Niki Stefanogiannis and Barry Borman (Public Health Intelligence, Ministry of Health) for reviewing this report and providing useful feedback.
Contents
TOC \o "1-2" Foreword PAGEREF _Toc132688638 \h iii
Executive Summary PAGEREF _Toc132688639 \h xii
Section 1: Introduction PAGEREF _Toc132688644 \h 1
Who is Asian in New Zealand? PAGEREF _Toc132688645 \h 1
Is Asian a meaningful ethnic grouping? PAGEREF _Toc132688646 \h 2
Asian ethnic groups PAGEREF _Toc132688647 \h 3
Migration, health selection and acculturation PAGEREF _Toc132688648 \h 3
Demography of Asian New Zealanders PAGEREF _Toc132688649 \h 4
Structure of the report PAGEREF _Toc132688650 \h 6
Section 2: Methodology PAGEREF _Toc132688651 \h 7
Selection of indicators PAGEREF _Toc132688652 \h 7
Data sources PAGEREF _Toc132688653 \h 8
Statistical methods PAGEREF _Toc132688654 \h 9
Section 3: Health Outcomes PAGEREF _Toc132688655 \h 11
Whole of life PAGEREF _Toc132688656 \h 11
Infants and children (014 years) PAGEREF _Toc132688657 \h 23
Young people (1524 years) PAGEREF _Toc132688658 \h 31
Adults (25+ years) PAGEREF _Toc132688659 \h 37
Section 4: Health Services Utilisation PAGEREF _Toc132688660 \h 69
Primary health care services PAGEREF _Toc132688661 \h 69
Clinical preventive service use PAGEREF _Toc132688662 \h 74
Section 5: Risk and Protective Factors PAGEREF _Toc132688663 \h 83
Biological risk factors PAGEREF _Toc132688664 \h 83
Behavioural risk factors PAGEREF _Toc132688665 \h 89
Protective factors PAGEREF _Toc132688666 \h 95
Section 6: Socioeconomic Determinants of Health PAGEREF _Toc132688667 \h 99
Deprivation PAGEREF _Toc132688668 \h 99
English-language competence PAGEREF _Toc132688669 \h 102
Income PAGEREF _Toc132688670 \h 102
Unemployment PAGEREF _Toc132688671 \h 103
Education PAGEREF _Toc132688672 \h 103
Benefit receipt PAGEREF _Toc132688673 \h 103
Home ownership PAGEREF _Toc132688674 \h 104
Section 7: Conclusion PAGEREF _Toc132688675 \h 105
Appendices
Appendix 1: Classifications and Codes PAGEREF _Toc132688676 \h 108
Appendix 2: Population Pyramids PAGEREF _Toc132688677 \h 112
Appendix 3: Socioeconomic Indicators, by Duration of Residence in New Zealand PAGEREF _Toc132688678 \h 114
Appendix 4: Tables of Data PAGEREF _Toc132688679 \h 116
References and Further Reading PAGEREF _Toc132688680 \h 119
List of Tables
TOC \t "Table,3" Table I: Summary indicators, whole of life PAGEREF _Toc132688681 \h xiii
Table II: Summary indicators, infant and children PAGEREF _Toc132688682 \h xiv
Table III: Summary indicators, young people PAGEREF _Toc132688683 \h xv
Table IV: Summary indicators, adult PAGEREF _Toc132688684 \h xvi
Table V: Summary indicators, health service utilisation PAGEREF _Toc132688685 \h xvii
Table VI: Summary indicators, risk and protective factors PAGEREF _Toc132688686 \h xix
Table VII: Summary indicators, socioeconomic determinants PAGEREF _Toc132688687 \h xx
Table 1: Asian ethnic group distribution, 2001 PAGEREF _Toc132688688 \h 4
Table 2: Age and sex distribution of Asian groups, 2001, percent PAGEREF _Toc132688689 \h 4
Table 3: Crude rate (per 100,000) of avoidable mortality, by Asian ethnic group and sex, 19982002 PAGEREF _Toc132688690 \h 12
Table 4: Crude rate (per 100,000) of ambulatory-sensitive hospitalisations, by Asian ethnic group and sex, 19992003 PAGEREF _Toc132688691 \h 16
Table 5: Mean SF-36 scores by Asian ethnic group and sex (age-standardised), 2002/03 PAGEREF _Toc132688692 \h 17
Table 6: Crude rate (per 100,000) of all-age suicide mortality, by Asian ethnic group and sex, 19982002 PAGEREF _Toc132688693 \h 20
Table 7: Infant mortality rate (per 1000), by ethnic group, 19982002 PAGEREF _Toc132688694 \h 23
Table 8: Neonatal and post-neonatal mortality rate (per 1000), by ethnic group, 19982002 PAGEREF _Toc132688695 \h 24
Table 9: Rate (per 100) of low birthweight, by ethnic group, 19992003 PAGEREF _Toc132688696 \h 25
Table 10: Rate (per 100,000) of unintentional injury hospitalisations (04 years), by ethnic groups and sex, 19992003 PAGEREF _Toc132688697 \h 27
Table 11: Rate (per 100,000) of unintentional injury hospitalisations (514 years), by ethnic group and sex, 19992003 PAGEREF _Toc132688698 \h 28
Table 12: Rate (per 100,000) of asthma hospitalisations (514 years), by ethnic group and sex, 19992003 PAGEREF _Toc132688699 \h 29
Table 13: Rate (per 100,000) of intentional injuries hospitalisation (19992003) and suicide mortality (19982002), by ethnic group and sex, 1524 years PAGEREF _Toc132688700 \h 31
Table 14: Rate (per 100,000) of road traffic injury hospitalisations (19992003) and mortality (19982002), by ethnic group and sex, 1524 years PAGEREF _Toc132688701 \h 33
Table 15: Birth rate (per 1000), 1519 years, by ethnic group, 20022004 PAGEREF _Toc132688702 \h 35
Table 16: Age-specific rate (per 100,000) of cardiovascular disease hospitalisation (19992003) and mortality* (19982002), by ethnic group and sex PAGEREF _Toc132688703 \h 37
Table 17: Age-specific rate (per 100,000) for ischaemic heart disease hospitalisation (1999- 2003) and mortality* (19982002), by ethnic group and sex PAGEREF _Toc132688704 \h 42
Table 18: Age-specific rate (per 100,000) of stroke hospitalisation (19992003) and mortality (19982002), by ethnic group and sex PAGEREF _Toc132688705 \h 44
Table 19: Prevalence (per 100) of self-reported diabetes, by Asian ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688706 \h 47
Table 20: Age-specific rate (per 100,000) of all cancer registrations (19972001) and mortality (19982002), by ethnic group and sex PAGEREF _Toc132688707 \h 48
Table 21: Age-specific rate (per 100,000) of lung cancer registrations (19972001) and mortality (19982002), by ethnic group and sex PAGEREF _Toc132688708 \h 51
Table 22: Age-specific rate (per 100,000) of non-lung cancer registrations (19972001) and non-lung cancer mortality (19982002), by Asian ethnic group and sex PAGEREF _Toc132688709 \h 53
Table 23: Rate (per 100,000) of breast cancer registrations (19972001) and mortality (19982002), by Asian ethnic group PAGEREF _Toc132688710 \h 59
Table 24: Rate (per 100,000) of stomach cancer registrations (19972001) and mortality (19982002), by Asian ethnic group and sex PAGEREF _Toc132688711 \h 61
Table 25: Rate (per 100,000) of fall-related injury hospitalisations (19992003) and mortality (19982002), by ethnic group PAGEREF _Toc132688712 \h 63
Table 26: Prevalence (per 100) of self-reported primary care services, by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688713 \h 69
Table 27: Multivariate odds ratios having a usual carer, by duration of residence in New Zealand, 15+ years, 2002/03 PAGEREF _Toc132688714 \h 70
Table 28: Rate (per 100) of uptake of breast cancer screening (5064 years), by ethnic group, 2001/02 PAGEREF _Toc132688715 \h 74
Table 29: Crude rate (per 100) of uptake of cervical screening, by ethnic group, 20012003 PAGEREF _Toc132688716 \h 75
Table 30: Multivariate odds ratio of having a cervical smear, by duration of residence in New Zealand, 15+ years, 2002/03 PAGEREF _Toc132688717 \h 76
Table 31: Prevalence (per 100) of self-reported cardiovascular screening, by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688718 \h 76
Table 32: Prevalence (per 100) of self-reported high cholesterol and high blood pressure, by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688719 \h 83
Table 33: Multivariate odds ratios of having high blood cholesterol, by duration of residence in New Zealand, 15+ years, 2002/03 PAGEREF _Toc132688720 \h 84
Table 34: Multivariate odds ratios of having high blood pressure, by duration of residence in New Zealand, 15+ years, 2002/03 PAGEREF _Toc132688721 \h 85
Table 35: Classification of overweight or obese according to BMI (kg/m) PAGEREF _Toc132688722 \h 86
Table 36: Standard cut-point prevalence (per 100) of overweight and obesity, by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688723 \h 86
Table 37: Ethnic-specific cut-point prevalence (per 100) of overweight and obesity, by Asian ethnic groups and sex, 15+ years, 2002/03 PAGEREF _Toc132688724 \h 86
Table 38: Prevalence (per 100) of self-reported hazardous alcohol consumption, by Asian ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688725 \h 89
Table 39: Prevalence (per 100) of self-reported alcohol abstention, by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688726 \h 90
Table 40: Prevalence (per 100) of self-reported tobacco use, by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688727 \h 91
Table 41: Prevalence (per 100) of self-reported physical activity, by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688728 \h 95
Table 42: Prevalence (per 100) of self-reported fruit and vegetable consumption by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688729 \h 96
Table 43: English-language competence, by ethnic group and sex, 2001, percent PAGEREF _Toc132688730 \h 102
Table 44: Low income, by ethnic group and sex, 2001, percent PAGEREF _Toc132688731 \h 102
Table 45: Unemployment, by ethnic group and sex, 2001, percent PAGEREF _Toc132688732 \h 103
Table 46: School completion, by ethnic group and sex, 2001, percent PAGEREF _Toc132688733 \h 103
Table 47: Means-tested benefits, by ethnic group and sex, 2001, percent PAGEREF _Toc132688734 \h 103
Table 48: Home ownership, by ethnic group and sex, 2001, percent PAGEREF _Toc132688735 \h 104
Table A1-1: Ethnic composition of Statistics New Zealand Asian category PAGEREF _Toc132688736 \h 108
Table A1-2: WHO standard population PAGEREF _Toc132688737 \h 108
Table A1-3: ICD-9 codes used in this report PAGEREF _Toc132688738 \h 109
Table A1-4: Avoidable mortality ICD-9 codes PAGEREF _Toc132688739 \h 110
Table A1-5: Avoidable hospitalisation ICD-9 codes PAGEREF _Toc132688740 \h 111
Table A3-1: Chinese socioeconomic indicators, by duration of residence in New Zealand, 2001 PAGEREF _Toc132688741 \h 114
Table A3-2: Indian socioeconomic indicators, by duration of residence in New Zealand, 2001 PAGEREF _Toc132688742 \h 114
Table A3-3: Other Asian socioeconomic indicators, by length of time in New Zealand, 2001 PAGEREF _Toc132688743 \h 115
Table A4-1: Crude rate (per 100,000) of avoidable mortality, by duration of residence in New Zealand, Asian ethnic group and sex PAGEREF _Toc132688744 \h 116
Table A4-2: Age-standardised rate (per 100,000) of avoidable mortality, by duration of residence in New Zealand, Asian ethnic group and sex PAGEREF _Toc132688745 \h 116
Table A4-3: Age-standardised mean SF- 36 scores (Mental Health, Social Functioning scales and Vitality), by Asian ethnic groups and total New Zealand population and sex, 2003 PAGEREF _Toc132688746 \h 116
Crude rate (per 100,000) of t,duration of residence in New Zealand, Asian ethnic group and sex PAGEREF _Toc132688747 \h 117
Table A4-5: Age-standardised rate (per 100,000) of total cardiovascular disease mortality, byduration of residence in New Zealand, Asian ethnic group and sex PAGEREF _Toc132688748 \h 117
Table A4-6: Crude rate (per 100,000) of all cancer mortality, by duration of residence in New Zealand, Asian ethnic groups and sex PAGEREF _Toc132688749 \h 117
Table A4-7: Age-standardised rate (per 100,000) of all cancer mortality, by duration of residence in New Zealand, Asian ethnic group and sex PAGEREF _Toc132688750 \h 117
Table A4-8: Crude rate (per 100,000) of non-tobacco-related cancer mortality, by duration of residence in New Zealand, Asian ethnic group and sex PAGEREF _Toc132688751 \h 118
Table A4-9: Age-standardised rate (per 100,000) of non-tobacco-related cancer mortality, by duration of residence in New Zealand, Asian ethnic group and sex PAGEREF _Toc132688752 \h 118
Table A4-10: Age-standardised rate (per 100) of uptake of cervical screening, by Asian ethnic group PAGEREF _Toc132688753 \h 118
List of Figures
TOC \t "Figure,3" Figure 1: Chinese in New Zealand distribution by duration of residence, 2001 PAGEREF _Toc132688754 \h 5
Figure 2: Indians in New Zealand distribution by duration of residence, 2001 PAGEREF _Toc132688755 \h 5
Figure 3: Other Asians in New Zealand distribution by duration of residence, 2001 PAGEREF _Toc132688756 \h 6
Figure 4: Conceptual model of health information domains and their relationships PAGEREF _Toc132688757 \h 7
Figure 5: Order of presentation of indicators PAGEREF _Toc132688758 \h 8
Figure 6: Life expectancy at birth, by ethnic group and sex, 19992003 PAGEREF _Toc132688759 \h 11
Figure 7: Standardised rate ratios for avoidable mortality, by Asian ethnic group and sex, 19982002 PAGEREF _Toc132688760 \h 13
Figure 8: Age-standardised avoidable mortality rates (per 100,000) for Chinese, by duration of residence and sex, 19982002 PAGEREF _Toc132688761 \h 14
Figure 9: Age-standardised avoidable mortality rates (per 100,000) for Indians, by duration of residence and sex, 19982002 PAGEREF _Toc132688762 \h 15
Figure 10: Age-standardised avoidable mortality rates (per 100,000) for Other Asian by duration of residence and sex, 19982002 PAGEREF _Toc132688763 \h 15
Figure 11: Standardised rate ratios for ambulatory sensitive hospitalisations, by Asian ethnic group and sex, 19992003 PAGEREF _Toc132688764 \h 16
Figure 12: Mean SF-36 mental health scores, by ethnic group and sex (age-standardised), 2002/03 PAGEREF _Toc132688765 \h 18
Figure 13: Mean SF-36 social functioning scores, by ethnic group and sex (age-standardised), 2002/03 PAGEREF _Toc132688766 \h 18
Figure 14: Mean SF-36 vitality scores, by ethnic group and sex (age-standardised), 2002/03 PAGEREF _Toc132688767 \h 19
Figure 15: Standardised rate ratios for all-age suicide mortality, by Asian ethnic group and sex, 19982002 PAGEREF _Toc132688768 \h 20
Figure 16: Rate ratios for infant mortality, by Asian ethnic group, 19982002 PAGEREF _Toc132688769 \h 23
Figure 17: Rate ratios for neonatal mortality, by Asian ethnic group, 19982002 PAGEREF _Toc132688770 \h 24
Figure 18: Rate ratios for post-neonatal mortality, by Asian ethnic group, 19982002 PAGEREF _Toc132688771 \h 25
Figure 19: Rate ratios for low birthweight, by Asian ethnic group, 19992003 PAGEREF _Toc132688772 \h 26
Figure 20: Rate ratios for unintentional injury hospitalisations (04 years) by Asian ethnic group and sex, 19992003 PAGEREF _Toc132688773 \h 27
Figure 21: Standardised rate ratios for unintentional injury hospitalisations (514 years), by Asian ethnic group and sex, 19992003 PAGEREF _Toc132688774 \h 28
Figure 22: Standardised rate ratios for asthma hospitalisations (514 years), by Asian ethnic group and sex, 19992003 PAGEREF _Toc132688775 \h 29
Figure 23: Standardised rate ratios for intentional injuries hospitalisation (1524 years), by Asian ethnic group and sex, 19992003 PAGEREF _Toc132688776 \h 31
Figure 24: Standardised rate ratios for suicide mortality (1524 years), by Asian ethnic group and sex, 19982002 PAGEREF _Toc132688777 \h 32
Figure 25: Standardised rate ratios for road traffic injury hospitalisations (1524 years), by Asian ethnic group and sex, 19992003 PAGEREF _Toc132688778 \h 33
Figure 26: Standardised rate ratios for road traffic mortality (1524 years), by Asian ethnic group and sex, 19982002 PAGEREF _Toc132688779 \h 34
Figure 27: Standardised rate ratios for cardiovascular disease hospitalisation, by Asian ethnic group, age and sex, 19992003 PAGEREF _Toc132688780 \h 38
Figure 28: Standardised rate ratios for cardiovascular disease mortality, by Asian ethnic group, age and sex, 19982002 PAGEREF _Toc132688781 \h 39
Figure 29: Age-standardised rate (per 100,000) of cardiovascular disease mortality for Chinese, by duration of residence and sex, 25+ years, 19982002 PAGEREF _Toc132688782 \h 40
Figure 30: Age-standardised rate (per 100,000) of cardiovascular disease mortality for Indians, by duration of residence and sex, 25+ years, 19982002 PAGEREF _Toc132688783 \h 40
Figure 31: Age-standardised rate (per 100,000) of cardiovascular disease mortality for Other Asians, by duration of residence and sex, 25+ years, 19982002 PAGEREF _Toc132688784 \h 41
Figure 32: Standardised rate ratios for ischaemic heart disease hospitalisation, by Asian ethnic group, age and sex, 19992003 PAGEREF _Toc132688785 \h 42
Figure 33: Standardised rate ratios for ischaemic heart disease mortality, by Asian ethnic group, age and sex, 19982002 PAGEREF _Toc132688786 \h 43
Figure 34: Standardised rate ratios for stroke hospitalisation, by Asian ethnic group, age and sex, 19992003 PAGEREF _Toc132688787 \h 45
Figure 35: Standardised rate ratios for stroke mortality, by Asian ethnic group, age and sex, 19982002 PAGEREF _Toc132688788 \h 46
Figure 36: Standardised rate ratios for self-reported diabetes prevalence, by Asian ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688789 \h 47
Figure 37: Standardised rate ratios for all cancer registrations, by Asian ethnic group, age and sex, 19972001 PAGEREF _Toc132688790 \h 49
Figure 38: Standardised rate ratios for all cancer mortality, by Asian ethnic group, age and sex, 19982002 PAGEREF _Toc132688791 \h 50
Figure 39: Standardised rate ratios for lung cancer registrations, by Asian ethnic group and sex, 65+ years, 19972001 PAGEREF _Toc132688792 \h 51
Figure 40: Standardised rate ratios for lung cancer mortality, by Asian ethnic group and sex, 65+ years, 19982002 PAGEREF _Toc132688793 \h 52
Figure 41: Standardised rate ratios for all cancer registrations (excluding lung cancer), by Asian ethnic group, age and sex, 19972001 PAGEREF _Toc132688794 \h 53
Figure 42: Standardised rate ratios for all cancer mortality (excluding lung cancer), by Asian ethnic group, age and sex, 19982002 PAGEREF _Toc132688795 \h 54
Figure 43: Age-standardised rate (per 100,000) of all cancer mortality for Chinese, by duration of residence in New Zealand and sex, 25+ years, 19982002 PAGEREF _Toc132688796 \h 55
Figure 44: Age-standardised rate (per 100,000) of all cancer mortality for Indians, by duration of residence in New Zealand and sex, 25+ years, 19982002 PAGEREF _Toc132688797 \h 56
Figure 45: Age-standardised rate (per 100,000) of all cancer mortality for Other Asians, by duration of residence in New Zealand and sex, 25+ years, 19982002 PAGEREF _Toc132688798 \h 56
Figure 46: Age-standardised rate (per 100,000) of non-lung cancer mortality for Chinese, by duration of residence in New Zealand and sex, 25+ years, 19982002 PAGEREF _Toc132688799 \h 57
Figure 47: Age-standardised rate (per 100,000) of non-lung cancer mortality for Indians, by duration of residence in New Zealand and sex, 25+ years, 19982002 PAGEREF _Toc132688800 \h 58
Figure 48: Age-standardised rate (per 100,000) of non-lung cancer mortality for Other Asians, by duration of residence in New Zealand and sex, 25+ years, 19982002 PAGEREF _Toc132688801 \h 58
Figure 49: Standardised rate ratios for breast cancer registrations by Asian ethnic group, 45+ years, 19972001 PAGEREF _Toc132688802 \h 59
Figure 50: Standardised rate ratios for breast cancer mortality, by Asian ethnic group, 45+years, 19982002 PAGEREF _Toc132688803 \h 60
Figure 51: Standardised rate ratios for stomach cancer registrations, by Asian ethnic group and sex, 45+ years, 19972001 PAGEREF _Toc132688804 \h 61
Figure 52: Standardised rate ratios for stomach cancer mortality, by Asian ethnic group and sex, 45+ years, 19982002 PAGEREF _Toc132688805 \h 62
Figure 53: Standardised rate ratios for fall-related injury hospitalisations, by Asian ethnic group, 65+ years, 19992003 PAGEREF _Toc132688806 \h 63
Figure 54: Standardised rate ratios for falls injury mortality, by Asian ethnic group, 65+years, 19982002 PAGEREF _Toc132688807 \h 64
Figure 55: Multivariate odds ratio of having a usual carer, by ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688808 \h 70
Figure 56: Multivariate odds ratio of having been to a doctor in the last 12 months, by ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688809 \h 71
Figure 57: Multivariate odds ratio of having been to a dentist in the last 12 months, by ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688810 \h 72
Figure 58: Multivariate odds ratio of having seen a complementary/alternative provider in the last 12 months, by ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688811 \h 73
Figure 59: Multivariate odds ratio of having a mammogram, by ethnic group, 5064 years, 2002/03 PAGEREF _Toc132688812 \h 74
Figure 60: Multivariate odds ratio of having a cervical smear, by ethnic group, 20-69 years, 2002/03 PAGEREF _Toc132688813 \h 75
Figure 61: Multivariate odds ratio of having a blood pressure test, by ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688814 \h 77
Figure 62: Multivariate odds ratios of having a blood cholesterol test, by ethnic group, 15+years, 2002/03 PAGEREF _Toc132688815 \h 78
Figure 63: Standardised rate ratios for having a diabetes test in the last 12 months, by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688816 \h 79
Figure 65: Multivariate odds ratios of self-reporting high blood cholesterol, by Asian ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688817 \h 84
Figure 65: Multivariate odds ratios of self-reporting high blood pressure, by ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688818 \h 85
Figure 66: Standardised rate ratios for overweight (BMI 2324), by Asian ethnic group and sex, 15+ years, 2002/03 PAGEREF _Toc132688819 \h 87
Figure 67: Multivariate odds ratios for obesity (ethnic-specific cut-points), by ethnic group, 15+years, 2002/03 PAGEREF _Toc132688820 \h 88
Figure 68: Standardised rate ratios for hazardous drinking, by Asian ethnic group, 15+years, 2002/03 PAGEREF _Toc132688821 \h 89
Figure 69: Multivariate odds ratios of alcohol abstinence, by ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688822 \h 90
Figure 70: Multivariate odds ratio of current smoking in males, by ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688823 \h 91
Figure 71: Multivariate odds ratios of current smoking in females, by ethnic group, 15+years 2002/03 PAGEREF _Toc132688824 \h 92
Figure 72: Standardised rate ratios for ex-smokers, by Asian ethnic group and sex, 15+years, 2002/03 PAGEREF _Toc132688825 \h 93
Figure 73: Multivariate odds ratios of never smokers in males, by ethnic group, 15+ years, 2002/03 PAGEREF _Toc132688826 \h 94
Figure 74: Multivariate odds ratios of never smokers in females, by ethnic group, 15+years, 2002/03 PAGEREF _Toc132688827 \h 94
Figure 75: Standardised rate ratios for physical activity, by Asian ethnic group and sex, 15+years, 2002/03 PAGEREF _Toc132688828 \h 96
Figure 76: Multivariate odds ratios of consuming fruit and vegetables by ethnic group, 15+years, 2002/03 PAGEREF _Toc132688829 \h 97
Figure 77: NZDep2001 distribution of Asian ethnic groups, 2001, percent PAGEREF _Toc132688830 \h 99
Figure 78: Chinese NZDep2001 distribution, by duration of residence in New Zealand, 2001, percent PAGEREF _Toc132688831 \h 100
Figure 79: Indian NZDep2001 distribution, by duration of residence in New Zealand, 2001, percent PAGEREF _Toc132688832 \h 101
Figure 80: Other Asian NZDep2001 distribution, by duration of residence in New Zealand, 2001, percent PAGEREF _Toc132688833 \h 101
Figure A2-1: Age and sex distribution of Chinese people in New Zealand PAGEREF _Toc132688834 \h 112
Figure A2-2: Age and sex distribution of Indian people in New Zealand PAGEREF _Toc132688835 \h 112
Figure A2-3: Age and sex distribution of Other Asian people in New Zealand PAGEREF _Toc132688836 \h 113
Figure A2-4: Age and sex distribution of the total population in New Zealand PAGEREF _Toc132688837 \h 113
Executive Summary
Background
One of the goals of the New Zealand Health Strategy (Minister of Health 2000) is to monitor the health of all New Zealanders and monitor inequalities in health between ethnic groups. M u c h p r o g r e s s h a s b e e n m a d e o v e r t h e p a s t d e c a d e t o w a r d s m o n i t o r i n g t h e h e a l t h o f M o r i , P k e h a n d P a c i f i c e t h n i c g r o u p s , b u t l i t t l e h a s b e e n c o n d u c t e d f o r A s i a n p e o p l e s . T h i s r e p o r t i s i n t e n d e d t o a d d r e s s t h i s g a p b y c o l l a t i n g e x i s t i n g h e a l t h - r e l a t e d d ata for Asian peoples in New Zealand, thereby providing a barometer of the current health status of Asian New Zealanders as a baseline from which to monitor future trends.
The definition of Asian used in this report is that developed by Statistics New Zealand in 1996. This definition includes people with origins in the Asian continent, from Afghanistan in the west to Japan in the east, and from China in the north to Indonesia in the south.
Asian New Zealanders differ widely in areas such as language, culture and settlement history, which could affect their health needs. Chinese and Indians are the two largest Asian communities and also have long histories of settlement in New Zealand. As a result, this report presents data for three ethnic groups separately Chinese, Indian and Other Asian, stratified by duration of residence. By doing so, we aim to recognise the diversity that exits within the Asian population, and so avoid the pitfall of averaging.
Data sources and statistical methods
Data in this report were derived from multiple sources, including the New Zealand Health Information Service, New Zealand Cancer Registry, Statistics New Zealand, National Screening Unit and New Zealand Health Survey. The data relate mostly to 20012003; no historical data sufficiently robust for a time series were available.
Most of the indicators in this report are presented as crude rates and/or age-specific rates in tabular format. Direct age-standardised rates are used to enable summary comparisons between ethnic groups and the total New Zealand population (for this reason, the standardised rates themselves are generally not shown only the rate ratios). For most rates and rate ratios, 95% confidence intervals are provided. Logistic regression models have been constructed to examine the association between various health outcomes and Asian ethnicity, adjusting for multiple covariates including age, sex, deprivation and duration of residence in New Zealand.
Key results
The indictors selected in this report were based on the conventional criteria:
signal wider health concerns
focus on the most important health issues in each life stage
can be reliably and validly monitored
are modifiable through intervention.
Health outcomes
Whole of life
Four indicators were selected to capture health across whole of life: life expectancy, avoidable mortality, ambulatory-sensitive hospitalisations and mental health.
Table I: Summary indicators, whole of life
IndicatorsChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleLife expectancy at birth, 1999200384.7(83.985.5)88.0(87.388.8)78.4(77.279.6)82.2(81.183.4)N/aN/a75.9(75.876.0)80.9(80.881.0)Avoidable mortality,19982002CR, per 100,000123.6(109.5138.9)65.1(55.475.9)174.0(153.1196.8)93.3(78.2-110.5)137.1(119.6156.5)73.7(62.286.7)N/aN/aSRR0.5(0.40.6)0.5(0.40.6)0.9(0.81.0)0.8(0.71.0)0.9(0.81.0)0.7(0.60.9)1.01.0Ambulatory-sensitive hospitalisations19992003CR, per 100,0001207.1(1162.41253.1)1119.1(1077.91161.6)3734.5(3635.63835.3)2754.5(2669.32841.7)1734.8(1670.81800.7)1515.5(1461.61570.9)N/aN/aSRR0.4(0.40.4)0.4(0.40.4)1.3(1.31.3)1.1(1.11.1)0.7(0.70.7)0.7(0.70.7)1.01.0All age suicide mortality,19982002CR, per 100,0007.4(4.311.8)4.4(2.27.8)21.9(15.030.9)6.2(2.811.8)9.3(5.215.4)6.6(3.511.2)N/aN/aSRR0.3(0.20.6)0.6(0.31.3)1.0(0.61.6)0.8(0.41.9)0.4(0.20.8)1.1(0.52.5)1.01.0* SRR: Standardised rate ratio. The reference group (rate ratio = 1) is the total New Zealand population. CR: Crude rate.
Chinese have a much longer life expectancy at birth than the total New Zealand population.
Avoidable mortality is significantly lower for Chinese, Indian and Other Asian ethnic groups than for the total population.
The avoidable mortality rate worsens for Chinese New Zealanders who were born in New Zealand or have lived in New Zealand for longer periods.
Chinese and Other Asians have significantly lower ambulatory-sensitive hospitalisation rates than the total population, while Indians have a significantly higher rate.
Chinese and Other Asian males have significantly lower suicide mortality rates than that of the total population.
Infants and children (014 years)
The indicators used in this section include infant mortality, low birthweight, injury and asthma.
Table II: Summary indicators, infant and children
IndicatorsChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleInfant mortality, per 1000,199820022.5(1.63.7)4.7(3.26.7)3.2(2.04.8)5.7(5.45.9)Neonatal mortality, per 1000, 199820021.8(1.12.9)3.4(2.15.2)1.7(0.93)3.3(3.13.5)Post-neonatal mortality, per 1000, 199820020.7(0.31.5)1.2(0.52.5)1.5(0.72.6)2.4(2.22.5)Low birthweight, per 100,199920035.5(5.06.0)10.9(10.211.7)6.9(6.37.5)6.6(6.56.7)Unintentional injuries hospitalisation (04 years), per 100,000,199920031290.3(1119.31480.1)1123.0(961.91303.4)2216.7(1959.72498.1)1673.1(1446.01925.9)1867.9(1638.62120.4)1394.6(1199.41612.6)2762.7(2723.72802.1)2151.4(2116.22187.1)Unintentional injuries hospitalisation(514 years), per 100,000,19992003896.0(796.61004.3)663.8(576.2760.9)1477.9(1330.31637.3)906.4(789.81035.4)1529.7(1396.71672.0)827.5(727.5937.4)2357.0(2332.42381.9)1492.4(1472.31512.8)Asthma hospitalisation(514 years), per 100,000,19992003164.0(123.2214.0)125.7(89.4171.8)561.3(471.8662.7)233.9(176.7303.8)182.6(138.6236.0)70.4(43.5107.5)297.2(288.5306.1)235.0(227.1243.2)
Infant mortality is significantly lower in Chinese and Other Asian ethnic groups than in the total population.
Chinese and Other Asian infants have a significantly lower neonatal mortality rate than the total population.
Chinese infants also have a significantly lower post "n e o n a t a l m o r t a l i t y r a t e t h a n t h e N e w Z e a l a n d a v e r a g e .
L o w b i r t h w e i g h t i s s i g n i f i c a n t l y l e s s p r e v a l e n t a m o n g C h i n e s e n e w b o r n s t h a n t h e t o t a l p o p u l a t i o n , w h i l e I n d i a n n e w b o r n s a r e a t s i g n i f i c a n t l y h i g h e r r i s k o f l o w b i r t h w e i g h t t h a n t h e t o t a l p o p u l a t i o n ( u s ing the conventional cut-point of 2500grams).
Chinese, Indian and Other Asian children are less likely to be hospitalised for an unintentional injury than the total population.
Indian boys are 1.5 times more likely to be hospitalised for asthma than the total population, while Chinese and Other Asian children are significantly less likely to be hospitalised for this condition.
Young people (15--24 years)
The health indicators selected for young people include intentional self-harm and suicide, road traffic injury and fertility the major health problems faced by young people.
Table III: Summary indicators, young people
IndicatorsChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleIntentional injuries hospitalisation (1524 years), per 100,000, 1998200215.0(6.928.5)87.1(64.4-115.1)112.6(74.2163.8)334.3(267.0413.4)55.2(34.284.4)167.8(130.3212.8)109.9(104.2115.9)267.5(258.6276.7)Suicide mortality (1524 years), per 100,000,1998200213.3(5.826.3)5.3(1.115.6)50.0(25.987.4)19.7(6.445.9)13.1(4.330.7)14.8(5.432.2)34.9(31.738.3)12.3(10.414.4)Road traffic hospitalisation(1524 years), per 100,000, 19982002193.5(159.9232.1)142.1(112.7176.9)216.8(161.9284.3)114.1(76.4163.8)323.3(268.7385.8)264.1(216.4319.1)639.1(625.2653.1)324.7(314.8334.8)Road traffic mortality (1524 years), per 100,000,1998200220.0(10.335.0)16.0(7.330.4)25.0(9.254.4)39.4(22.165.0)14.8(5.432.2)38.1(34.841.7)14.8(12.817.1)Birth rate per 1000 female population (1519 years),20022004N/a5.4(4.46.6)N/a16.1(13.319.2)N/a11.5(9.813.5)N/a38.0(37.438.6)
Chinese and Other Asian youth have significantly lower intentional injury hospitalisation rates than the total population, while Indian female youth have a higher rate than the total population.
Chinese and Other Asian male youth have significantly lower suicide mortality rates than the total population.
Youth road traffic injury hospitalisation rates for all Asian ethnic groups are significantly lower than the all New Zealand average.
In the 15 to 19 years age group, Asian females have significantly lower birth rates than the total population.
Adults (25+ years)
The indicators selected for this section focus on the key health issues facing adults, including: cardiovascular diseases, diabetes, cancer and injuries from falls.
Table IV: Summary indicators, adult
IndicatorsChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleIHD hospitalisation (4564 years), per 100,000, 19992003433.8(374500.5)180.0(145.1220.8)4217.5(3976.24469.7)1256.0(1120.51403.4)895.7(776.21028.5)307.1(246.6377.9)1643.2(1625.61660.9)693.3(682.1704.7)IHD hospitalisation (65+ years), per 100,000, 199920031735.7(1522.61970.2)1239.8(1066.71433.1)8264.3(7491.89094.8)5031.4(4459.35656.6)3719.0(3118.14401.9)1798.6(14502205.9)4547.3(4505.24589.7)2859.4(28302889.1)IHD mortality(4564 years), per 100,000, 1998200269.2(46.798.8)185.0(137.3243.9)48.3(25.084.4)89.1(54.4137.6)17.3(5.640.3)158.6(153.1164.1)45.1(42.248)IHD mortality(65+ years), per 100,000, 19982002406.7(307.2528.1)365.9(274.8477.4)1380.7(1076.31744.4)916.4(682.41205.0)826.4(557.61179.8)567.0(379.7814.2)1401.5(1378.21425.2)1061.2(1043.31079.3)Stroke hospitalisation (65+ years), per 100,000, 199920031002.2(842.01184.0)948.5(797.91119.3)1814.6(1462.82225.4)1725.1(1397.32106.6)1432.5(1069.91878.5)1407.6(1101.41772.7)1587.5(1562.61612.6)1337.9(1317.81358.2)Stroke mortality(65+ years), per 100,000, 19982002377.6(282.0495.2)426.8(328.0546.1)473.4(303.3704.3)413.3(262.0620.1)220.4(95.1434.2)469.2(300.6698.1)480.5(466.9494.4)622.6(608.9636.5)Diabetes (self-reported) 15+ years, 2002/03CR, per 1003.4(0.66.3)9.4(3.915)5.7(1.89.6)N/aSRR1.4(0.32.5)3.3(1.64.9)1.8(0.33.2)1.0All cancer registrations (4564 years), per 100,000, 19972001270.0(223.3323.6)266.1(223.3314.8)185.0(137.3243.9)310.0(244.6387.4)343.1(270.8428.9)414.1(343.3495.1)652.4(641.3663.6)701.8(690.5713.3)All cancer registrations (65+ years) per 100,000, 199720011060.3(895.31246.9)806.2(667.9964.8)1104.5(834.41434.3)700.8(498.3958)2011.0(1576.32528.6)1446.7(11361816.2)3047.6(3013.13082.3)1685.6(16631708.4)All cancer mortality (4564 years), per 100,000,19982002106.1(77.7-141.6)82.2(59.2111.1)81.4(51.0123.2)100.6(65.1148.6)129.2(86.5185.6)120.8(84.1168)239.3(232.6246.1)228.7(222.3235.3)All cancer mortality (65+ years), per 100,000,19982002631.8(506.1779.3)460.7(357.8584.1)631.2(431.7891.0)521.1(349.0748.4)1239.7(904.21658.8)782.0(558.71064.9)1524.2(1499.91548.9)987.2(969.91004.7)Breast cancer registrations (45+ years), per 100,000, 19972001N/a100.2(77.5127.5)N/a161.2(119.2213.1)N/a173.0(131.7223.2)N/a292.7(286.9298.5)Breast cancer mortality (45+ years), per 100,000,19972001N/a21.3(11.635.7)N/a29.6(13.556.2)N/a41.1(22.468.9)N/a84.5(81.487.7)Notes: CVD: cardiovascular disease; IHD: ischaemic heart disease; CR: crude rate; SRR: standardised rate ratio.
The reference group (rate ratio = 1) is the total New Zealand population.
Indian males and females have significantly higher cardiovascular disease hospitalisation and mortality rates than the total population.
There is a dose-response relationship between duration of residence in New Zealand and cardiovascular disease mortality for the Asian ethnicity groups.
Ischaemic heart disease hospitalisation is significantly higher for Indian males and females across all age groups than the total population.
Ischaemic heart disease mortality is significantly higher in Indian females than in their Chinese and Other Asian counterparts.
Overall, stroke hospitalisation and mortality are lower for Chinese than for the total population, while Indian and Other Asian have higher stroke hospitalisation than the total population.
The prevalence of self-reported diabetes is over three times higher for Indian people than for the total population.
Overall, cancer registrations and mortality rates are lower for all Asian ethnic groups than for the total population. This applies both to lung cancer (a proxy for tobacco-attributable cancers) and non-lung cancer.
Female breast cancer registrations and mortality are lower for all Asian ethnic groups than for the total population.
Stomach cancer registrations are higher for Chinese females and Other Asian males than for the total population.
Health services utilisation
The indicators in this section focus on utilisation of primary health care and clinical preventive services.
Table V: Summary indicators, health service utilisation
IndicatorsChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleUsual care, 15+ years, per 100, 2002/0357.0(45.368.7)80.6(73.987.3)84.9(77.892.1)84.0(75.292.8)84.4(75.193.8)85.2(75.894.5)N/aN/aBeen to the doctor, 15+ years, per 100, 2002/0348.8(39.158.4)70.3(62.777.8)73.6(63.184.1)74.5(64.184.9)66.0(54.977.1)70.6(60.281.1)N/aN/aBeen to the dentist, 15+ years, per 100, 2002/0317.0(10.523.5)21.9(15.528.2)23.5(10.736.4)32.5(20.444.5)32.9(21.943.9)25.6(16.434.9)N/aN/aComplementary/alternative provider use, 15+years, per 100, 2002/038.2(3.513)19.9(13.426.5)8.3(2.713.9)9.6(3.216.1)6.9(1.312.6)12.0(5.418.5)N/aN/aMammography, 5064 years, per 100, 2001/02N/a57.0(55.258.9)N/a57.5(54.960.3)N/a56.4(53.859.1)N/a66.8(66.467.1)Cervical screening, 2069 years, per 100,20012003N/a52.5(51.753.2)N/a64.6(63.465.7)N/a44.6(43.845.4)N/a73.0(72.673.1)Blood pressure test, 15+ years, per 100, 2002/0333.6(22.544.7)38.8(30.746.9)45.1(32.357.9)49.3(37.561.2)30.4(19.241.7)37.1(25.948.2)N/aN/aCholesterol test, 15+ years, per 100, 2002/0318.7(9.328.1)19.3(12.925.7)36.5(23.849.1)25.7(14.537)26.7(16.137.3)18.3(8.728)N/aN/aDiabetes test, 15+ years, per 100, 2002/0317.0(8.925.2)19.5(13.125.8)39.4(25.952.9)28.8(18.039.7)14.6(7.122.2)17.6(8.326.9)N/aN/a
Among the Asian ethnic groups, Chinese are less likely than New Zealand Europeans to have a usual carer (after controlling for age, sex, deprivation and duration of residence in New Zealand).
All Asian ethnic groups are significantly less likely to have been to a doctor or a dentist in the last 12 months than New Zealand Europeans (after controlling for age, sex and deprivation).
All Asian ethnic groups are less likely to have seen a complementary/alternative provider than the New Zealand Europeans (after controlling for age and deprivation).
Women of all Asian ethnic groups have lower mammography screening uptake than New Zealand European women, but the differences are not statistically significant (perhaps reflecting relatively small numbers).
All of the Asian ethnic groups have a lower rate of cervical screening than New Zealand European women.
Indians are more likely to have had a cholesterol test than New Zealand Europeans.
Indians are also more likely to report having been tested for diabetes than the total population.
Risk and protective factors
The indicators selected in this section focus on key biological risk factors and key lifestyle behaviours, including: high blood cholesterol, high blood pressure, body weight, physical activity, dietary pattern and tobacco use.
Table VI: Summary indicators, risk and protective factors
IndicatorsChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleHigh blood cholesterol, 15+ years, 2002/03CR per 1007.7(2.213.1)9.4(3.815.1)19.2(929.4)10.2(3.117.2)8.9(2.915)7.1(0.613.7)MOR1.06(0.6, 1.88)1.74(0.95, 3.2)0.98(0.48, 2)High blood pressure, 15+ years, 2002/03CR per 1008.5(2.814.1)7.0(2.311.7)19.3(9.429.2)9.4(2.216.6)6.4(1.511.3)10.5(3.118)MOR0.62(0.32, 1.22)1.03(0.57, 1.88)0.72(0.38, 1.35)Obese (BMI ( 25*) 15+years, 2002/03CR per 10020.1(12.128.1)10.5(6.015.1)34.2 (22.246.2)52.9(41.4 64.3)32.7(20.3 45.1)19.3(10.7 27.9)MOR1.08(0.69, 1.68)4.12(2.65, 6.41)2.04(1.25, 3.33)Hazardous drinking(audit score > 8), 15+years, 2002/03CR per 1002.3(0.14.5)6.8(2.011.5)5.4(1.49.4)SRR0.1(0, 0.2)0.3(0.1, 0.5)0.3(0.1, 0.5)Current smoker (daily), 15+ years, 2002/03CR per 10020.4(12.528.2)7.0(2.411.6)18.4(9.727)20.7(11.629.8)3.9(1.26.6)MOR0.98(0.53, 1.8)0.3(0.13, 0.66)0.7(0.36, 1.35)0.1(0.03, 0.38)0.98(0.52, 1.86)0.2(0.06, 0.4)Physical activity (150minutes/week), 15+years, 2002/03Per 10066.7(58.375.0)50.5(40.960.2)68.8(59.478.3)58.0(47.169.0)72.9(62.083.7)46.4(35.857.0)SRR0.9(0.8, 1)0.7(0.6, 0.9)0.8(0.7, 0.9)0.9(0.7, 1.1)0.9(0.8, 1.1)0.7(0.5, 0.8)5+ a day fruits + vegetables 15+ years, 2002/03CR per 10025.9(16.435.4)39.8(29.250.5)21.2(12.130.2)23.0(13.132.9)22.5(11.833.1)36.7(24.748.6)MOR0.77(0.5, 1.1)0.43(0.3, 0.7)0.68(0.4, 1.1)* Ethnic-specific cut-point. CR: Crude rate. SRR: Standardised rate ratio. The reference group (rate ratio = 1) is the total New Zealand population. MOR: Multivariate odd ratios, model 2, controls for age, sex, deprivation and duration of residence. The reference group (odds ratios=1) is the New Zealand European population.
After controlling for age, sex, deprivation and Asian ethnicity, longer duration of residence of Asian New Zealanders is significantly related to the likelihood of self-reporting high blood cholesterol and high blood pressure.
Indians appear to have a higher prevalence of obesity than New Zealand Europeans after controlling for age, sex and deprivation.
Chinese, followed by Other Asian and Indian ethnic groups, have a significantly lower prevalence of hazardous alcohol consumption than the total population.
All Asian females are significantly less likely to be current smokers than European females (controlling for age, deprivation and duration of residence in New Zealand).
Chinese and Other Asian females are significantly less likely to participate in at least 150 minutes of physical activity per week than their total population counterparts.
Indians and Other Asians appear less likely to consume the recommended intake of fruit and vegetables than Europeans (controlling for age, sex and deprivation).
Socioeconomic determinants
Table VII: Summary indicators, socioeconomic determinants
IndicatorsChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleEnglish language, percent, 200179.376.891.288.079.979.293.593.6Income $20,000 or less, 15+ years, percent, 200159.865.842.856.652.961.137.955.2Unemployment, 15+ years, percent, 20017.46.27.97.98.67.25.04.76th form certificate or higher, 15+ years, percent, 200173.673.070.165.369.970.449.348.1Home ownership, 15+ years, percent, 200136.839.437.937.725.732.049.952.2
Asian New Zealanders are more likely to have higher educational qualifications than the all New Zealand average.
Incomes of Asian New Zealanders are lower than those of the total population.
Overall, the unemployment rate of Asian New Zealanders is higher than the all New Zealand average.
Asian New Zealanders are less likely than average to own their own homes.
English-language competence is an issue for some Chinese and Other Asians, but generally not for Indians.
The deprivation distribution of Asian New Zealanders does not differ substantively from that of the population as a whole.
Conclusion
This report reveals major differences in health outcomes and exposure to health hazards between the Chinese and Indian ethnic groups, with Other Asians generally intermediate. Positive health outcomes are shown in a range of health indicators for the Asian ethnic groups, especially the Chinese ethnic group, compared to the total New Zealand population. On the other hand, the relatively high rate of obesity, type 2 diabetes and cardiovascular disease among the Indian ethnic group is concerning.
The report also reveals major differences in health and health service use between recent migrants and established communities, similar for all three Asian ethnic groups. For almost all health indicators, recent or first-generation migrants do better than longstanding migrants or the New Zealand born. This is believed to largely reflect a healthy migrant effect (ie, health selection). Over time, this health advantage is likely to dissipate, as the selection effect wears off and acculturation progresses. The relatively low utilisation of health services by Asian peoples, particularly recent migrants, will need to be carefully monitored.
The information contained in this report will be used by the health sector to help identify the health needs of Asian peoples in New Zealand. It may also help to inform Asian communities themselves, so that they can actively engage in debating their health needs and health service requirements. This report is a starting point. It provides a baseline for Asian health in New Zealand and will require regular updating.
Section 1: Introduction
Under the Health Act 1956, the Ministry of Health is charged with a statutory obligation to monitor the health of all New Zealanders. The New Zealand Health Strategy ADDIN EN.CITE Health2000336Ministry of HealthThe New Zealand Health Strategy2000WellingtonMinistry of Health(Minister of Health 2000) adds to this obligation the goal of monitoring (and reducing) inequalities in health between ethnic groups. M u c h p r o g r e s s h a s b e e n m a d e o v e r t h e p a s t d e c a d e t o w a r d s m o n i t o r i n g t h e h e a l t h o f M o r i , P k e h a n d P a c i f i c e t h n i c g r o u p s ( M i n i s t r y o f H e a l t h 2 0 0 4 a ; M i n i s t r y o f H e a l t h 2 0 0 4 b ) . H o w e v e r , u n t i l n o w , l i t t l e m o n i t o r i n g o f t h e h e a l t h s t a t u s o f A s i a n N e w Z e a l a n d ers has been possible.
This report, the Asian Health Chart Book 2006, is intended to address this gap by collating existing health-related data for Asian peoples in New Zealand, drawn largely from Statistics New Zealand, the New Zealand Health Information Service and the 2002/03 New Zealand Health Survey. The report is intended for use by both providers and consumers of health services, and in particular to inform Asian communities themselves. It provides a barometer of the current status of the health of Asian New Zealanders as a baseline from which to monitor future trends.
Who is Asian in New Zealand?
The definition of Asian used in this report is that developed by Statistics New Zealand (SNZ) in 1996 (Statistics New Zealand 1996). Because this definition is employed for the analysis of census data, most state sector and health sector data users have fallen into line with it.
The SNZ definition includes people with origins in the Asian continent from Afghanistan in the west to Japan in the east, and from China in the north to Indonesia in the south. A full listing of the classification can be found in Appendix 1 (Table A-1.1). It excludes people originating from the Middle East (including Iran and Iraq), Central Asia (except Afghanistan) and Asian Russia; accordingly, these ethnic groups are excluded from this report.
The SNZ definition of Asian is unique to New Zealand ADDIN EN.CITE Rasanathan2004141410Rasanathan, K., Craig, D., & Perkins, R. Is "Asian" a useful category for health research in New Zealand?, in S. Tse, A. Thapliyal, S. Garg, G. Lim & M. Chatterji (Eds.), Proceedings of the inaugural international Asian health conference: Asian health and wellbeing, now and into the future8-172004AucklandUniversity of Auckland(Rasanathan et al 2004) and does not correspond to definitions used in other Western countries such as the United Kingdom or Australia. Moreover, it is important to note that this definition of Asian includes peoples with very diverse cultures, languages, and religions indeed, it covers more than half of the worlds population.
Colloquial usage of the term Asian in New Zealand also does not always correspond to the SNZ definition. Indian and other South Asian peoples may not be labelled Asian ADDIN EN.CITE McKinnon199612126McKinnon, M. (1996). Wellington, .Immigrants and citizens: New Zealanders and Asian immigration in historical context1996WellingtonInstitute of Policy Studies, Victoria University of Wellington(McKinnon 1996), with the term being reserved instead for East and Southeast Asian peoples. In fact, prior to the change in immigration policy in 1987 that led to a rapid increase in immigration from East and South Asia, the descriptor Asian was not widely used colloquially in New Zealand.
However, Asian is widely used as a n e t h n i c d e s c r i p t o r i n N e w Z e a l a n d t o d a y , a n d i s g e n e r a l l y u s e d a s a c o u n t e r p o i n t t o E u r o p e a n ( o r P k e h ) , M o r i a n d P a c i f i c a s a b r o a d e t h n i c g r o u p i n g . R e f l e c t i n g t h i s , s e r v i c e s h a v e e m e r g e d o v e r t h e l a s t d e c a d e t o m e e t t h e h e a l t h n e e d s o f A s i a n N e w Z e a landers, as seen in the story boxes included in this report.
One reason for the emergence of these services is the rapid growth of the population considered to be Asian under the SNZ definition approximately 6.4% of the New Zealand total in the 2001 Census, and projected to increase to about 12% in 2021 ADDIN EN.CITE Statistics New Zealand2005102EndNote012(Statistics New Zealand 2005a).
The construct of an Asian ethnic grouping has provided a banner or label under which to consider the needs of these communities a recognition or visibility that did not exist when they were classified as Other (as Chinese and Indian peoples were for almost 140 years). There are parallels between the use of Asian in this regard and the progress of the Pacific category in New Zealand over the last 20 years ADDIN EN.CITE Bedford R & Didham R2001666Bedford R & Didham R,Who are the "Pacific Peoples"? Ethnic identification and the New Zealand census, in C. Macpherson, P. Spoonley & M. Anae (Eds.), Tangata o te moana nui: the evolving of Pacific peoples in Aotearoa/New Zealand21-432001Palmerston NorthDunmore PressMacpherson C200110106Macpherson C,, Spoonley, P., & Anae, M.Tangata o te moana nui : the evolving identities of Pacific peoples in Aotearoa /New Zealand2001Palmerston NorthDunmore Press(Bedford and Didham 2001; Macpherson 2001).
Is Asian a meaningful ethnic grouping?
Asian New Z e a l a n d e r s d o i n f a c t s h a r e s o m e e x p e r i e n c e s t h a t e x t e n d b e y o n d s i m p l y b e i n g n o t E u r o p e a n , M o r i o r P a c i f i c . M o s t A s i a n e t h n i c g r o u p s i n c l u d e b o t h l o n g - e s t a b l i s h e d c o m m u n i t i e s a n d m i g r a n t s w h o a r r i v e d a f t e r 1 9 8 7 . M a n y o f t h e s e c o m m u n i t i e s n o t o n l y s h a r e common values, with a strong emphasis on family, education and community ties (Inoguchi and Newman 1997) but also share the experience of a younger generation engaged in negotiating between these traditional values and those of the dominant culture. Migrants, in particular, share the experience of settling in a new country and acculturating to a very different way of life.
However, in using the term Asian to describe an ethnic grouping with specific health needs, the diversity within this grouping must be borne in mind. Asian New Zealanders differ widely not only in language and culture, but also in socioeconomic status, English-language ability and settlement history in New Zealand. Because all of these factors can impact on health, there are limitations in using Asian as a catch-all ethnic descriptor. In particular, smaller ethnic minorities may be lost by averaging within the grouping, and their specific health needs rendered invisible as a result.
This report attempts to avoid this pitfall (to the extent possible) by stratifying within the Asian grouping along two axes: ethnicity and settlement history. We analyse three ethnic groups separately Chinese, Indian and Other Asian and also analyse the data (where possible) by duration of residence in New Zealand (as a proxy for the migration effects of health selection and acculturation). By so doing we aim to avoid the pitfall of averaging and instead identify some of the causes differentiating health status among Asian peoples.
Asian ethnic groups
The choice of ethnic groups listed above reflects the fact that the Chinese and Indian communities are the two largest. Chinese and Indian peoples have long histories of settlement in New Zealand ADDIN EN.CITE Leckie19959917Leckie, J.South Asians: old and new migrations, in S. Greif (Ed.), Immigration and national identity in New Zealand; one people, two peoples, many peoples?133-1601995Palmerston NorthDunmore PressIp M1996776Ip M,Dragons on the long white cloud: the making of Chinese New Zealanders1996North ShoreTandem Press(Leckie 1995; Ip 1996), but historically there have been few connections between the two communities. Chinese and Indian are not necessarily singular ethnic identities both contain many different ethnicities. However, there are many similarities among the people they describe, and many people in New Zealand would describe themselves in such a fashion. Moreover, overseas research on these communities in other Western countries has shown similar factors that affect health within these communities; for example, increased risk of diabetes and cardiovascular disease in most Indian peoples ADDIN EN.CITE Kuppuswamy20058817Kuppuswamy, VC & Gupta, SExcess coronary heart disease in South Asians in the United KingdomBMJBMJ1223-12243302005(Kuppuswamy 2005).
The Other Asian category is a pragmatic device to enable monitoring of the health of numerically smaller Asian communities in New Zealand (included in the Statistics New Zealand definition). This approach is no less prone to the problems of averaging than the overall Asian category, yet still provides a means to report health statistics for this group instead of simply excluding them. In future editions we hope to be able to report separately on the health of at least some of the specific ethnic groups included within this very heterogeneous Other Asian category.
Migration, health selection and acculturation
The analysis by duration of residence included in this report recognises the important impacts of migration on health status. There is a very large literature on the health impacts of migration, and recent studies of Asian peoples in New Zealand confirm the potential for the migration experience to negatively affect health in the short term ADDIN EN.CITE Abbott MW20004417Abbott MW, Wong S, Williams M, Au MK, Young WRecent Chinese migrants' heatlh, adjustment to life in New Zealand and primary health care utilizationDisability and RehabilitationDisability and Rehabilitation43-56222000North2004131310North, N., Trlin, A., & Henderson, A. Asian and other skilled immigrants' self-reported illnesses in the first four years of settlement in New Zealand, in S. Tse, A. Thapliyal, S. Garg, G. Lim & M. Chatterji (Eds.), Proceedings of the inaugural international Asian health conference: Asian health and wellbeing, now and into the future38-562004AucklandUniversity of Auckland(Abbott et al 2000; North et al 2004).
Conversely, there is also increasing international evidence for health selection, such that migrants are typically healthier than the native-born (once acute stresses related to the migration process have passed). This selection effect dissipates as migrants reside longer in their new country ADDIN EN.CITE McDonald2004111117McDonald, J. T., & Kennedy, S.Insights into the 'healthy immigrant effect': health status and health service use of immigrants to CanadaSocial Science & MedicineSocial Science & Medicine1613-1627592004(McDonald and Kennedy 2004) and of course is absent for the second (and subsequent) generations who show regression to the mean. At the same time, acculturation processes are occurring, which may enhance or worsen the health of the ethnic minority group, depending on a wide range of political, social, cultural and economic circumstances involving both the group itself and the host population.
As such, settlement history may be a significant source of variation in health status among Asian New Zealanders, especially as the grouping includes people who have family histories of several generations settlement in New Zealand along with others who have arrived very recently.
Demography of Asian New Zealanders
The demography of Asian peoples in New Zealand shows marked differences from that of the total population. There are also differences between the Chinese, Indian and Other Asian ethnic groups.
As shown in Table 1, the Chinese community is approximately 100,000 strong and comprises over 40% of the Asian ethnic grouping, while the Indian community numbers approximately 60,000 (25% of the grouping), with the Other Asian group (including Koreans, Japanese, Vietnamese, Filipinos, Bangladeshis, Pakistanis and Afghanis among others) making up the remaining approximately 70,000 (30%).
Table 1: Asian ethnic group distribution, 2001 Census usually resident population
ChineseIndianOther AsianTotal AsianNew Zealand totalTotal number104,58061,80371,076237,4593,737,277Percent of total Asian44.0%26.0%29.9%Percent of New Zealand total2.8%1.7%1.9%6.4%Source: Statistics New Zealand
Chinese, Indian and Other Asian peoples in New Zealand all have markedly different age distributions to that of the general population (Table 2). These ethnic groups are characterised by youthful population structures, with only 5.9% of Chinese, 3.7% of Indians and 2.5% of Other Asians being aged 65 years or over, compared to 12.1% of the New Zealand population as a whole.
Table 2: Age and sex distribution of Asian groups, 2001, percent
Age group (years)ChineseIndianOther AsianNew Zealand totalMaleFemaleMaleFemaleMaleFemaleMaleFemale046.96.18.38.07.96.67.66.951414.312.316.916.519.715.116.214.7152426.022.316.417.523.720.413.913.1254428.133.236.437.032.440.729.230.2456418.820.218.517.114.014.622.321.865+6.05.83.53.82.32.610.813.3Source: Statistics New Zealand
The Chinese and Other Asian, but not the Indian, populations show a bulge in the1524 years age group, possibly reflecting relatively large student numbers.
One-fifth of Chinese New Zealanders are New Zealand-born, as shown in Figure 1. This proportion has decreased in the past decade with increasing immigration, but may now be expected to increase with changing immigration policy and increased New Zealand births. Slightly more than a third of Chinese New Zealanders have been in New Zealand less than five years.
Figure 1: Chinese in New Zealand distribution by duration of residence, 2001
Source: Statistics New Zealand
* Note: Not specified includes birth place not stated, not elsewhere classifiable (NEC) and other from Statistics New Zealand categories.
A quarter of the Indian population is New Zealand-born, with another quarter resident in New Zealand for over 10 years, as seen in Figure 2. Similar to the Chinese population, one-third are recent migrants, having arrived in New Zealand in the last five years.
Figure 2: Indians in New Zealand distribution by duration of residence, 2001
Source: Statistics New Zealand
* Note: Not specified includes birth place not stated, not elsewhere classifiable (NEC) and other from Statistics New Zealand categories.
The Other Asian population has a higher proportion of recent migrants (40% resident less than five years) and a lower New Zealand-born proportion (13%) than the Chinese and Indian groups, as seen in Figure 3.
Figure 3: Other Asians in New Zealand distribution by duration of residence, 2001
Source: Statistics New Zealand
* Note: Not specified includes birth place not stated, not elsewhere classifiable (NEC) and other from Statistics New Zealand categories.
Structure of the report
The Asian Health Chart Book 2006 aims to provide baseline information for planning and resourcing health services and research aimed at improving the health of Asian New Zealanders. Despite the issues of ethnic classification identified above, and the imperfections of the available data (as with any data), we hope that this report will be a useful resource for health service funders and providers, and for the communities themselves.
Reflecting this goal, interspersed among the statistical indicators presented (see Methodology chapter) are stories about innovative services that have already been developed to meet the specific needs of Asian peoples in New Zealand. These stories illustrate that the diversity of Asian communities is mirrored by the diversity of health services provided. We hope that these narratives will encourage others to further extend the range of innovative and culturally safe services available for Asian New Zealanders.
We intend to update this profile approximately every five years. As the time series extends, trend analysis will become possible and the usefulness of the statistical indicators and qualitative narratives for policy and planning should be further enhanced.
Section 2: Methodology
Selection of indicators
The selection of indicators to describe the health profile of any population needs to be based on a conceptual model of health. The framework used in this report to identify health information domains and define the relationship between them is shown below (Figure 4).
Figure 4: Conceptual model of health information domains and their relationships
Health outcomes (fatal and non-fatal) are considered to be the result of exposure to proximal risk and protective factors, which may be behavioural (lifestyle) or biological, acting through disease and injury pathways. These risk exposures are in turn shaped by distal historical, socioeconomic, cultural and political determinants, influenced by demographic forces and environmental conditions. Health services are conceptualised as a bridge between risk exposure and outcome.
For each information domain included in REF _Ref119982383 \h Figure 4, indicators were selected using conventional criteria relating to their ability to signal wider health concerns, to focus on salient health issues, to be reliably and validly monitored, and for their responsiveness to change. To the extent possible, indicators were aligned with those already selected for use at the national level in the annual monitoring report, An Indication of New Zealanders Health (Ministry of Health 2004a). Indicators are ordered as shown below (Figure 5).
Figure 5: Order of presentation of indicators
Data sources
Data for the indicators were derived from multiple sources, including the population census and vital statistics, administrative databases and national health surveys.
For administrative data, five years of data centred around the year 2001 (the most recent Census year) were aggregated to provide an adequate number of counts for stable rate estimates. The most recent survey data from the 2002/03 New Zealand Health Survey were analysed. Data sources for the indicators are listed below.
SourceDataPeriodNew Zealand Health Information Service (NZHIS)Mortality collection data set mortality19982002National Minimum Data Set (NMDS) hospitalisations19992003New Zealand Cancer RegistryCancer registrations19972001Statistics New ZealandInfant mortality19982002Low birthweight19992003National Screening Unit (NSU)Mammography (female breast cancer screening)20012002Cervical screening coverage20012003New Zealand Health Survey (NZHS)Risk and protective factors
Health services utilisation
Chronic diseases2002/03
Details of ICD-9 codes used for administrative data are given in Appendix 1.
Population information was sourced from 2001 Census data (Statistics New Zealand). The total census count (multiplied by 5) was used as denominator for most rates.
Statistical methods
Variable definitions
Ethnicity
Total response output was used to categorise ethnicity in this report. A person is counted more than once if he/she self-reports more than one ethnic identity. The ethnic groups included are Chinese, Indian and Other Asian (combining Southeast Asians and all other Asians). The Statistics New Zealand ethnic composition codes are provided in Appendix 1.
Age groups
Indicators are stratified (where possible) into the following life-cycle stages:
children (014 years) (sometimes disaggregated to 04 and 514 years)
young people (1524 years)
young adults (2544 years)
middle-aged adults (4564 years)
older adults (65+ years).
Estimation of rates
Most of the indicators are presented as crude rates and/or age-specific rates in tabular format. The crude and age-specific rates provide a measure of disease burden or risk, or health service utilisation, for each Asian ethnic group
Age-specific rates can be compared across ethnic groups, but crude rates cannot because the groups differ in their age distributions. Instead, direct age-standardised rate ratios are used to enable summary comparisons between ethnic groups, as well as between each Asian ethnic group and the total New Zealand population. Note that standardised rates are not meaningful in themselves (and so are not shown) their sole purpose is for comparison, so only the ratio of standardised rates is meaningful (and usually only this statistic is shown). The reference population used for age standardisation is the WHO World Population (see Appendix 1, Table A1.1).
Rates were not calculated for counts that were less than 5 (New Zealand Health Information Service data) or less than 10 (2002/03 New Zealand Health Survey data).
Where possible, rates are provided by duration of residence in New Zealand, to reflect processes of acculturation and selection. Three duration of residence categories are used for each Asian ethnic group: less than five years, five to nine years, and ten years or more plus New Zealand-born.
For most rates and rate ratios, 95% confidence intervals are provided. These have been calculated using standard parametric techniques.
Regression analysis
Logistic regression models were constructed to examine the association between various health outcomes and Asian ethnicity, adjusting for multiple covariates including age, sex, deprivation (NZDep2001 quintiles) and duration of residence in New Zealand (less than five years, five to nine years, ten or more years or New Zealand-born).
All explanatory variables were kept in the model, even if not statistically significant, to ensure that the model was controlling for these variables. For each outcome variable two models were built: with and without duration of residence in New Zealand.
Both step-up (running a main effects model with no interaction terms first and adding interaction terms) and step-down (starting with a full model with all interaction terms) models were run. In both cases interaction terms were removed if they were non-significant (that is, their overall Wald p-value was >0.05).
For each final model, standard diagnostic tests (including Hosmer-Lemeshow goodness of fit test and Wald tests) were run to ensure that model assumptions were met and that the fit was satisfactory.
A note on interpreting rates
Crude rates indicate the actual level of the indicator in each Asian ethnic group, and so are meaningful in themselves. However, comparison of crude rates across ethnic groups or with the all New Zealand rate is subject to confounding by age, because the groups being compared have differing age structures.
Instead, standardised rate ratios are provided to enable such comparisons to be made free of age confounding.
Note that it is only the ratio of the age-standardised rates that is meaningful, not the standardised rates themselves (which, therefore, are generally not shown).
Section 3: Health Outcomes
Health outcome or health status indicators make up the top three tiers of the indicator pyramid (Figure 5, page 8). Summary measures of population health, capturing health over the whole of the life course, are presented first. Key indicators tapping major health outcomes for each life-cycle stage are then presented in turn from childhood to old age.
Whole of life
Four indicators have been selected to capture health across the life course as a whole: life expectancy, avoidable mortality, ambulatory-sensitive hospitalisations and mental health. The highest-level summary measure of population health health expectancy could not be included because of data limitations.
Life expectancy
Life expectancy at birth is the average number of years a child born now could expect to live if current mortality rates persisted for the whole of its life. Life tables for Asian ethnic groups were constructed by Public Health Intelligence because Statistics New Zealand does not produce official life tables for these ethnic groups.
Note that life expectancies can be validly compared between populations because this statistic is not affected by differences in population age structure.
Figure 6: Life expectancy at birth, by ethnic group and sex, 19992003*
Source of base data : Statistics New Zealand
* Mortality rates for the Other Asian group did not display a pattern suitable for construction of a life table, so no estimate of life expectancy is available for this group.
Chinese males and females have a much longer life expectancy than the total population: 8.8 years and 7.1 years higher, respectively.
Indian males and females have a moderately longer life expectancy than the total population: 2.5 years and 1.3 years higher, respectively.
The gender difference in life expectancy at birth is 5.0 years for the total population, but only 3.4 years for the Chinese ethnic group and 3.8 years for the Indian ethnic group.
The long life expectancies of the Chinese and Indian ethnic groups (especially the former) may reflect (at least in part) selection processes the so-called healthy immigrant and unhealthy emigrant effects.
Avoidable mortality
The concept of avoidable mortality includes deaths that are preventable though population-based interventions as well as those responsive to preventive and curative interventions at an individual level. An age threshold of 75 years is applied because of the high prevalence of co-morbidity at older ages.
Table 3: Crude rate (per 100,000) of avoidable mortality, by Asian ethnic group and sex, 19982002
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleAvoidable mortality123.6(109.5138.9)65.1(55.475.9)174.0(153.1196.8)93.3(78.2110.5)137.1(119.6156.5)73.7(62.286.7)Source of base data: New Zealand Health Information Service, Ministry of Health
Note: The crude rate for the total population has not been presented so as to avoid invalid comparisons.
Figure 7: Standardised rate ratios* for avoidable mortality, by Asian ethnic group and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
The avoidable mortality rate is significantly lower for Chinese, Indian and Other Asian females than the total population, and almost so for males.
Among the Asian ethnic groups, avoidable mortality is significantly lower for Chinese than for Indian or Other Asian ethnic groups (both sexes).
Note: Crude rates cannot be compared between ethnic groups (or with the all New Zealand rate) because the groups differ in their age distributions. Standardised rate ratios enable comparisons between Asian ethnic groups and the all New Zealand rate (reference group), as well as between one ethnic group and another.
Duration of residence
Figure 8: Age-standardised avoidable mortality rates (per 100,000) for Chinese, by duration of residence and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population.
Figure 9: Age-standardised avoidable mortality rates (per 100,000) for Indians, by duration of residence and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population.
Figure 10: Age-standardised avoidable mortality rates (per 100,000) for Other Asian by duration of residence and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population.
There seems to be a dose-response relationship between duration of residence (a proxy for selection and/or acculturation effects) and avoidable mortality among the Chinese ethnic group, and perhaps among Other Asian females.
This finding of worsening health (increasing avoidable mortality) with duration of residence and generation suggests that the life expectancy advantage of Chinese New Zealanders over other ethnic groups may erode over time.
Ambulatory-sensitive hospitalisations
Ambulatory-sensitive hospitalisations are hospitalisations that result from diseases and conditions sensitive to interventions delivered through primary health care, and that could therefore potentially be avoided by improving primary health care access and/or quality. An age threshold of 75 years is applied because of the high prevalence of comorbidity at older ages.
Table 4: Crude rate (per 100,000) of ambulatory-sensitive hospitalisations, by Asian ethnic group and sex, 19992003
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleAmbulatory-sensitive hospitalisations1207.1(1162.41253.1)1119.1(1077.91161.6)3734.5(3635.63835.3)2754.5(2669.32841.7)1734.8(1670.81800.7)1515.5(1461.61570.9)Source: New Zealand Health Information Service
Note: Crude rate for the total population has not been presented so as to avoid invalid comparisons.
Figure 11: Standardised rate ratios* for ambulatory sensitive hospitalisations, by Asian ethnic group and sex, 19992003
Source: New Zealand Health Information Service
Note: Age-standardised to WHO world population.
* The reference group is the total New Zealand population.
Chinese, followed by Other Asians, have significantly lower ambulatory-sensitive hospitalisation rates than the total population, while Indians have a significantly higher ambulatory-sensitive hospitalisation rate (both sexes).
The latter finding suggests a difference in primary health care access or utilisation by Indians compared to other New Zealanders.
Among the Indian ethnic group (but not the remaining groups), males have a significantly higher rate of ambulatory-sensitive hospitalisation than females.
Mental health
Reliable estimates of the prevalence of psychiatric morbidity (eg, anxiety and depressive disorders) in the Asian population are not currently available for New Zealand. In the absence of such information, we use three scales from the eight-scale SF-36 (a standardised health status instrument included in the 2002/03 New Zealand Health Survey): mental health, vitality and social functioning.
Scores for each of the three scales are expressed on a 0100 scale, with higher scores representing better self-perceived health. Note that concepts of mental health are strongly culture-specific, so estimates based on self-report should be interpreted with care.
All-age suicide mortality is also used as an indicator of mental health, given the strong association between suicide and depression.
SF-36
Table 5: Mean SF-36 scores by Asian ethnic group and sex (age-standardised), 2002/03
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleSF-36 mental health84.8(82.287.5)83.6(81.285.9)81.5(77.186)81.9(77.885.9)85.1(82.287.9)80.5(77.183.9)SF-36 vitality scale75.1(71.778.5)70.7(67.673.8)72.9(6778.7)69.7(65.673.8)77.3(73.481.2)67.9(63.272.5)SF-36 social functioning95.3(92.598.2)94.2(91.397.2)94.4(90.898.1)94.7(92.197.3)91.0(85.896.1)90.2(84.595.8)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: Age-standardised to WHO world population.
Figure 12: Mean SF-36 mental health scores, by ethnic group and sex (age-standardised), 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: Age-standardised to WHO world population.
Figure 13: Mean SF-36 social functioning scores, by ethnic group and sex (age-standardised), 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: Age-standardised to WHO world population.
Figure 14: Mean SF-36 vitality scores, by ethnic group and sex (age-standardised), 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: Age-standardised to WHO world population.
Self-reported level of good mental health (more precisely, absence of psychological distress), as defined by a mean score on the SF-36 mental health scale, appears lower for Indian (both sexes) and Other Asian females, and slightly higher for Chinese (both sexes) and Other Asian males than for the total population, but these differences are not statistically significant.
Self-reported social functioning, as defined by a mean score on the relevant SF-36 scale, is similar for all three Asian ethnic groups.
Males have better self-reported mental health and social functioning than females among all groups except the Indian ethnic group (where there are no significant gender differences in mean scores on these scales).
Vitality scores (a measure of positive mental and to a lesser extent physical wellbeing) are higher among all the Asian ethnic groups than the total population, with males having higher mean vitality scores than females in all ethnic groups.
Suicide
Table 6: Crude rate (per 100,000) of all-age suicide mortality, by Asian ethnic group and sex, 19982002
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleAll-age suicide mortality7.4(4.311.8)4.4(2.27.8)21.9(15.030.9)6.2(2.811.8)9.3(5.215.4)6.6(3.511.2)Source: New Zealand Health Information Service, Ministry of Health
Figure 15: Standardised rate ratios* for all-age suicide mortality, by Asian ethnic group and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese and Other Asian males have all-age suicide mortality rates approximately half those of the total population.
Chinese females may also have lower suicide rates than the all New Zealand average, but the confidence interval is very wide (reflecting small numbers).
Indian males and females, and Other Asian females, have similar rates to the total New Zealand population, but note that the confidence intervals are wide, especially for Indian and Other Asian females.
Summary
Life expectancy is much higher for the Chinese ethnic group, and slightly higher for the Indian ethnic group, than the all New Zealand average.
Avoidable mortality is significantly lower for Chinese, Indian and Other Asian ethnic groups than for the total population.
The avoidable mortality rate worsens for Chinese New Zealanders who were born in New Zealand or have lived in New Zealand for longer periods.
Chinese and Other Asians have significantly lower ambulatory-sensitive hospitalisation rates than the total population, while Indians have a significantly higher ambulatory-sensitive hospitalisation rate.
Vitality scores (an SF-36 scale tapping positive mental wellbeing) are higher among all the Asian ethnic groups than the total population.
SF-36 mental health (a measure of psychological distress) and social functioning mean scale scores are similar to the total population for all Asian ethnic groups.
Chinese and Other Asian males have age-standardised suicide mortality rates approximately half that of the total population.
Asian mental health promotion
The Mental Health Foundation has been involved in key initiatives over the last two years aimed at helping to address the mental health promotion needs of Asian youth, adults and older people, in the Auckland region. Initiatives include:
development of a Youre Not Alone Chinese youth mental health promotion brochure series
development of a Chinese Youth Mental Wellbeing train the trainer workshop
scoping of a Chinese Parenting Programme
needs analysis around the advocacy needs of Korean older people.
The target population for the Youre Not Alone resource series is young Chinese people aged 1425, including international students. The dynamic four-brochure series covers feeling lonely, feeling stressed, feeling sad and depressed, and feeling angry. The initiative was an innovative collaboration between health professionals, the community and business, with some of the funding being provided by a Chinese business with a largely Chinese youth clientele. The brochures were written and designed by Chinese young people. The resource series has been extremely well received, with requests already being made for the series to be adapted for other Asian cultures and made available in other Asian languages.
Following the piloting of the Chinese Youth Mental Wellbeing workshop, there was significant interest expressed by agencies in the Auckland region wanting to both receive the training and deliver it.
The outcome of the Korean Older Peoples Advocacy Project has been the proposed development of a Korean Buddy Programme in collaboration with the Senior College and a Korean Church in Auckland. The development of this programme is currently under way.
The Chinese Parenting Programme Scoping Report provides some valuable information on the needs of Chinese parents, which will be useful for agencies working in this area.Shae RonaldNorthern Regional ManagerMental Health FoundationPhone: 09 300 7010Fax: 09 300 7020Email: HYPERLINK "mailto:shae@mentalhealth.org.nz" shae@mentalhealth.org.nzWebsite: HYPERLINK "http://www.mentalhealth.org.nz" www.mentalhealth.org.nz
Infants and children (014 years)
Major issues in infant and child health for Asian peoples (and other ethnic groups) include infant mortality, low birthweight, injury and asthma.
Infant mortality
The infant mortality rate (IMR) is the number of deaths in the first year of life per 1000 live births. The IMR can be broken down into neonatal (deaths in the first 28 days of life) and post-neonatal (deaths from the 29th to 365th day of life) components.
Infant mortality rate
Table 7: Infant mortality rate (per 1000), by ethnic group, 19982002
ChineseIndianOther AsianTotal populationInfant mortality2.5(1.63.7)4.7(3.26.7)3.2(2.04.8)5.7(5.45.9)Source: New Zealand Health Information Service, Ministry of Health
Figure 16: Rate ratios* for infant mortality, by Asian ethnic group, 19982002
Source: New Zealand Health Information Service, Ministry of Health
* The reference group (rate ratio = 1) is the total New Zealand population.
The infant mortality rate is significantly lower for Chinese and Other Asian ethnic groups than the total population about half the latter.
The Indian IMR is not significantly lower than the all New Zealand average.
Neonatal and post-neonatal mortality rates
Table 8: Neonatal and post-neonatal mortality rate (per 1000), by ethnic group, 19982002
ChineseIndianOther AsianTotal populationNeonatal mortality1.8(1.12.9)3.4(2.15.2)1.7(0.93.0)3.3(3.13.5)Post-neonatal mortality0.7(0.31.5)1.2(0.52.5)1.5(0.72.6)2.4(2.22.5)Source: New Zealand Health Information Service, Ministry of Health
Figure 17: Rate ratios* for neonatal mortality, by Asian ethnic group, 19982002
Source: New Zealand Health Information Service, Ministry of Health
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese and Other Asian infants have a significantly lower neonatal mortality rate than the total population.
There was no difference in the neonatal mortality rate between Indian infants and the total population.
Figure 18: Rate ratios* for post-neonatal mortality, by Asian ethnic group, 19982002
Source: New Zealand Health Information Service, Ministry of Health
* The reference group (rate ratio = 1) is the total New Zealand population.
The post-neonatal mortality rate is lower for Chinese (and possibly Indian and Other Asian) infants than for the total population.
The very low post-neonatal mortality of Chinese infants is particularly noteworthy (less than one-third the all New Zealand rate).
Low birthweight
Low birthweight is defined as a birthweight less than 2500 grams, and is correlated with infant mortality and other poor health outcomes. Low birthweight may be due to premature birth or to intrauterine growth retardation.
Table 9: Rate (per 100 live births) of low birthweight, by ethnic group, 19992003
ChineseIndianOther AsianTotal populationLow birthweight 5.5(5.06.0)10.9(10.211.7)6.9(6.37.5)6.6(6.56.7)Source: New Zealand Health Information Service, Ministry of Health
Figure 19: Rate ratios* for low birthweight, by Asian ethnic group, 19992003
Source: New Zealand Health Information Service, Ministry of Health
* The reference group (rate ratio = 1) is the total New Zealand population.
Low birthweight is significantly less prevalent among Chinese newborns than among the total population.
Indian newborns are about 70% more at risk of low birthweight than the total population. The explanation for the finding (whether it reflects higher rates of premature birth or intrauterine growth retardation, or at least in part an inappropriate birthweight norm) is unclear.
Other Asian newborns have similar low birthweight rates to the total population.
Unintentional injuries
Unintentional injuries (accidental injuries) include injuries due to causes such as motor vehicle collisions, falls, drowning, burns and poisoning, but not medical misadventures or complications. Because of different causal compositions, we present rates separately for pre-schoolers and school-age children. Hospitalisation rates are preferred to mortality rates as a more sensitive and comprehensive measure of serious injury.
Pre-schoolers (0 to 4 years)
Table 10: Rate (per 100,000) of unintentional injury hospitalisations (04 years), by ethnic groups and sex, 19992003
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleUnintentional injuries hospitalisation (04 years)1290.3(1119.31480.1)1123.0(961.91303.4)2216.7(1959.72498.1)1673.1(1446.01925.9)1867.9(1638.62120.4)1394.6(1199.41612.6)2762.7(2723.72802.1)2151.4(2116.22187.1)Source: New Zealand Health Information Service, Ministry of Health
Figure 20: Rate ratios* for unintentional injury hospitalisations (04 years) by Asian ethnic group and sex, 19992003
Source: New Zealand Health Information Service, Ministry of Health
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese, Indian and Other Asian children aged 0 to 4 years, have significantly lower rates of hospitalisation for unintentional injuries than the total population. For Chinese, the rate is one-half that of the total New Zealand population.
Chinese pre-schoolers have significantly lower rates of hospitalisation for unintentional injuries than Indian pre-schoolers (both sexes). Chinese boys also have a significantly lower rate than Other Asian boys.
School-aged children 5 to 14 years
Table 11: Rate (per 100,000) of unintentional injury hospitalisations (514 years), by ethnic group and sex, 19992003
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleUnintentional injuries hospitalisation (514 years)896.0(796.61004.3)663.8(576.2760.9)1477.9(1330.31637.3)906.4(789.81035.4)1529.7(1396.71672.0)827.5(727.5937.4)2357.0(2332.42381.9)1492.4(1472.31512.8)Source: New Zealand Health Information Service, Ministry of Health
Figure 21: Standardised rate ratios* for unintentional injury hospitalisations (514 years), by Asian ethnic group and sex, 19992003
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (5-14 years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese, Indian and Other Asian children aged between 5 and 14 years have significantly lower unintentional injury hospitalisation rates than the total population.
Once again, Chinese children have the lowest rates of all groups less than half that of the total New Zealand population.
For both boys and girls, the Chinese rates are significantly lower than the Indian or Other Asian rates.
Asthma
Asthma is characterised by episodic, reversible airflow obstruction (experienced as wheeze, breathlessness and cough). It is a common chronic disease in affluent societies, with the prevalence of the disease having increased over recent decades.
The findings of the New Zealand arm of the International Study of Asthma and Allergies in Childhood (ISAAC) suggests that 2530% of New Zealand children and adolescents have symptoms of asthma (Asher et al 2001).
Here we use hospitalisation as an indicator of the impact of asthma on New Zealand children. High hospitalisation rates can reflect high prevalence of asthma, lack of access to primary health care and asthma education, or both.
Table 12: Rate (per 100,000) of asthma hospitalisations (514 years), by ethnic group and sex, 19992003
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleAsthma hospitalisation (514 years)164.0(123.2214.0)125.7(89.4171.8)561.3(471.8662.7)233.9(176.7303.8)182.6(138.6236.0)70.4(43.5107.5)297.2(288.5306.1)235.0(227.1243.2)Source: New Zealand Health Information Service, Ministry of Health
Figure 22: Standardised rate ratios* for asthma hospitalisations (514 years), by Asian ethnic group and sex, 19992003
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (5-14 years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese and Other Asian children have a significantly lower rate of asthma hospitalisation than the total population.
Indian boys are 1.5 times more likely to be hospitalised for asthma than their total population counterparts, a significant result.
Rates for Indian girls are similar to the all New Zealand average.
Summary
Among the Asian ethnic groups, infant mortality is significantly lower in Chinese and Other Asian ethnic groups than in the total population.
Chinese and Other Asian infants have a significantly lower neonatal mortality rate than the total population.
Chinese infants also have a significantly lower post-neonatal mortality rate.
Low birthweight is significantly less prevalent among Chinese newborns than in the total population.
Indian newborns are about 70% more at risk of low birthweight than the total population.
Chinese, Indian and Other Asian children are less likely to be hospitalised for an unintentional injury than the total population.
Indian boys (514 years) are 1.5 times more likely to be hospitalised for asthma than the total population, while Chinese and Other Asian children are significantly less likely to be hospitalised for this condition.
Young people (1524 years)
Youth is usually a time of good physical health. The main health challenges faced by young people of all ethnic groups include risk-taking behaviour which may result in injuries such as motor vehicle crashes, and issues relating to mental health and wellbeing, and sexual and reproductive health. The indicators used in this section are intentional self-harm and suicide, road traffic injuries, and fertility.
Intentional self-harm hospitalisation and suicide
Hospitalisation for intentional self-harm is an internationally recognised indicator for attempted suicide (MoH 2006). To avoid errors in coding, we use hospitalisation for all intentional injuries, the vast majority of which are self-inflicted.
Table 13: Rate (per 100,000) of intentional injuries hospitalisation (19992003) and suicide mortality (19982002), by ethnic group and sex, 1524 years
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleIntentional injuries hospitalisation15.0(6.928.5)87.1(64.4115.1)112.6(74.2163.8)334.3(267.0413.4)55.2(34.284.4)167.8(130.3212.8)109.9(104.2115.9)267.5(258.6276.7)Suicide mortality13.3(5.826.3)5.3(1.115.6)50.0(25.987.4)19.7(6.445.9)13.1(4.330.7)14.8(5.432.2)34.9(31.738.3)12.3(10.414.4)Source: New Zealand Health Information Service, Ministry of Health
Intentional injury hospitalisations
Figure 23: Standardised rate ratios* for intentional injuries hospitalisation (1524 years), by Asian ethnic group and sex, 19992003
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (15-24 years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese and Other Asian youth have significantly lower intentional injury hospitalisation rates than the total population (both sexes).
By contrast, Indian youth have a similar (males) or higher (females) rate than the total population.
Among all the young Asian ethnic groups, females have a higher intentional injury hospitalisation rate than their male counterparts. This pattern is consistent with other population groups in New Zealand and elsewhere.
Suicide mortality
Figure 24: Standardised rate ratios* for suicide mortality (1524 years), by Asian ethnic group and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (15-24 years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese and Other Asian male youth have significantly lower suicide mortality rates than the total population.
Chinese female youth may also have a lower rate than the total New Zealand population, although the difference does not reach statistical significance, perhaps because of small numbers.
Indian youth (both sexes) and Other Asian female youth have similar rates to the total population.
Road traffic injuries
Among young people, road traffic injuries are a leading cause of hospitalisation and death. Both indicators are presented here.
Table 14: Rate (per 100,000) of road traffic injury hospitalisations (19992003) and mortality (19982002), by ethnic group and sex, 1524 years
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleRoad traffic hospitalisation193.5(159.9232.1)142.1(112.7176.9)216.8(161.9284.3)114.1(76.4163.8)323.3(268.7385.8)264.1(216.4319.1)639.1(625.2653.1)324.7(314.8334.8)Road traffic mortality20.0(10.335.0)16.0(7.330.4)25.0(9.254.4)39.4(22.165.0)14.8(5.432.2)38.1(34.841.7)14.8(12.817.1)Source: New Zealand Health Information Service, Ministry of Health
Road traffic hospitalisations
Figure 25: Standardised rate ratios* for road traffic injury hospitalisations (1524 years), by Asian ethnic group and sex, 19992003
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (15-24 years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese, Indian and Other Asian youth all have significantly lower road traffic hospitalisation rates than the total population (both sexes).
Other Asian female youth have significantly higher road traffic injury hospitalisation rates than their male counterparts.
Hospitalisation rates for young Chinese and Indians are similar (about 70% lower than the all New Zealand rates) and lower than that of Other Asian youth.
This finding of very low hospitalisation rates for road traffic injury for Asian ethnic groups is not fully mirrored in road traffic mortality rates in young people (see below). The reason for this discrepancy is unclear.
Road traffic mortality
Figure 26: Standardised rate ratios* for road traffic mortality (1524 years), by Asian ethnic group and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (15-24 years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese and Indian male youth have a lower road traffic mortality rate than the total population (although this is not statistically significant for Indians), in keeping with their low road traffic hospitalisation rates.
This is not the case for Other Asian young people (both sexes) or Chinese female youth. However, note that the confidence intervals are wide, which suggests small numbers, and may account for the apparent inconsistency between fatal and nonfatal outcomes.
Fertility
Birth rates in young people, especially the 15 to 19 years age group, provide an indirect measure of sexual health. Teenagers with adolescent conduct problems, poor school achievement and family adversity may be more likely to become (generally unpartnered) teenage mothers ADDIN EN.CITE Woodward L2001171717Woodward L, Horwood L, Fergusson D.Teenage pregnancy: cause for concern.New Zealand Medical JournalNew Zealand Medical Journal301-31142001(Woodward and Fergusson 2001).
Table 15: Birth rate (per 1000), 1519 years, by ethnic group, 20022004
ChineseIndianOther AsianTotal populationBirth rate per 1000 female population (1519 years)5.4(4.46.6)16.1(13.319.2)11.5(9.813.5)38.0(37.438.6)Source: Statistics New Zealand
In the 15 to 19 years age group, Chinese, followed by Other Asian and Indian girls have a significantly lower birth rate than the total population.
The very low birth rate among teenage Chinese girls, relative to other Asian ethnic groups and the total population, is particularly noteworthy.
Summary
Chinese and Other Asian youth have significantly lower intentional injury hospitalisation rates than the total population, while Indian female youth have a higher rate than the total population.
Chinese and Other Asian male youth have significantly lower suicide mortality rates than the total population.
Chinese, Indian and Other Asian ethnic groups have significantly lower youth road traffic injury hospitalisation rates but not mortality rates (except for Chinese males) than the total population.
In the 15 to 19 years age group, Chinese followed by Other Asian and Indian females, have a significantly lower birth rate than the total population.
Family Planning Association Services for Asian Communities
The Family Planning Association (FPA) is seeing an increasing number of Asian clients in both its clinics and education sessions. The organisation is working on extending services to better meet the needs of this community.
Clinical services
The Family Planning clinics in the major cities of New Zealand are able to provide Chinese interpreters who will translate between clinician and client, either at a regular time or when requested. Clinics provide confidential information and advice on a wide range of sexual and reproductive health matters: contraception, sexually transmitted infection (STI) checks, cervical smear tests, menopause, condoms, emergency contraception, pregnancy, premenstrual syndrome (PMS) and vasectomy.
Resources
FPA has produced two sexual health pamphlets in Chinese, Korean and Japanese:
Contraception Your Choice
Sexually Transmitted Infections STIs.
These pamphlets are available from Family Planning clinics or may be ordered from the Family Planning Resource Unit (phone 04 384 4349). Contraception Your Choice outlines the range of contraceptives available and how they work in preventing pregnancy. The STI pamphlet outlines the list of STIs, their symptoms and where to go to for help if someone thinks he/she may have been exposed to an STI through unprotected sex. It also outlines how people can protect themselves from contracting an STI.
Education and training
FPA provides education sessions in sexual and reproductive health at some international language schools around New Zealand. Topics covered are: keeping safe from unplanned pregnancy and STIs, relationships and communication, the sexual environment in New Zealand (which may be very different from that in students home countries), and help and support agencies available to students. Classes can be taught in single-sex groups, with female and male educators available.
FPA also provides training for organisations working with Asian people, so that they are able to educate and support clients themselves.
For more information about education or training sessions, please phone the Family Planning education service on 09 524 3354. (The telephone numbers of all Family Planning clinics are on the website HYPERLINK "http://www.fpanz.org.nz" www.fpanz.org.nz or they can be found listed in the White Pages under F.)
Website HYPERLINK "http://www.fpanz.org.nz" www.fpanz.org.nzAdults (25+ years)
The key health issue facing adults of all ethnic groups in New Zealand is the risk of chronic disease including cancer, cardiovascular disease, diabetes and others. Although mortality and disability from these conditions occur most often in old age, chronic disease usually reflects cumulative exposure to behavioural and biological risk factors over the life course, with onset of subclinical or clinical disease often occurring in middle age.
In this section we focus on selected major chronic diseases cardiovascular diseases (hospitalisation and mortality rates), diabetes (prevalence rates), cancer (registration and mortality rates), and injuries from falls in older people (age-specific hospitalisation rates).
Cardiovascular diseases
Cardiovascular diseases (CVDs) are major causes of death for all ethnic groups in New Zealand. Ischaemic heart disease, ischaemic and haemohorrhagic stroke, hypertensive heart disease, rheumatic and other valvular heart disease and dysrhythmias are major diseases within this category.
Six sub-indicators are used in this report to capture the burden of cardiovascular disease on Asian New Zealanders: mortality and hospitalisation rates of cardiovascular disease as a whole, corresponding rates of ischaemic heart disease, and corresponding rates of stroke.
Table 16: Age-specific rate (per 100,000) of cardiovascular disease hospitalisation(19992003) and mortality* (19982002), by ethnic group and sex
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleHospitalisation2544 years151.3(122.8184.3)111.0(89.6136.0)859.2(782.2941.7)290.4(246.6339.7)343.9(295.4398.1)162.2(135.6192.5)559.5(550.6568.6)358.7(351.8365.7)Hospitalisation4564 years978.4(887.51076.1)628.1(561.3700.7)5508.7(5232.45795.8)2343.0(2156.52541.3)1689.0(1523.21867.8)824.7(723.5936.2)3161.3(3136.93185.9)1724.7(1706.91742.6)Hospitalisation65+ years4255.6(3918.04614.6)3760.2(3453.84086.4)13846.2(12840.714909.4)10727.8(9884.411623.9)7272.7(6421.88205.0)5239.5(4630.95905.8)10997.4(10931.811063.2)8012.3(79638061.8)Mortality4564 years99.2(71.8133.7)15.7(6.830.8)210.9(159.7273.2)84.5(52.3129.2)138.1(93.9196.1)51.8(29.085.4)226.0(219.5232.6)91.9(87.896.1)Mortality65+years915.0(762.21089.5)975.6(822.81148.6)1992.1(1622.62420.6)1455.5(1155.91809.1)1239.7(904.21658.8)1231.7(946.51575.8)2299.8(2269.82330.0)2129.6(2104.32155.2)Source: New Zealand Health Information Service, Ministry of Health
* CVD mortality rates for the 2544 years age group were not calculated because of small numbers.
CVD hospitalisations
Figure 27: Standardised rate ratios* for cardiovascular disease hospitalisation, by Asian ethnic group, age and sex, 19992003
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* Reference group (rate ratio = 1) is the total New Zealand population.
In all age groups, Chinese and Other Asian ethnic groups have significantly lower CVD hospitalisation rates than the total population (both sexes).
The CVD hospitalisation rate is significantly higher for Indians (for all age groups) than for Chinese and Other Asians (both sexes) and the total population (apart from 2544-year-old females).
The CVD hospitalisation rate is significantly higher for Indian males than for Indian females in the 2544 and 4564 years age groups. For the 65+ age group this contrast is reversed.
Among older people (65+ years), females have a higher cardiovascular disease hospitalisation rate than males for all Asian ethnic groups (although this is not statistically significant for Other Asians).
CVD mortality
Figure 28: Standardised rate ratios* for cardiovascular disease mortality, by Asian ethnic group, age and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* Reference group (rate ratio = 1) is the total New Zealand population.
In the 45 to 64 years and 65+ age groups, CVD mortality is significantly lower for Chinese than the total population.
Among the Asian ethnic groups aged 45 to 64 years and 65+, CVD mortality is significantly higher for Indian than Chinese ethnic groups (both sexes).
CVD mortality is higher in Indian females aged 65+ years than in the total population. For males the difference is not significant.
This pattern of low cardiovascular disease mortality among Chinese, intermediate among Other Asian and relatively high among Indian ethnic groups probably accounts for much of the life expectancy differences between these groups shown on page 11.
The relatively high cardiovascular disease mortality among the Indian ethnic groups may be explained (in part) by the high prevalence of type 2 diabetes in this ethnic group (see page 47).
CVD mortality, by duration of residence
Figure 29: Age-standardised rate (per 100,000) of cardiovascular disease mortality for Chinese, by duration of residence and sex, 25+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (25+ years).
Figure 30: Age-standardised rate (per 100,000) of cardiovascular disease mortality for Indians, by duration of residence and sex, 25+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (25+ years).
Figure 31: Age-standardised rate (per 100,000) of cardiovascular disease mortality for Other Asians, by duration of residence and sex, 25+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (25+ years).
There is a clear dose-response relationship between duration of residence in New Zealand (or being New Zealand-born) and cardiovascular disease mortality among Chinese and Other Asians (both sexes) and among Indian females.
Once again, this finding of worsening health (increasing cardiovascular disease mortality) with duration of residence whether the result of selection or acculturation effects, or both suggests that the life expectancy of Asian ethnic groups (most clearly demonstrated for Chinese) may be expected to decline (unless high immigration rates return).
Ischaemic heart disease
Ischaemic heart disease (IHD) is the leading specific cause of mortality in New Zealand, for all ethnic groups. IHD is related to atherosclerosis of the coronary arteries. Established risk factors for IHD include high blood cholesterol, high blood pressure, tobacco use, overweight and obesity, physical inactivity, diabetes, and inadequate vegetable and fruit intake.
Table 17: Age-specific rate (per 100,000) for ischaemic heart disease hospitalisation (1999- 2003) and mortality* (19982002), by ethnic group and sex
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleIHD hospitalisation(2544 years)30.9(18.947.7)3.6(0.710.5)594.1(530.4663.3)59.6(40.784.1)123.0(94.7157)26.0(16.139.8)189.8(184.6195.1)56.9(54.259.7)IHD hospitalisation(4564 years)433.8(374500.5)180.0(145.1220.8)4217.5(3976.24469.7)1256.0(1120.51403.4)895.7(776.21028.5)307.1(246.6377.9)1643.2(1625.61660.9)693.3(682.1704.7)IHD hospitalisation(65+ years)1735.7(1522.61970.2)1239.8(1066.71433.1)8264.3(7491.89094.8)5031.4(4459.35656.6)3719.0(3118.14401.9)1798.6(14502205.9)4547.3(4505.24589.7)2859.4(28302889.1)IHD mortality(4564 years)69.2(46.798.8)185.0(137.3243.9)48.3(25.084.4)89.1(54.4137.6)17.3(5.640.3)158.6(153.1164.1)45.1(42.248)IHD mortality(65+ years)406.7(307.2528.1)365.9(274.8477.4)1380.7 (1076.31744.4)916.4(682.41205.0)826.4(557.61179.8)567.0(379.7814.2)1401.5 (1378.21425.2)1061.2 (1043.31079.3)Source: New Zealand Health Information Service, Ministry of Health
* IHD mortality rates for the 2544 years age group were not calculated because of small numbers.
IHD hospitalisations
Figure 32: Standardised rate ratios* for ischaemic heart disease hospitalisation, by Asian ethnic group, age and sex, 19992003
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
For all age groups, ischaemic heart disease hospitalisation rates are significantly lower for Chinese and Other Asians than for Indians or the total New Zealand population (both sexes).
Indian New Zealanders have significantly higher IHD hospitalisation rates than the all New Zealand average (except for 2544-year-old females, where the difference is not significant).
For all age groups, rates are significantly higher (both sexes) among Other Asian than Chinese ethnic groups. That is, the Chinese ethnic group has the lowest rates, followed by the Other Asian ethnic group, the all New Zealand average, and finally the Indian ethnic group.
IHD mortality
Figure 33: Standardised rate ratios* for ischaemic heart disease mortality, by Asian ethnic group, age and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
In the 4564 and 65+ age groups, ischaemic heart disease mortality is higher for Indian males and females than for the total population. However, the difference is statistically significant only for females aged 65+ (perhaps reflecting relatively small numbers of deaths).
Chinese people aged 4564 and 65+ years have ischaemic heart disease mortality rates significantly lower than the total New Zealand population.
For Other Asians, the point estimates are also well below the total population rates (except for females aged 65+, where the rates are similar), but the differences are not statistically significant, perhaps reflecting small numbers.
Ischaemic heart disease mortality is significantly higher in Indians than in Chinese and Other Asians for most age-by-sex groups.
Stroke
Stroke refers to the sudden onset of neurological deficit caused by an interruption of the brains blood supply. Stroke can be divided into two main types: cerebral infarct (associated with blockage of arteries) and cerebral haemorrhage (associated with haemorrhage into the brain). These types are not differentiated in the selected indicators, however.
Table 18: Age-specific rate (per 100,000) of stroke hospitalisation (19992003) and mortality (19982002), by ethnic group and sex
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleStroke hospitalisation(4564 years)159.2(123.9201.5)129.1(99.9164.3)392.2(321.1474.3)233.5(177.3301.8)410.0(330.5502.8)162.2(119.2215.7)296.9(289.5304.5)226.4(220.0233.0)Stroke hospitalisation(65+ years)1002.2(842.01184.0)948.5(797.91119.3)1814.6(1462.82225.4)1725.1(1397.32106.6)1432.5(1069.91878.5)1407.6(1101.41772.7)1587.5(1562.61612.6)1337.9(1317.81358.2)Stroke mortality(4564 years)23.1(11.142.4)9.8(3.222.8)20.1(6.547)26.7(9.858.2)26.6(24.428.9)24.0(22.026.2)Stroke mortality(65+ years)377.6(282.0495.2)426.8(328.0546.1)473.4(303.3704.3)413.3(262.0620.1)220.4(95.1434.2)469.2(300.6698.1)480.5(466.9494.4)622.6(608.9636.5)Source: New Zealand Health Information Service, Ministry of Health
Stroke hospitalisations
Figure 34: Standardised rate ratios* for stroke hospitalisation, by Asian ethnic group, age and sex, 19992003
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
In the 45 to 64 years age group, stroke hospitalisation is significantly higher for Other Asian and Indian males than for the total population.
In both age groups, stroke hospitalisation is lower for Chinese males and females than for Indian or Other Asian ethnic groups and the total New Zealand population.
In the 65+ years age group, stroke hospitalisation is significantly higher for Indian males and females and Other Asian females than for the total population.
Stroke mortality
Figure 35: Standardised rate ratios* for stroke mortality, by Asian ethnic group, age and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
With the exception of Other Asian males, in the 45 to 64 years age groups stroke mortality may be lower for all Asian ethnic groups than the total population (although confidence intervals include 1, perhaps reflecting small numbers).
Stroke mortality in the 65+ years age group may be slightly higher for Indian and Other Asian females than for the total population, although the differences are again not statistically significant.
This pattern is reasonably consistent with the hospitalisation pattern, although the Chinese ethnic group appears to have similar stroke mortality rates yet lower stroke hospitalisation rates than the national average.
Diabetes
Diabetes is a heterogeneous collection of metabolic disorders characterised by raised blood glucose levels. Most diabetics (8590% in New Zealand) have type 2 diabetes. Type 2 diabetes usually develops in adults who are overweight or obese. Hospitalisation and mortality rates for diabetes are not used as indicators in this report, because of coding issues (many such events are coded to the proximate cause, such as IHD, rather than to diabetes as the underlying cause). Instead, the burden of diabetes is indexed through its prevalence.
The indicator used in this report is self-reported doctor-diagnosed diabetes, with the data being sourced from the 2002/03 New Zealand Health Survey. Measured prevalence would be preferable to self-reported prevalence, because many people living with diabetes are unaware of their condition; however, such data are not currently available. It should be borne in mind that measured prevalence may be one-third or more higher than the self-reported prevalence shown below.
Table 19: Prevalence (per 100) of self-reported diabetes, by Asian ethnic group, 15+ years, 2002/03
ChineseIndianOther AsianDiabetes (self-reported)3.4(0.66.3)9.4(3.915)5.7(1.89.6)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: Sexes have been pooled because of small numbers.
Figure 36: Standardised rate ratios* for self-reported diabetes prevalence, by Asian ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: Age-standardised to WHO world population (15+ years); sexes pooled because of small numbers.
* The reference group (rate ratio = 1) is the total New Zealand population.
The prevalence of self-reported diabetes is over three times higher for Indian people than for the total population, a statistically significant result.
Chinese and Other Asians also have higher point prevalence estimates of self-reported diabetes than the total population, but these differences are not statistically significant, perhaps reflecting small numbers.
Possibly for the same reason, differences between the Chinese or Other Asian ethnic groups and the Indian ethnic group are not statistically significant, although the point estimate is higher for the latter group.
Cancer
Cancer is a major cause of premature mortality and disability for all ethnic groups, and cancer control is a high priority within the New Zealand Health Strategy (Ministry of Health 2000).
This section looks at all cancers combined, lung cancer (a proxy for smoking-related cancers), non-lung cancer (a proxy for non-smoking-related cancers), and two specific cancers of particular importance for the Asian ethnic groups: breast cancer and stomach cancer. Cancer registrations and mortality are used as indicators.
All cancer
Table 20: Age-specific rate (per 100,000) of all cancer registrations (19972001) and mortality (19982002), by ethnic group and sex
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleAll cancer registrations(2544 years)32.4(20.149.5)89.5(70.4112.2)54.5(36.578.3)80.1(57.9107.8)63.4(43.689.0)87.9(68.7110.9)100.6(96.8104.5)172.7(168.0177.6)All cancer registrations(4564 years)270.0(223.3323.6)266.1(223.3314.8)185.0(137.3243.9)310.0(244.6387.4)343.1(270.8428.9)414.1(343.3495.1)652.4(641.3663.6)701.8(690.5713.3)All cancer registrations(65+ years)1060.3(895.31246.9)806.2(667.9964.8)1104.5(834.41434.3)700.8(498.3958)2011.0(1576.32528.6)1446.7(11361816.2)3047.6(3013.13082.3)1685.6(16631708.4)All cancer mortality(2544 years)17.0(8.530.4)21.5(12.734.0)11.3(4.124.6)18.6(8.934.2)3.8(0.513.9)21.1(12.333.7)24.1(22.326.0)33.9(31.836.1)All cancer mortality(4564 years)106.1(77.7141.6)82.2(59.2111.1)81.4(51.0123.2)100.6(65.1148.6)129.2(86.5185.6)120.8(84.1168.0)239.3(232.6246.1)228.7(222.3235.3)All cancer mortality(65+ years)631.8(506.1779.3)460.7(357.8584.1)631.2(431.7891.0)521.1(349.0748.4)1239.7(904.21658.8)782.0(558.71064.9)1524.2(1499.91548.9)987.2(969.91004.7)Source: New Zealand Health Information Service, Ministry of Health
All cancer registrations
Figure 37: Standardised rate ratios* for all cancer registrations, by Asian ethnic group, age and sex, 19972001
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
Cancer registration rates are significantly lower for all Asian ethnic groups than the total population in all age groups (with the single exception of Other Asian females aged 65+).
Among the Asian ethnic groups, Other Asians have significantly higher cancer registration rates than Chinese or Indian ethnic groups from middle age onwards (both sexes).
All cancer mortality
Figure 38: Standardised rate ratios* for all cancer mortality, by Asian ethnic group, age and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
Cancer mortality is lower in all the Asian ethnic groups than in the total population, for both sexes and all age groups, although the differences are not all statistically significant.
Among the Asian ethnic groups, Other Asians have a higher cancer mortality rate than Chinese and Indians (both sexes) although again the differences are mainly not statistically significant.
Lung cancer
Lung cancer is the major tobacco-associated cancer. Almost 90% of lung cancer may be attributable to smoking. Lung cancer is used in this report as a proxy for tobacco-attributable cancers.
Table 21: Age-specific rate (per 100,000) of lung cancer registrations (19972001) and mortality (19982002), by ethnic group and sex
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleLung cancer registrations(65+ years)188.8(123.3276.7)94.9(51.9159.1)98.6(32.0230.1)330.6(170.8577.5)195.5(93.8359.5)353.7(342.0365.7)160.4(153.5167.5)Lung cancer mortality(65+ years)196.1(129.2285.3)101.6(56.9167.6)440.8(251.9715.8)78.2(21.3200.2)330.8(319.5342.3)155.9(149.1163.0)Source: New Zealand Health Information Service, Ministry of Health
Lung cancer registrations
Figure 39: Standardised rate ratios* for lung cancer registrations, by Asian ethnic group and sex, 65+ years, 19972001
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (65+ years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Lung cancer registrations are significantly lower for Chinese and Indian males (and almost so for Chinese females) than for the total population.
Among the Asian ethnic groups, the age-standardised lung cancer registration rate is higher for Other Asian than Chinese and Indian ethnic groups (both sexes), although the differences are not statistically significant at the 5% level.
Lung cancer mortality
Figure 40: Standardised rate ratios* for lung cancer mortality, by Asian ethnic group and sex, 65+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (65+ years). SRR could not be calculated for the Indian ethnic group because of small numbers.
* The reference group (rate ratio = 1) is the total New Zealand population.
Lung cancer mortality is 1.5 times higher for Other Asian males than for the total population, a difference that is borderline significant.
Chinese males have an age-standardised lung cancer mortality rate that is borderline significantly lower than the total population, and almost so for Chinese females.
Non-lung cancer
Non-lung cancer is used in this report as a proxy for cancers not caused by tobacco use or exposure to second-hand smoke.
Table 22: Age-specific rate (per 100,000) of non-lung cancer registrations (19972001) and non-lung cancer mortality (19982002), by Asian ethnic group and sex
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleNonlung cancer registrations(2544 years)29.3(17.745.8)89.5(70.4112.2)54.5(36.578.3)80.1(57.9107.8)55.7(37.380.0)87.9(68.7110.9)97.4(93.7101.2)169.6(164.9174.4)Nonlung cancer registrations(4564 years)228.5 (185.7278.1)254.4(212.5302.1)170.2(124.6227.0)301.9(237.5378.5)298.6(231.4379.2)396.8(327.6476.3)588.8(578.3599.5)653.8(642.9664.8)Nonlung cancer registrations(65+ years)871.5(722.51042.1)711.4(581.8861.2)1005.9(749.01322.6)682.8(483.2937.3)1680.4(1285.42158.6)1251.2(963.61597.8)2693.9(2661.52726.5)1525.2(1503.81546.9)Nonlung cancer mortality(2544 years)10.8(4.322.3)20.3(11.832.5)9.4(3.121.9)16.8(7.731.8)3.8(0.513.9)21.1(12.333.7)21.7(20.023.6)31.5(29.533.6)Nonlung cancer mortality(4564 years)83.1(58.2115.0)74.4(52.6102.1)74.0(45.2114.3)96.6(61.9143.8)107.0(68.5159.1)107.0(72.7151.8)187.1(181.2193.1)189.1(183.2195.1)Nonlung cancer mortality(65+ years)435.7(332.5560.9)359.1(269.0469.7)572.0(383.1821.5)485.2(319.7705.9)798.9(5351147.4)703.8(492.9974.4)1193.5(1172.01215.3)831.2(815.4847.3)Source: New Zealand Health Information Service, Ministry of Health
Non-lung cancer registrations
Figure 41: Standardised rate ratios* for non-lung cancer registrations, by Asian ethnic group, age and sex, 19972001
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
Non-lung cancer registration rates are significantly lower in all Asian ethnic groups, across all age-by-sex groups, than in the total population (with the exception of Other Asian females aged 65+).
In the 65+ age group, cancer registrations are significantly higher among Other Asian females than in Chinese and Indian females.
Non-lung cancer mortality
Figure 42: Standardised rate ratios* for non-lung cancer mortality, by Asian ethnic group, age and sex, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised within age categories to WHO world population.
* The reference group (rate ratio = 1) is the total New Zealand population.
Non-lung cancer mortality is lower in all Asian ethnic groups than in the total population for all age-by-sex groups, again with the exception of older Other Asian females (who have a similar rate to the all New Zealand average).
Among older women, Other Asians have a significantly higher non-lung cancer mortality rate than Chinese women.
Duration of residence
All cancer mortality by duration of residence
Figure 43: Age-standardised rate (per 100,000) of all cancer mortality for Chinese, by duration of residence in New Zealand and sex, 25+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (25+ years).
Figure 44: Age-standardised rate (per 100,000) of all cancer mortality for Indians, by duration of residence in New Zealand and sex, 25+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (25+ years).
Figure 45: Age-standardised rate (per 100,000) of all cancer mortality for Other Asians, by duration of residence in New Zealand and sex, 25+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (25+ years).
For most Asian ethnic groups (except Indian males), there is a tenancy to increase in all cancer mortality when duration of residence in New Zealand increases from <5years to 59 years, but no further increase in the mortality when residence increases from59 years to 10 years or longer.
Non-lung cancer mortality by duration of residence
Figure 46: Age-standardised rate (per 100,000) of non-lung cancer mortality for Chinese, by duration of residence in New Zealand and sex, 25+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (25+ years).
Figure 47: Age-standardised rate (per 100,000) of non-lung cancer mortality for Indians, by duration of residence in New Zealand and sex, 25+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (25+ years).
Figure 48: Age-standardised rate (per 100,000) of non-lung cancer mortality for Other Asians, by duration of residence in New Zealand and sex, 25+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (25+ years).
Again there is a tenancy for non-lung cancer mortality to increase in most Asian ethnic groups except Indian males when duration of stay in New Zealand increases from <5 years to 59 years.
Breast cancer
Breast cancer is the most common cancer among females (excluding non-melanotic skin cancer), contributing to nearly one-fifth of all cancer deaths among women in New Zealand. Substantial reduction in the risk of dying from breast cancer is possible through mammography screening.
Table 23: Rate (per 100,000) of breast cancer registrations (19972001) and mortality(19982002), by Asian ethnic group
ChineseIndianOther AsianTotal populationFemale breast cancer registrations (45+ years)100.2(77.5127.5)161.2(119.2213.1)173.0(131.7223.2)292.7(286.9298.5)Female breast cancer mortality (45+ years)21.3(11.635.7)29.6(13.556.2)41.1(22.468.9)84.5(81.487.7)Source: New Zealand Health Information Service, Ministry of Health
Breast cancer registrations
Figure 49: Standardised rate ratios* for breast cancer registrations by Asian ethnic group, 45+ years, 19972001
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (45+ years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Breast cancer registrations are significantly lower than the New Zealand average for Chinese, Indian and Other Asian females.
Among the Asian ethnic groups, breast cancer registrations are significantly higher for Indian and Other Asian than Chinese females.
Breast cancer mortality
Figure 50: Standardised rate ratios* for breast cancer mortality, by Asian ethnic group, 45+years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (45+ years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Breast cancer mortality is significantly lower for Chinese and most probably Indian women than the total population. It may also be lower for Other Asian women, but the confidence interval is wide and extends well beyond 1.
Among the Asian ethnic groups, breast cancer mortality may be higher for Other Asian and possibly Indian than Chinese women. However, the differences are not statistically significant, perhaps reflecting small numbers.
Stomach cancer
Stomach cancer comprises two distinct sub-types: cancer of the body of the stomach (related to Helicobacter pylori infection and the use of salt as a food preservative) and cancer of the oesophago-gastric junction (related to gastro-oesophageal reflux disease). A proportion of stomach cancers also display a familial (genetic) pattern. It is the latter that is believed to particularly affect some East Asian families. Due to data restrictions, all types of stomach cancer have been combined here.
Table 24: Rate (per 100,000) of stomach cancer registrations (19972001) and mortality (19982002), by Asian ethnic group and sex
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleStomach cancer registrations(45+ years)22.8(12.138.9)27.3(16.243.2)65.2(38.0104.4)38.5(36.340.8)21.7(20.223.4)Stomach cancer mortality(45+ years)12.3(4.925.3)16.7(8.329.9)15.6(5.136.3)34.5(15.865.5)31.2(29.233.2)17.0(15.618.4)Source: New Zealand Health Information Service, Ministry of Health
Stomach cancer registrations
Figure 51: Standardised rate ratios* for stomach cancer registrations, by Asian ethnic group and sex, 45+ years, 19972001
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (45+ years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Stomach cancer registrations are significantly higher for Chinese females and Other Asian males than for the total population.
The rates for Indian are uncertain due to small numbers.
Stomach cancer mortality
Figure 52: Standardised rate ratios* for stomach cancer mortality, by Asian ethnic group and sex, 45+ years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (45+ years).
* The reference group (rate ratio = 1) is the total New Zealand population.
Stomach cancer mortality is higher for Chinese females than for the national average (although the confidence interval just includes 1).
With the exception of Chinese, stomach cancer mortality is higher in Indian and Other Asian males than in their female counterparts (although again rate estimates are highly uncertain due to small numbers).
The (possibly) increased stomach cancer risk among Chinese females in particular may reflect a familial pattern.
Fall-related injury
Fall-related injuries among older people are a major cause of morbidity and mortality in this age group, both in New Zealand and throughout the developed world. This indicator has been selected to reflect the health of older people specifically, although this age group is also represented in the other adult indicators presented earlier in this report. Two sub-indicators are included, namely falls-related hospitalisations and deaths.
Table 25: Rate (per 100,000) of fall-related injury hospitalisations (19992003) and mortality (19982002), by ethnic group
ChineseIndianOther AsianTotal populationFalls injury hospitalisation(65+ years)31.5(14.459.9)56.4(20.7122.8)56.4(53.359.6)Falls injury mortality(65+ years)21.0(7.745.8)57.2(18.6133.4)48.9(46.151.9)Source: New Zealand Health Information Service, Ministry of Health
Fall-related injury hospitalisations
Figure 53: Standardised rate ratios* for fall-related injury hospitalisations, by Asian ethnic group, 65+ years, 19992003
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (65+ years).
* The reference group (rate ratio = 1) is the total New Zealand population.
There is no significant difference in fall-related injury hospitalisations between Asian ethnic groups and the total population. However, the point estimates for Chinese and possibly Other Asian, but not Indian, ethnic groups suggest that rates may in fact be lower in these groups (confidence intervals are wide, reflecting small numbers).
Falls injury mortality
Figure 54: Standardised rate ratios* for falls injury mortality, by Asian ethnic group, 65+years, 19982002
Source: New Zealand Health Information Service, Ministry of Health
Note: Age-standardised to WHO world population (65+ years).
* The reference group (rate ratio = 1) is the total New Zealand population.
There is no significant difference in fall-related mortality between Asian ethnic groups and the total population, although the rate ratio for Other Asians is almost significant.
Note that the falls mortality and hospitalisation rates are reasonably consistent for Chinese and Indian ethnic groups, but less so for the Other Asian group.
Summary
Indian males and females have significantly higher cardiovascular disease hospitalisation and mortality rates than the total population. While not unexpected, this represents a major finding of this report.
There is a clear dose-response relationship* between duration of residence in New Zealand and cardiovascular disease mortality among Chinese and Other Asian ethnic groups (both sexes) and among Indian females.
Ischaemic heart disease hospitalisation is significantly higher for Indian males and females across all age groups than the total population.
Ischaemic heart disease mortality is significantly higher in Indian females than in their Chinese and Other Asian counterparts.
In the 45 to 64 years age group, stroke hospitalisation is significantly higher for Other Asians than for the total population.
The prevalence of self-reported diabetes is over three times higher for Indian people than for the total population. Again, this is not unexpected, but remains a major finding of this report.
Cancer registrations and mortality rates in the 25 to 44 and 45 to 64 years age group are lower than the total population for all Asian ethnic groups.
Stomach cancer registrations are significantly higher for Chinese females and Other Asian males than for the total population. This finding may reflect familial factors.
Breast cancer registrations are significantly lower for Chinese, Indian and Other Asian females than for the total population. Breast cancer mortality is also significantly lower for Chinese women, and most probably also for Indian and Other Asian women (although the difference does not quite reach conventional levels of statistical significance for these groups).
* That is, the longer the duration of residence in New Zealand, the higher the rate.
Asian Health Website
One-stop health website for Asian people launched
The Asian health website HYPERLINK "http://www.asianhealth.govt.nz" www.asianhealth.govt.nz was successfully launched on 29 June 2005. With an easy-to-remember web address, the website will allow health professionals and the community to find and download health fact-sheets and information about health services and service providers. Information is currently available in English and Asian languages, such as Chinese, Hindi, Korean, Vietnamese, Khmer and Japanese.
This initiative is an attempt to improve access to health services for the Asian community, says Janet Chen of Auckland Regional Public Health Service. Links to important local and international websites are also offered to the community.
At initial set-up, as many as 40 organisations in the Auckland region have contributed information to the Asian health website. The website will be updated regularly and expanded as more information becomes available. This project is a response to what the Asian community has told the Asian Public Health Project in 2003. The development of the website was confirmed following the Asian Health Information Needs Analysis in early 2004.
Posters about the website in English and Chinese are available at: Auckland Regional Public Health Service, Cornwall Complex Resource Centre (phone: 09 623 4600 extension 27188).
Update: During the period of 20 June to 16 September 2005, there were 23,844 total hits to the website, with 8163 total page views, including an average of 91 page views per day and 9.36 average page views per visitor.
If you have any information you think is suitable for the website, please contact:
Janet ChenAsian Public HealthAuckland Regional Public Health ServicePhone: 09 623 4600 x 27193Fax: 09 623 4633Email: HYPERLINK "mailto:JanetChen@adhb.govt.nz" JanetChen@adhb.govt.nz
Chinese New Settlers Services Trust
Chinese New Settlers Services Trust (CNSST) is a charitable trust that offers culturally and linguistically appropriate services to both Chinese new settlers and the community. Activities, in partnership with local and central government, NGOs and the community, include social services case work, English and Chinese language education, cultural and social maintenance activities, as well as employment assistance and education. Services and programmes are available to all people in New Zealand who are Chinese-speaking or have Chinese cultural background (regardless of country of origin, religion, age or gender).
The vision of the Trust is to meet the needs of the Chinese elderly, children and young people, and all other new settlers, and to facilitate the successful integration of Chinese new settlers into the wider New Zealand society.
CNSST runs safety workshops (eg, Injury Prevention, Tai Chi, and WaterSafety). Road Safety projects offer translation, media safety messages and educational seminars and have recently been awarded a Community Safety Award from the Auckland City Council. Excellent outcomes have been achieved in the learner and restricted licensing workshops, with a 99% success rate to date. The social work component of the Trust enables Chinese new settlers facing difficulties in their settlement to access community and government resources, and empowers them to make positive changes.
Contact details:
Chinese New Settlers Services Trust2nd floor, PGF Building, 128 Khyber Pass RoadNewmarket, AucklandPO Box 8822 Symonds Street, AucklandPhone: 09 355 0008Fax: 09 355 0003Email: HYPERLINK "mailto:info@cnsst.org.nz" info@cnsst.org.nzWebsite: HYPERLINK "http://www.chineseservice.org.nz" www.chineseservice.org.nz
Promoting Health in Asian Communities
The Asian Network Incorporated (TANI) was set up with the vision of developing strong and healthy Asian communities through advocating for and promoting the wellbeing of these communities. TANI offers knowledge, networks and skills that are culturally appropriate for Asian communities and agencies which serve them.
TANI has been involved in many key initiatives over the past five years addressing the health needs of Asian communities in the Auckland region. These include implementing the TB Awareness Programme with the Indian community to raise awareness about tuberculosis and encourage people to seek early treatment; organising the Asian Cultural Competency Workshop: Asian cultures and values in public health and publishing Asian Health in Aotearoa: An analysis of the 20022003 New Zealand Health Survey. Services delivered by TANI include:
health promotion, community development and behavioural change
identifying the changing health needs of Asian communities
providing culturally specific knowledge and advice
meeting Asian health workforce needs
sharing health information
For more information, please contact:
Phone: 09 815 7851Fax: 09 815 7852Email: HYPERLINK "mailto:asian_network@xtra.co.nz" asian_network@xtra.co.nzWebsite: HYPERLINK "http://www.asiannetwork.org.nz" www.asiannetwork.org.nz
Section 4: Health Services Utilisation
Hospitalisation rates for selected high-admission conditions have been reported in the previous chapter as health outcome indicators. Here we focus on the utilisation of primary health care services, and clinical preventive services in particular, as indicators of access to the health care system more generally.
Crude rates are presented first, as in earlier chapters. However, rather than then presenting age-standardised rate ratios for comparative purposes, we have built multivariable regression models instead. This allows us to compare rates for each Asian ethnic group with a reference group (for technical reasons, this is now the European rate rather than the all New Zealand rate), controlling not only for differences in age and sex, but also deprivation and (in some models) duration of residence in New Zealand.
Primary health care services
Primary care is defined as care that a person can access without a referral and is generalist in nature. We first consider indicators relating to the utilisation of primary health care services in general, followed by indicators capturing the uptake of clinical preventive services.
Use of primary care services
Four sub-indicators are used: having a usual carer; self-reported use of conventional providers; self-reported visit to a dentist; and self-reported use of complementary/ traditional providers.
Table 26: Prevalence (per 100) of self-reported primary care services, by Asian ethnic group and sex, 15+ years, 2002/03
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleUsual carer57.0(45.368.7)80.6(73.987.3)84.9(77.892.1)84.0(75.292.8)84.4(75.193.8)85.2(75.894.5)Been to the doctor48.8(39.158.4)70.3(62.777.8)73.6(63.184.1)74.5(64.184.9)66.0(54.977.1)70.6(60.281.1)Been to a dentist17.0(10.523.5)21.9(15.528.2)23.5(10.736.4)32.5(20.444.5)32.9(21.943.9)25.6(16.434.9)Complementary/ alternative provider use8.2(3.513.0)19.9(13.426.5)8.3(2.713.9)9.6(3.216.1)6.9(1.312.6)12.0(5.418.5)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: The crude rate for the total population has not been presented so as to avoid invalid comparisons.
Usual carer
Figure 55: Multivariate odds ratio* of having a usual carer, by ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group is the European ethnic group.
Controlling for age, sex and deprivation, Chinese, Indian and Other Asian people appear less likely to have a usual carer than Europeans.
After controlling for duration of residence in New Zealand, this association remains significant for Chinese people only.
Table 27: Multivariate odds ratios having a usual carer, by duration of residence in New Zealand, 15+ years, 2002/03
Duration of residenceOdds ratio(95% CI)< 5 years0.29(0.190.44)59 years1.31(0.742.31)> 10 years and New Zealand born1.00Source: 2002/03 New Zealand Health Survey, Ministry of Health
Controlling for Asian ethnicity, age, sex and deprivation, Asian people who have lived in New Zealand less than five years are significantly less likely to have a usual carer than those who have lived in New Zealand for 10 or more years or who were born here.
Been to a doctor
Figure 56: Multivariate odds ratio* of having been to a doctor in the last 12 months, by ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: Model 1: controls for age, sex and deprivation.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, sex and deprivation, Chinese, Indian and Other Asian people are less likely to have seen a doctor in the last 12 months than Europeans.
Duration of residence is not included because the model including this variable did not fit the data well.
Been to a dentist
Figure 57: Multivariate odds ratio of having been to a dentist in the last 12 months, by ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, sex and deprivation, all Asian ethnic groups are less likely to have seen a dentist than Europeans.
Duration of residence is not associated with the use of dental services.
Complementary/alternative provider
Figure 58: Multivariate odds ratio* of having seen a complementary/alternative provider in the last 12 months, by ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Chinese, Indian and Other Asian people are significantly less likely to report having seen an alternative/complementary provider than Europeans, after controlling for age, sex and deprivation.
Duration of residence in New Zealand is not associated with use of complementary/ alternative providers.
Summary
Among the Asian ethnic groups, Chinese are less likely than New Zealand Europeans to have a usual carer (after controlling for age, sex, deprivation and duration of residence in New Zealand).
All Asian ethnic groups are significantly less likely to have been to a doctor in the last 12 months than New Zealand Europeans.
All Asian ethnic groups (both sexes) are less likely to have seen a complementary/ alternative provider than the New Zealand European ethnic group (after controlling for age and deprivation).
Clinical preventive service use
Clinical preventive services are preventive services delivered to individuals within a primary health care setting, such as immunisation, well child care, contraception, antenatal care and many screening programmes.
Two sub-indicators are included in this report: uptake of the organised cancer screening programmes, and uptake of (opportunistic) cardiovascular screening.
Cancer screening
Formal screening programmes for cervical cancer using cytology, and breast cancer using mammography, currently operate in New Zealand.
Mammography
Table 28: Rate (per 100) of uptake of breast cancer screening (5064 years), by ethnic group, 2001/02
ChineseIndianOther AsianTotal populationMammography (5064 years)57.0(55.258.9)57.5(54.960.3)56.4(53.859.1)66.8(66.467.1)Source: National Screening Unit, Ministry of Health
Figure 59: Multivariate odds ratio* of having a mammogram, by ethnic group, 5064 years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for deprivation. Controlling for duration of residence in addition to deprivation did not fit the data well and so is not reported here.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for deprivation, there is no significant association between ethnicity and screening mammography uptake for all Asian ethnic groups, although point estimates are below unity in all cases. Note that the confidence intervals are very wide, reflecting relatively small numbers.
Cervical cancer screening
Table 29: Crude rate (per 100) of uptake of cervical screening, by ethnic group, 20012003
Cervical smear coverage (%)AgeChineseIndianOther AsianTotal population2069 years52.5(51.753.2)64.6(63.465.7)44.6(43.845.4)73.0(72.673.1)Source: National Screening Unit, Ministry of Health
Figure 60: Multivariate odds ratio* of having a cervical smear, by ethnic group, 20-69 years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age and deprivation; model 2: controls for age, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, deprivation and duration of residence, women in all Asian ethnic groups are significantly less likely to have had a cervical smear than European women.
Uptake of cervical screening increases in all Asian ethnic groups with duration of residence in New Zealand.
Table 30: Multivariate odds ratio of having a cervical smear, by duration of residence in New Zealand, 15+ years, 2002/03
Duration of residenceAll Asian women< 5 years0.37(0.250.53)59 years0.94(0.531.68)10+ years and New Zealand born1.00Source: 2002/03 New Zealand Health Survey, Ministry of Health
Controlling for Asian ethnicity, deprivation and age, there is a statistically significant association between duration of residence and participation in cervical screening by Asian women, comparing recent migrants (<5 years) with the established community (10 or more years or born in New Zealand).
Cardiovascular screening
Three indicators of opportunistic cardiovascular screening have been selected for this report, with the data source being the 2002/03 New Zealand Health Survey: having had a blood pressure test, a cholesterol test or a diabetes test within the previous 12months. Because the data are self-reported, their accuracy is questionable and underestimation is likely.
Table 31: Prevalence (per 100) of self-reported cardiovascular screening, by Asian ethnic group and sex, 15+ years, 2002/03
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleBlood pressure test33.6(22.544.7)38.8(30.746.9)45.1(32.357.9)49.3(37.561.2)30.4(19.241.7)37.1(25.948.2)Cholesterol test18.7(9.328.1)19.3(12.925.7)36.5(23.849.1)25.7(14.537.0)26.7(16.137.3)18.3(8.728.0)Diabetes test17.0(8.925.2)19.5(13.125.8)39.4(25.952.9)28.8(18.039.7)14.6(7.122.2)17.6(8.326.9)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: The crude rate for the total population has not been presented so as to avoid invalid comparisons. Self-reported data on CVD screening are not very well reported.
Blood pressure test
Figure 61: Multivariate odds ratio* of having a blood pressure test, by ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, sex and deprivation, Chinese and Other Asians but not Indians appear less likely to self-report having had a blood pressure test than Europeans.
After controlling for duration of residence in New Zealand, this association remains statistically significant for Other Asians and becomes borderline significant for Chinese.
Cholesterol test
Figure 62: Multivariate odds ratios* of having a blood cholesterol test, by ethnic group, 15+years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
After controlling for age and sex, Indians appear more likely to self-report having had a blood cholesterol test in the past 12 months than Europeans. This association strengthens after duration of residence is controlled for.
After controlling Asian ethnicity, shorter duration of residence (<5 years vs 10 years or more and New Zealand-born) may be associated with less likelihood of reporting a blood cholesterol test (OR 0.70, 0.461.06) among Asian New Zealanders, but the difference does not quite reach the conventional threshold of statistical significance.
Diabetes test
Figure 63: Standardised rate ratios* for having a diabetes test in the last 12 months, by Asian ethnic group and sex, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Age-standardised to WHO world population (15+ years). Multiple logistic regression models did not fit the data well and so standardised rate ratios are reported instead.
* The reference group (rate ratio = 1) is the total New Zealand population.
Indian males and females are more likely to report having been tested for diabetes than the total population.
Chinese and Other Asians are as likely to report having been tested for diabetes as the total population.
This suggests a good understanding among primary health care providers and the communities themselves of the higher rate of diabetes among people of Indian ethnic groups.
Summary
Women of all Asian ethnic groups have a lower mammography screening uptake to New Zealand European women, although confidence intervals are very wide and the difference does not reach statistical significance.
All of the Asian ethnic groups have a lower rate of cervical screening than New Zealand European women (much lower for Chinese and especially Other Asian women).
Indians are significantly more likely to have had a cholesterol test than New Zealand Europeans.
Indian males and females are more likely to report having been tested for diabetes in the past 12 months than the total population.
Well Womens Nursing ServiceAsian Health Services
Well Womens Nursing Service (WONS) employs Chinese and Korean health promoters to provide health promotion services on a range of womens health issues.
Free cervical smear clinics are available in all areas of Auckland. Chinese and Korean health promoters work with nurses in the Howick, Epsom and Otahuhu clinics. Free smear tests are offered to women who:
have never had a cervical smear test
have had no cervical smear test in the last five years
are due to have a cervical smear test and have a Community Services Card.
These Asian health promoters also offer education sessions on a range of womens health issues.
WONS provides womens health days on a regular basis to the Chinese and Korean community, promoting cervical and breast screening; and providing education on issues such as period problems, premenstrual syndrome, menopause, osteoporosis and pelvic floor exercises. Random blood testing for glucose and cholesterol levels, blood pressure checks and cervical smear tests are also included. This holistic approach enables women to have a wellness check and receive education in a language appropriate and friendly manner provided by female staff.
Chinese Womens Health Day
In addition, WONS supports the Chinese and Korean Womens Wellness Community Groups with fundraising for resources that are language and culturally appropriate. Currently, these include resources on periods, premenstrual syndrome, menopause, cystitis, contraception, sexually transmitted infections, termination of pregnancy, and osteoporosis. Indian-language resources only cover osteoporosis.
The Korean Womens Wellness Community Group has produced a contraception and sexuality education resource, currently available in the community through donations.
For more information, please contact:
Phone: 09 523 0263Fax: 09 523 0264Email: HYPERLINK "mailto:wonsnurse@xtra.co.nz" wonsnurse@xtra.co.nzWebsite: HYPERLINK "http://www.wellwomensnursing.co.nz" www.wellwomensnursing.co.nz
Waitemata DHBs Asian Health Support Service
The response of Waitemata District Health Board (DHB) to Asian migrant and refugee health care needs led to the establishment of Asian Health Support Service (AHSS) in 2001. An Asian responsiveness strategy was developed to ensure health services delivered by Waitemata DHB services are accessible, culturally appropriate, effective and safe for this group of service users. The goals are:
Goal 1: to deliver services that are more responsive, accessible and culturally appropriate for the Asian population
Goal 2: to collaborate with communities and other agencies to achieve better health outcomes, improve communication, reduce inequalities and remove cultural barriers
Goal 3: to provide access to resources and Interpreters for Waitemata DHB health professionals
Goal 4: to provide cultural training for staff and develop appropriate resources to improve cultural awareness.
The service model was designed to address the access and information needs of Asian new settlers, and to provide support to health care providers (primary and secondary health care services). Services, programmes and initiatives developed since 2001 include:
Waitemata Auckland Translation and Interpreting Service operating 24 hours a day, seven days a week)
culturally responsive services: Asian Home Help Service and Asian Needs Assessment Service
iCare programme providing information and advice
iCare Volunteer Programme (North Shore and Waitakere sites), providing patient support services
patient education, in Chinese and Korean languages (diabetes, stroke, falls prevention for elderly)
translation of pamphlets, patient information and articles
community engagement, development and awareness projects
intranet/internet development ( HYPERLINK "http://www.asianhealthservices.co.nz" www.asianhealthservices.co.nz) with English and Chinese versions (Korean version under way)
Workforce Training/Development Project
Cultural Perspective on Asian Patient Care Workshops for health professionals
Asian Mental Health Interpreters Workforce Development Project
health promotion projects.
For more information, please visit our website: HYPERLINK "http://www.asianhealthservices.co.nz" www.asianhealthservices.co.nz.
Phone: 09 442 3219Fax: 09 486 8307Email: HYPERLINK "mailto:sue.lim@waitematadhb.govt.nz" sue.lim@waitematadhb.govt.nz HYPERLINK "http://www.asianhealthservices.co.nz" www.asianhealthservices.co.nzSection 5: Risk and Protective Factors
Risk and protective factors are the proximal or downstream causes of the diseases and injuries that ultimately determine health outcomes. Monitoring exposure of the population to these risks is therefore critical for planning health promotion and disease and injury prevention services: the risk factors of today are the diseases of tomorrow.
At the same time, we need to recognise that biological states and lifestyle behaviours are in turn shaped by the social context in which they are embedded, including cultural norms and economic realities. To ignore this is to risk victim blaming and stereotyping, which could result in counterproductive policies leading to widening health inequalities.
Here, however, we focus on key biological risk factors (high blood cholesterol, high blood pressure and bodyweight); and on key lifestyle behaviours (physical activity, dietary pattern and tobacco use). Diabetes could be considered another biological risk factor, but instead is included under Section 2 of this report (ie, as a disease).
Once again, we present crude risk factor prevalences, followed by multivariable odds ratios.
Biological risk factors
Three biological risk factors are presented in this section: high cholesterol, high blood pressure, and overweight and obesity.
High cholesterol and high blood pressure
Table 32: Prevalence (per 100) of self-reported high cholesterol and high blood pressure, by Asian ethnic group and sex, 15+ years, 2002/03
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleHigh blood cholesterol7.7(2.213.1)9.4(3.815.1)19.2(9.029.4)10.2(3.117.2)8.9(2.915)7.1(0.613.7)High blood pressure8.5(2.814.1)7.0(2.311.7)19.3(9.429.2)9.4(2.216.6)6.4(1.511.3)10.5(3.118.0)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: The crude rate for the total population has not been presented so as to avoid invalid comparisons. Overweight and obesity prevalence rates are not included in the table due to their complexity (see later).
High cholesterol
Figure 65: Multivariate odds ratios* of self-reporting high blood cholesterol, by Asian ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, sex, deprivation and duration of residence, there is no statistically significant association for self-reported high cholesterol between Asian ethnic groups and Europeans (although the multivariable odds ratio is almost significant for Indians after controlling for duration of residence).
Table 33: Multivariate odds ratios of having high blood cholesterol, by duration of residence in New Zealand, 15+ years, 2002/03
Duration of residence in New ZealandAll Asians< 5 years0.30(0.160.57)59 years0.75(0.421.35)10+ years and New Zealand born1.00Source: 2002/03 New Zealand Health Survey, Ministry of Health
Controlling for age, sex, deprivation and Asian ethnicity, longer duration of residence is significantly related to likelihood of self-reporting high blood cholesterol (possible reflecting increasing acculturation, or a waning healthy migrant effect).
High blood pressure
Figure 65: Multivariate odds ratios* of self-reporting high blood pressure, by ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, sex and deprivation, Chinese and Other Asians appear less likely to self-report high blood pressure than Europeans. However, after controlling for duration of residence in New Zealand, these associations are no longer statistically significant.
Table 34: Multivariate odds ratios of having high blood pressure, by duration of residence in New Zealand, 15+ years, 2002/03
Duration of residence in New ZealandAll Asians< 5 years0.54(0.330.87)59 years0.46(0.250.85)10+ years and New Zealand born1.00Source: 2002/03 New Zealand Health Survey, Ministry of Health
Longer duration of residence is significantly associated with likelihood of self-reported high blood pressure (after controlling for age, sex, deprivation and Asian ethnicity). This may reflect acculturation, waning of a selection (healthy migrant) effect, or improving access to health services (leading to diagnosis of pre-existent condition).
Overweight and obesity
Excess body fat is an important modifiable risk factor for a number of chronic diseases, including type 2 diabetes, cardiovascular disease, and some cancers. Body mass index (BMI) is used as an indicator of excess weight in this report.
Obesity in adults was calculated using both the standard cut-points and the ethnic specific cut-points for Asians suggested by a WHO consultation in 2004 (WHO 2004). These cut-points are outlined in REF _Ref119988719 \h Table 35.
Table 35: Classification of overweight or obese according to BMI (kg/m)
ClassificationAsian ethnic-specific cut-pointStandard cut-pointOverweight23.024.925.029.0Obese e" 2 5 . 0 e" 3 0 . 0
T h e u s e o f d i f f e r e n t c u t - p o i n t s f o r A s i a n s i s b a s e d o n l i m i t e d d a t a , a n d t h e p r o p o s e d c u t - p o i n t s m a y b e l e s s a p p r o p r i a t e f o r I n d i a n t h a n f o r C h i n e s e o r O t h e r A s i a n e t h n i c g r o u p s . O n t h e o t h e r h a n d , r e l i a n c e o n t h e s t a n d a r d c u t - p o i n t s m a y w ell lead to underestimation of these biological states in most if not all Asian ethnic groups.
Table 36: Standard cut-point prevalence (per 100) of overweight and obesity, by Asian ethnic group and sex, 15+ years, 2002/03
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleOverweightBMI 252916.1(8.723.4)9.6(5.114.1)27.1(15.438.8)38.1(25.850.5)28.3(16.040.6)13.3(7.319.2)42.1(40.144.1)28.4(26.930.0)ObeseBMI e" 3 0 4 . 0 ( 1 . 0 7 . 1 ) 7 . 1 ( 0 . 6 1 3 . 6 ) 1 4 . 8 ( 7 . 7 2 1 . 8 ) 6 . 2 ( 0 . 4 1 2 . 1 ) 2 0 . 1 ( 1 8 . 7 2 1 . 5 ) 2 1 . 7 ( 2 0 . 3 2 3 . 2 ) S o u r c e : 2 0 0 2 / 0 3 N e w Z e a l a n d H e a l t h S u r v e y , M i n i s t r y o f H e a l t h
T a b l e 3 7 : E t h n i c - s p e c i f i c c u t - p o i n t p r e v a l e n c e ( p e r 1 0 0 ) o f o v e r w e i g h t a n d o b e s i t y , b y A s i a n e t h n i c g r o u p s a n d s e x , 1 5 + y e a r s , 2 0 0 2 / 0 3
C h i n e s e I n d i a n O t h e r A s i a n M a l e F e m a l e M a l e F e m a l e M a l e F e m a l e O v e r w e i g h t B M I 2 3 2 4 1 9 . 7 ( 9 . 6 2 9 . 8 ) 1 9 . 3 ( 1 2 . 8 2 5 . 8 ) 2 4 . 9 ( 1 3 . 0 3 6 . 9 ) 1 5 . 3 ( 6 . 0 2 4 . 6 ) 1 2 . 1 ( 4 . 9 1 9 . 4 ) 2 0 . 8 ( 1 1 . 4 3 0 . 1 ) O b e s e B M I e" 2 5 2 0 . 1 ( 1 2.128.1)10.5(6.015.1)34.2(22.246.2)52.9(41.464.3)32.7(20.345.1)19.3(10.727.9)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Overweight defined using ethnic-specific cut-points
Figure 66: Standardised rate ratios* for overweight (BMI 2324), by Asian ethnic group and sex, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Age-standardised to WHO world population (15+ years). The multiple logistic regression model did not fit the data well, so SRRs are reported instead.
* The reference group (rate ratio = 1) is the total New Zealand population.
Using the ethnic-specific BMI cut-points, Chinese and Other Asian males and Indians (both sexes) have a significantly lower prevalence of overweight than the total population.
Chinese and Other Asian females have a higher prevalence of overweight than their male counterparts (although the difference is not statistically significant).
Obesity defined using ethnic-specific cut-points
Figure 67: Multivariate odds ratios* for obesity (ethnic-specific cut-points), by ethnic group, 15+years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, sex and deprivation, Indians appear to have a higher prevalence of obesity than Europeans (although this difference has been exaggerated by the use of ethnic-specific cut-points, which may be less appropriate for the Indian than for other Asian ethnic groups). After controlling for duration of residence in New Zealand, this association gets stronger.
When duration of residence is controlled for, Other Asians appear to have a slightly higher prevalence of obesity than Europeans.
These results suggest that Asian people (other than Chinese) do have higher rates of obesity than European New Zealanders if appropriate (ethnic-specific) cut-points are used to define obesity.
Duration of residence is significantly associated with likelihood of being obese (defined using ethnic-specific cut-points), suggesting that acculturation and/or waning of selection pressure is associated with weight gain in adulthood among Asian New Zealanders.
Behavioural risk factors
Two behavioural risk factors are presented in this section: alcohol consumption and tobacco consumption.
Alcohol consumption
Two indicators of alcohol use are reported here: potentially hazardous drinking, defined as an Alcohol Use Disorders Identification Test (AUDIT) score of 8 or greater; and alcohol abstention, defined as alcohol consumption less than once per year.
Hazardous drinking
Table 38: Prevalence (per 100) of self-reported hazardous alcohol consumption, by Asian ethnic group, 15+ years, 2002/03
ChineseIndianOther AsianHazardous drinking(AUDIT score > 8)2.3(0.14.5)6.8(2.011.5)5.4(1.49.4)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: The crude rate for the total population has not been presented so as to avoid invalid comparisons.
Figure 68: Standardised rate ratios* for hazardous drinking, by Asian ethnic group, 15+years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Age-standardised to WHO world population (15+ years). Multiple logistic regression model did not fit the data well, so SRRs are reported instead.
* The reference group (rate ratio = 1) is the total New Zealand population.
Chinese, followed by Indians and Other Asians, have a significantly lower prevalence of hazardous alcohol consumption than the total population.
Abstention
Table 39: Prevalence (per 100) of self-reported alcohol abstention, by Asian ethnic group and sex, 15+ years, 2002/03
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleNon-drinkers38.7(28.249.2)59.5(51.567.6)42.1(28.056.3)71.7(61.182.4)34.7(22.447.0)52.9(42.963.0)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: The crude rate for the total population has not been presented so as to avoid invalid comparisons.
Figure 69: Multivariate odds ratios* of alcohol abstinence, by ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, sex and deprivation, all Asian ethnic groups are much more likely to abstain from alcohol than Europeans (odds ratios of around 812).
After controlling for duration of residence in New Zealand, this association weakens slightly in all Asian ethnic groups.
Tobacco consumption
Tobacco smoking is the leading modifiable risk factor in New Zealand, and is responsible for approximately 18% of all deaths (Ministry of Health 2004c). Second-hand cigarette smoke is now also recognised to be a substantial health hazard (Hill et al 2004).
Three sub-indicators are presented in this section: current smoker, ex-smoker and never smoker prevalence rates.
Table 40: Prevalence (per 100) of self-reported tobacco use, by Asian ethnic group and sex, 15+ years, 2002/03
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemaleCurrent smoker (daily)20.4(12.528.2)7.0(2.411.6)18.4(9.727)20.7(11.629.8)3.9(1.26.6)Ex-smokers16.1(8.024.2)3.9(0.08.1)12.3(4.620.1)16.9(8.725.1)6.5(1.411.6)Never smokers63.5(54.672.3)89.1(82.296)69.3(57.581.1)94.3(90.897.8)62.4(52.272.6)89.6(83.795.6)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: The crude rate for the total population has not been presented so as to avoid invalid comparisons.
Current smokers
Figure 70: Multivariate odds ratio* of current smoking in males, by ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, deprivation and duration of residence in New Zealand, males in all three Asian ethnic groups are not significantly less or more likely to be current smokers than European males.
Figure 71: Multivariate odds ratios* of current smoking in females, by ethnic group, 15+years 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, deprivation and duration of residence in New Zealand, all Asian females are significantly less likely to be current smokers than European females.
Ex-smokers
Figure 72: Standardised rate ratios* for ex-smokers, by Asian ethnic group and sex, 15+years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: Age-standardised to WHO world population (15+ years).
* The reference group (rate ratio = 1) is the total New Zealand population.
The prevalence of ex-smokers is significantly lower in Chinese and Other Asian females than in the total population.
Ex-smoker prevalence is significantly lower among Indian and Other Asian males than among their national counterpart. This prevalence may also be lower among Chinese males, although for this group the difference is not significant.
Never smokers
Figure 73: Multivariate odds ratios* of never smokers in males, by ethnic group, 15+ years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Figure 74: Multivariate odds ratios* of never smokers in females, by ethnic group, 15+years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Multivariate analysis confirms that all Asian ethnic groups (both sexes) are more likely to be never smokers than New Zealand Europeans, although this difference reduces after adjusting for duration of residence. It is noted that the tobacco use indicators are not entirely consistent with the lung cancer registration and mortality rates reported earlier (pages 50-52), especially for Other Asian females. The reason for the inconsistency needs to be further investigated.
Protective factors
Physical activity
Being physically active is defined here as participating in at least 150 minutes per week of physical activity, equivalised to moderate intensity.
Physical activity can reduce the risk of many major diseases (such as cardiovascular diseases, certain cancers, diabetes, osteoporosis, obesity, and possibly depression (US Department of Health and Human Services 1996).
For benefits to health, the current recommendation is that all adult New Zealanders should do at least 30 minutes of moderate-intensity physical activity (equivalent to brisk walking) on most, if not all, days of the week (Hillary Commission 2001).
Table 41: Prevalence (per 100) of self-reported physical activity, by Asian ethnic group and sex, 15+ years, 2002/03
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemalePhysically active(150 minutes/week)66.7(58.375.0)50.5(40.960.2)68.8(59.478.3)58.0(47.169.0)72.9(62.083.7)46.4(35.857.0)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: The crude rate for the total population has not been presented so as to avoid invalid comparisons.
Figure 75: Standardised rate ratios* for physical activity, by Asian ethnic group and sex, 15+years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: Age-standardised to WHO world population (15+ years). SRRs rather than multivariate ORs are presented as the latter model
did not fit the data well.
* The reference group (rate ratio = 1) is the total New Zealand population.
Among the Asian ethnic groups, Chinese and Other Asian females are significantly less likely to participate in at least 150 minutes of physical activity per week than their total population counterparts.
Chinese and Indian males are significantly less likely to participate in physical activity than the total population.
Fruit and vegetable consumption
Recommended fruit and vegetable intakes are at least two and three servings per day, respectively (a serving is approximately 80 grams). Adequate fruit and vegetable intake protects against cardiovascular diseases and possibly certain cancers.
Table 42: Prevalence (per 100) of self-reported fruit and v e g e t a b l e c o n s u m p t i o n b y A s i a n e t h n i c g r o u p a n d s e x , 1 5 + y e a r s , 2 0 0 2 / 0 3
C h i n e s e I n d i a n O t h e r A s i a n M a l e F e m a l e M a l e F e m a l e M a l e F e m a l e 5 + a d a y ( e" 2 f r u i t s + e" 3 v e g e t a b l e s ) 2 5 . 9 ( 1 6 . 4 3 5 . 4 ) 3 9 . 8 ( 2 9 . 2 5 0 . 5 ) 2 1 . 2 ( 1 2 . 1 3 0 . 2 ) 2 3 . 0 ( 1 3 . 1 3 2 . 9 ) 2 2 . 5 ( 1 1 . 8 33.1)36.7(24.748.6)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Note: The crude rate for the total population has not been presented so as to avoid invalid comparisons.
Figure 76: Multivariate odds ratios of consuming fruit and vegetables by ethnic group, 15+years, 2002/03
Source: 2002/03 New Zealand Health Survey, Ministry of Health
Notes: Model 1: controls for age, sex and deprivation; model 2: controls for age, sex, deprivation and duration of residence in New Zealand.
* The reference group (odds ratio = 1) is the total New Zealand European population.
Controlling for age, sex and deprivation, Indians and Other Asians appear less likely to consume the recommended intake of fruit and vegetables than Europeans. However, after controlling for duration of residence in New Zealand, this association is only statistically significant for Indians (although it is almost so for Other Asians).
Summary
Longer duration of residence is significantly related to the likelihood of self-reporting high blood cholesterol and high blood pressure among Asian New Zealanders (controlling for age, sex, deprivation and Asian ethnicity).
Controlling for age, sex and deprivation, Indians appear to have a higher prevalence of obesity than New Zealand Europeans (using ethnic-specific cut-points). After controlling for duration of residence in New Zealand, this association gets stronger.
Chinese, followed by Indian and Other Asian ethnic groups, have a significantly lower prevalence of hazardous alcohol consumption than the total population.
All Asian ethnic groups are much more likely to abstain from alcohol than Europeans (controlling for age, sex and deprivation).
All Asian females are significantly less likely to be current smokers than European females (controlling for age, deprivation and duration of residence in New Zealand).
Among the Asian ethnic groups, Chinese and Other Asian females are significantly less likely to participate in at least 150 minutes of physical activity per week than their total population counterparts.
Indian and Other Asians appear less likely to consume the recommended intake of fruit and vegetables than Europeans (controlling for age, sex and deprivation).
Section 6: Socioeconomic Determinants of Health
Socioeconomic conditions are major determinants of health. Social factors acting at a collective level shape individual biology, individual risk and protective behaviours, environmental exposures, and access to resources that promote health. While public health programmes alone cannot improve the social factors that are associated with poor health outcomes, developing a better understanding of the social determinants of health is critical to reducing health disparities among Asian people of differing socioeconomic position.
This section presents seven socioeconomic determinants: deprivation, English-language competence, income, unemployment, education, means-tested benefit receipt and home ownership.
Deprivation
NZDep2001 is a small area-based index of deprivation derived from nine Census 2001 variables (ie, income, transport, living space, home ownership, employment status, qualifications, support and access to a telephone). Small area scores are usually grouped into deciles or quintiles (quintile 1=least deprived; quintile 5 = most deprived).
In the total population there is a strong association between NZDep distribution and health outcomes. This relationship is weaker, but still present, for the Asian ethnic grouping as a whole (Tobias and Yeh 2006); data are not available for each of the three Asian ethnic groups separately.
Figure 77: NZDep2001 distribution of Asian ethnic groups, 2001, percent
Source: Statistics New Zealand
Asian ethnic groups are fairly evenly distributed across the deprivation quintiles.
Chinese are moderately over-represented in quintiles 1 and 2, and under-represented in quintiles 4 and 5.
The opposite pattern is seen among the Indian ethnic group.
Figure 78: Chinese NZDep2001 distribution, by duration of residence in New Zealand, 2001, percent
Source: Statistics New Zealand
Chinese who have lived in New Zealand for less than five years are more likely to be living in the most deprived quintile of small areas than those who have lived in New Zealand for longer.
Figure 79: Indian NZDep2001 distribution, by duration of residence in New Zealand, 2001, percent
Source: Statistics New Zealand
Indians who have lived in New Zealand for less than five years are more likely to be living in the most deprived quintile of small areas than those who were born in New Zealand.
Figure 80: Other Asian NZDep2001 distribution, by duration of residence in New Zealand, 2001, percent
Source: Statistics New Zealand
Other Asians show little relationship between duration of residence in New Zealand and deprivation of small area of residence.
English-language competence
Table 43: English-language competence, by ethnic group and sex, 2001, percent
IndicatorChineseIndianOther AsianNew Zealand totalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalEnglish language, 2001, percent79.376.878.091.288.089.679.979.279.593.593.693.5Source: Statistics New Zealand
The majority of Chinese, Indian and Other Asian people speak English. This is highest for Indians (~90%), followed by the Other Asian (~80%) and Chinese (~78%) ethnic groups.
New Zealand-born Chinese have higher English-language competence than those who have lived in New Zealand for less than five years (93% vs 68%) (see Appendix3).
New Zealand-born Other Asians have higher English-language competence than those who have lived in New Zealand for less than five years (93% vs 74%) (see Appendix 3).
Income
Table 44: Low income, by ethnic group and sex, 2001, percent
IndicatorChineseIndianOther AsianNew Zealand totalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalIncome $20,000 or less, 15+years, 2001, percent59.865.863.042.856.649.752.961.157.637.955.246.9Source: Statistics New Zealand
About two-thirds of Chinese and Other Asian people have an annual income less than $20,000 compared to half the total population.
Chinese who have lived in New Zealand for less than five years are more likely to receive an income lower than $20,000 compared to New Zealand-born Chinese (see Appendix 3).
Unemployment
Table 45: Unemployment, by ethnic group and sex, 2001, percent
IndicatorChineseIndianOther AsianNew Zealand totalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalUnemployment, 15+ years, 2001, percent7.46.26.87.97.97.98.67.27.85.04.74.8Source: Statistics New Zealand
Chinese, Indian and Other Asian people have a higher unemployment rate than the total population (approximately 8% vs 5%).
New Zealand-born Chinese have a lower unemployment rate than those who have lived in New Zealand for less than five years (6% vs 8%) (see Appendix 3).
New Zealand-born Indians have a lower unemployment rate than those who have lived in New Zealand for less than five years (8% vs 11%) (see Appendix 3).
Education
Table 46: School completion, by ethnic group and sex, 2001, percent
IndicatorChineseIndianOther AsianNew Zealand totalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotal6th form certificate or higher, 15+ years, 2001, percent73.673.073.370.165.367.769.970.470.249.348.148.7Source: Statistics New Zealand
Over two-thirds of Chinese, Indian and Other Asian people have a sixth form certificate or higher, compared to half of the total population.
Benefit receipt
Table 47: Means-tested benefits, by ethnic group and sex, 2001, percent
IndicatorChineseIndianOther AsianNew Zealand totalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMeans tested benefit, 15+years, 2001, percent14.215.014.613.516.114.816.315.115.613.116.514.9Source: Statistics New Zealand
Note: Where a person reported more than one source of personal income, they have been counted in each applicable group.
The proportion of Chinese, Indian and Other Asian people receiving a means-tested benefit is similar to the proportion of the total population.
Home ownership
Table 48: Home ownership, by ethnic group and sex, 2001, percent
IndicatorChineseIndianOther AsianNew Zealand totalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotalHome ownership, 15+ years, 2001, percent36.839.438.237.937.737.825.732.029.349.952.251.1Source: Statistics New Zealand
Less than 40% of Chinese and Indian people and 30% of Other Asian people own their own home, compared to 50% of the total population.
Summary
Asian New Zealanders deprivation distribution does not differ substantively from that of the population as a whole.
Asian New Zealanders are more likely to have higher educational qualifications than the all New Zealand average.
Nevertheless, on average, incomes of Asian New Zealanders are lower than those of the total population, mainly reflecting the relatively low labour-force participation rate of recent migrants.
Overall, the unemployment rate of Asian New Zealanders is higher than the all New Zealand average (approximately 8% versus 5% in 2004).
Asian New Zealanders are no more likely than average to be receiving a means-tested benefit.
Asian New Zealanders are less likely than average to own their own homes.
English-language competence is an issue for some Chinese and Other Asians, but generally not for Indians.
The health status of Asian New Zealanders (especially Chinese) is higher than would be expected given their socioeconomic position. This Asian paradox resembles the well known Hispanic paradox in the USA (Markides and Coreil 1986) and probably likewise reflects health selection effects.
Asian New Zealanders do exhibit a socioeconomic mortality gradient, but this is shallower than those of M o r i a n d E u r o p e a n N e w Z e a l a n d e r s .
S e c t i o n 7 : C o n c l u s i o n
P e r h a p s t h e k e y c o n c l u s i o n t o e m e r g e f r o m t h i s r e p o r t i s t h e d i v e r s i t y o f h e a l t h s t a t u s , h e a l t h r i s k p r o f i l e a n d h e a l t h s e r v i c e u t i l i s a t i o n t h a t e x i s t s w i t h i n t h e A s i a n p o p u l a t i o n c a t e g o r y . T h u s monitoring of health at the level of this broad category may disguise, through averaging or masking, as much as it reveals. Beyond the conventional decompositions of age, gender and social class, our findings suggest that ethnicity and migrant status must also be taken into account.
This report reveals major differences in health outcomes and exposure to health hazards between the Chinese and Indian ethnic groups, with Other Asians generally intermediate. The relatively high rates of obesity (defined using ethnic specific cut-points), type 2 diabetes and cardiovascular disease among the Indian ethnic group is especially concerning.
The report also reveals major differences in health and health service use between recent or first-generation migrants and long-standing migrants or second and subsequent generations (ie, the established communities), similar for all three Asian ethnic groups. For almost all health indicators, recent or first-generation migrants have better health status than longstanding migrants or the New Zealand-born.
This finding is consistent with the international literature on migration and health (Harding 2003), and in part reflects health selection. First-generation Asian migrants to New Zealand are selected for health, both directly through health screening including self-screening and indirectly through selection for factors such as occupation, education and wealth, which are in turn predictive of current and to a lesser extent future health status. This applies particularly to younger migrants and to general and business migrants, but less so to family reunification migrants and negatively to refugees and asylum seekers (but these make up only a small proportion of the total migrant population). In addition to this healthy immigrant effect, there may also be a (smaller) unhealthy emigrant effect " a t e n d e n c y f o r c h r o n i c a l l y i l l m i g r a n t s t o r e t u r n t o t h e i r c o u n t r y o f o r i g i n t o d i e , f u r t h e r i n c r e a s i n g t h e a p p a r e n t g o o d h e a l t h s t a t u s o f t h e m i g r a n t p o p u l a t i o n . W i t h i n c r e a s i n g t i m e s i n c e m i g r a t i o n , s e l e c t i o n w e a k e n s a n d i s o f c o u r s e a b s e n t f r o m t h e s econd generation onwards. So, as the proportion of recent migrants/first-generation settlers in the population reduces and selection effects decrease, the average health of the Asian ethnic category will deteriorate towards the all New Zealand average (regression to the mean).
While this is to some extent inevitable, it can be partially offset (or exacerbated) by other processes, including acculturation, settlement pattern and host population response. On the one hand, acculturation may contribute to worsening health through loss of cultural buffering, including traditional cultural values, extended family support and protective dietary patterns, as well as through the adoption of unhealthy behaviours prevalent in the host population such as tobacco and alcohol use. On the other hand, acculturation may improve health through increasing English-language competence (where this is relevant), and more generally by reducing cultural barriers to employment and social service (including health service) use.
Similarly, settlement patterns can also have opposing effects on health. Thus residence in ethnic enclaves can provide strong social support, increase pride in ethnic identity and help to retain healthy traditional practices. Yet ghettoisation can reduce employment opportunities, retard English-language learning and create barriers to accessing high-quality health care. Finally, discrimination against Asian New Zealanders both interpersonal and institutional can impact severely on health (Abbott et al 2000; Harris et al 2006).
Policy implications
The information contained in this report will be used by the health sector to assist in identifying the health needs of Asian peoples in New Zealand. The Ministry of Health will use the information to assist in formulating the advice it gives to the Minister of Health on how these needs should be addressed in the future. The report may also help to inform Asian communities themselves, so that they can actively engage in debating their health needs and health service requirements. Indeed, this report may be of value beyond the Asian population itself. Understanding the advantage in health of Asian New Zealanders is as important as understanding the relative disadvantage of non-Asian New Zealanders, in that such understanding could also contribute to improvement of the latters health.
It is clear that on almost all indicators the health of Asian New Zealanders in general, and that of the Chinese ethnic group in particular, is excellent but will inevitably regress towards the mean as selection effects wane. Policy settings cannot influence this, but can ensure that acculturation impacts adaptively rather than maladaptively on Asian health (Berry 1990). This will require recognition of the diversity of the Asian population, both ethnically and generationally; full engagement of the communities themselves; and adoption of a strengths-based model for health promotion that builds on the cultural strengths of these communities.
Specific policy issues may include initiatives to reduce cultural barriers to health service access, improve the cultural safety of mainstream health services, and foster growth of Asian-specific health services (as illustrated by the story boxes included in this report) and of the Asian health workforce. Social services for new immigrants, to foster English-language competence and re-integration into the workforce in particular, are critical for further development. Health promotion efforts are needed to preserve cultural anti-smoking norms (among Asian females) and dietary practices (both sexes), and to encourage participation in culturally acceptable forms of physical activity (females especially).
Beyond fostering adaptive patterns of acculturation, policy settings can also address broader structural issues relating to the social determinants of health. These include issues relating to socioeconomic stratification (eg, recognition of overseas qualifications and work experience), and to racial discrimination (especially institutional discrimination in the housing and labour markets, and in health care). This is so despite the Asian paradox and the relatively shallow socioeconomic mortality gradient currently exhibited by Asian New Zealanders as a group.
With respect to health care policy, a key finding of this report is the relatively low utilisation of primary health (including dental) services by Asian New Zealanders (especially recent migrants) in general, and clinical preventive services such as cervical screening in particular. The early detection and effective management of type 2 diabetes (and cardiovascular risk more generally) in Indian people is clearly also a high priority. Culturally appropriate mental health services are of concern to recent migrants, and to refugees and asylum seekers in particular. The story boxes included in this report provide insights into the sorts of innovative services that can be developed. It is worth noting that use of traditional or alternative remedies/providers does not appear, from our findings, to be a valid explanation for the relatively low uptake of conventional primary health services by Asian peoples in New Zealand.
Monitoring implications
This report is a starting point. It provides a baseline for Asian health in New Zealand and will require regular updating. Public Health Intelligence has undertaken to update the report every five years. The report will continue to evolve, with new indicators being added and some existing ones being dropped, as a result of feedback from users and as new data sources become available.
It is unfortunate that no trend data could be included in this report, due to a lack of reliable historical time series for most if not all indicators. Future editions will include trend information for the indicators as such information becomes available. Hence, a key focus of future reports will be the analysis of time trends to assess progress in Asian health, and the production of projections of Asian health status, health risk profiles and health service utilisation patterns for planning and resource allocation purposes.
The value of this report (and its updates) as a monitoring tool would be further enhanced if ethnicity reporting in health information systems could be improved. The Ministrys Ethnicity Data Protocol (Ministry of Health 2004) and the new standard for ethnicity measurement developed by Statistics New Zealand (2005b) should enable a robust time series of Asian vital and health statistics to evolve. Collection and analysis of data for at least some specific ethnic groups within the Other Asian category remains a challenge for the future.
Appendix 1: Classifications and Codes
Table A1-1: Ethnic composition of Statistics New Zealand Asian category
ChineseIndianOther AsianChinese NFD
Hong Kong Chinese
Cambodian Chinese
Malaysian Chinese
Singaporean Chinese
Vietnamese Chinese
Taiwanese
Chinese NECIndian NFD
Bengali
Fijian Indian
Gujarati
Tamil
Punjabi
Sikh
Anglo Indian
Indian NECAsian NFD
Southeast Asian NFD
Filipino
Cambodian
Vietnamese
Burmese
Indonesian
Laotian
Malay
Thai
Southeast Asian NEC
Japanese
Korean
Afghani
Bangladeshi
Nepalese
Pakistani
Tibetan
Eurasian
Asian NECNotes: NEC = not elsewhere classified; NFD = not further defined.
Table A1-2: WHO standard population
Age group(years)Weighting048.80598.7010148.6015198.5020248.2025297.9030347.6035397.2040446.6045496.0050545.4055594.6060643.7065693.0070742.2075791.5080840.9085+0.60All100.00Table A1-3: ICD-9 codes used in this report
ConditionICD-9All cancer140208Stomach cancer151(Female) breast cancer174Asthma493Total cardiovascular disease (CVD)390459Ischaemic heart disease (IHD)410414Unintentional injuriesE800E949Suicide and self-harmE950E959Falls injuryE880-E886, E888
Table A1-4: Avoidable mortality ICD-9 codes
ConditionICD-9Tuberculosis*010018, 137Selected invasive bacterial and protozoal infection*034036, 038, 084, 320, 481482, 485, 681682HIV/AIDS042Hepatitis (all types)070Viral pneumonia and influenza480, 487Lip, oral cavity and pharynx cancers140149Oesophageal cancer150Stomach cancer151Colorectal cancer*153, 154Liver cancer155Lung cancer162Melanoma of skin*172Non-melanotic skin cancer*173Breast cancer*174Uterine cancer*179, 182Cervical cancer*180Bladder cancer*188Thyroid cancer*193Hodgkins disease*201Leukaemia*204.00, 204.01, 204.10, 204.11Benign tumours*210229Thyroid disorders*240246Diabetes*250Alcohol-related disease291, 303, 305.0, 425.5, 535.3, 571.0571.3, 760.8Illicit drug-use disorders292, 304, 305.2305.9Epilepsy*345Rheumatic and other valvular heart disease*390398Hypertensive heart disease*402Ischaemic heart disease*410414Cerebrovascular diseases*430438Aortic aneurysm441Nephritis and nephrosis*403, 580589, 591Obstructive uropathy and prostatic hyperplasia*592, 593.7, 594, 598, 599.6, 600Deep vein thrombosis with pulmonary embolism415.1, 451.1Chronic obstructive pulmonary disease490492, 496Asthma*493Peptic ulcer disease*531534Acute abdomen, appendicitis, intestinal obstruction, cholecystitis/lithiasis, pancreatitis, hernia*540543, 550553, 574577Cirrhosis, chronic hepatitis and other chronic liver disease571Birth defect*740759Complications of perinatal period*764779Road traffic injuries, other transport injuriesE810E819Accidental poisoningsE850E869FallsE880E886, E888Fires, burnsE890E899Drownings (swimming)E910Suicide and self-inflicted injuriesE950E959, E980E989ViolenceE960E969* These conditions are amenable to health care.
Table A1-5: Avoidable hospitalisation ICD-9 codes
ConditionICD-9Tuberculosis*010018, 137HIV/AIDS*042Skin cancers*140, 172, 173Oral cancers*141, 143146, 148149, 161Colorectal cancer*153, 154Lung cancer*162Breast cancer*174Cervical cancer*180Nutrition*260269, 280281Alcohol-related conditions*291, 303, 305.0, 425.5, 535.3, 571.0571.3Angina411.1, 411.8, 413, 786.5Gastroenteritis*001009, 558.9, 779.3, 787.0, 787.9Other infections*023, 027, 034035, 084, 770.0, 771.1771.2, 771.4771.9Immunisation preventable*032033, 037, 045, 055056, 072, 320.0, 771.0, 771.3Hepatitis and liver cancer*070, 155Sexually transmitted diseases*090099, 614.0614.5, 614.7616.9, 633Thyroid disease*240244Diabetes*250, 251.0, 251.2Dehydration*276.0, 276.5Epilepsy*345, 780.3ENT infections*381383, 461463, 472.1Rheumatic fever/heart disease*390398Hypertensive disease*276.8, 401405, 437.2Ischaemic heart disease*410, 412, 414, 411.0Congestive heart failure*428, 518.4Stroke*431, 433, 434, 436Respiratory infections*460, 465, 466.0, 480483, 485487CORD*490492, 494, 496Asthma*493Dental conditions*521523, 525, 528Peptic ulcer*531534Ruptured appendix*540Obstructed hernia*550.0550.1, 551552Kidney/urinary infection*590, 599.0Cellulitis*680686Failure to thrive*783.3783.4Gangrene*785.4Burns and scaldsE890E899DrowningE910Falls from playground equipmentE884.0, E884.5Indeterminately caused injuriesE980E989PoisoningE850E869Road traffic injuryE810E829Sports injuriesE886.0, E917.0, E927Swimming pool accidentsE883.0, E910.5, E910.6SuicideE950E959* These conditions are ambulatory sensitive (ASH).
Appendix 2: Population Pyramids
Figure A2-1: Age and sex distribution of Chinese people in New Zealand
Age Group
SHAPE \* MERGEFORMAT
Source: Statistics New Zealand
Figure A2-2: Age and sex distribution of Indian people in New Zealand
SHAPE \* MERGEFORMAT
Source: Statistics New Zealand
Figure A2-3: Age and sex distribution of Other Asian people in New Zealand
Source: Statistics New Zealand
Figure A2-4: Age and sex distribution of the total population in New Zealand
Source: Statistics New Zealand
Appendix 3: Socioeconomic Indicators, by Duration of Residence in New Zealand
Table A3-1: Chinese socioeconomic indicators, by duration of residence in New Zealand, 2001
GenderEnglish language, percentIncome $20,000 or less, 15+years, percentUnemployment, 15+years, percent6th form certificate or higher, 15+years, percentMeans-tested benefit, 15+years, percentHome ownership, 15+years, percent< 5 yearsMale68.169.69.078.113.419.6Female67.473.17.478.514.122.5Total67.871.58.278.313.821.259 yearsMale83.370.18.483.319.238.5Female78.073.66.580.818.745.2Total80.472.07.481.919.042.210+ yearsMale83.451.25.070.111.960.3Female79.659.44.267.112.462.2Total81.455.54.668.612.261.3New Zealand bornMale93.042.65.764.915.440.1Female93.350.85.665.417.940.4Total93.146.75.665.116.740.2Not specifiedMale46.638.110.238.16.020.3Female43.240.06.936.47.120.7Total45.039.08.537.46.420.4Source: Statistics New Zealand
Note: Where a person reported more than one source of personal income, they have been counted in each applicable group.
Table A3-2: Indian socioeconomic indicators, by duration of residence in New Zealand, 2001
GenderEnglish language, percentIncome $20,000 or less, 15+years, percentUnemployment, 15+years, percent6th form certificate or higher, 15+ years, percentMeans tested benefit, 15+years, percentHome ownership, 15+years, percent< 5 yearsMale88.050.410.976.912.818.0Female83.962.111.473.314.019.3Total86.056.411.275.113.418.759 yearsMale93.242.56.577.616.038.5Female87.759.26.570.219.740.5Total90.251.76.473.418.039.510+ yearsMale94.436.75.469.612.160.3Female91.153.15.061.515.159.5Total92.844.45.265.713.559.9New Zealand bornMale95.044.58.161.017.432.3Female95.054.67.160.421.035.0Total95.049.57.660.719.233.7Not specifiedMale63.630.98.340.39.724.6Female56.639.38.435.711.724.0Total60.034.98.537.810.724.1Source: Statistics New Zealand
Note: Where a person reported more than one source of personal income, they have been counted in each applicable group.
Table A3-3: Other Asian socioeconomic indicators, by length of time in New Zealand, 2001
GenderEnglish language, percentIncome $20,000 or less, 15+years, percentUnemployment, 15+years, percent6th form certificate or higher, 15+ years, percentMeans tested benefit, 15+years, percentHome ownership, 15+years, percent< 5 yearsMale74.457.49.671.313.913.8Female73.063.07.571.711.617.0Total73.660.68.471.512.615.659 yearsMale85.659.88.382.422.934.8Female84.369.36.880.021.140.6Total84.965.17.581.121.938.010+ yearsMale90.843.66.869.215.446.6Female91.457.46.071.016.657.5Total91.151.86.370.316.153.1New Zealand bornMale92.966.010.157.024.212.7Female92.266.410.062.625.514.0Total92.666.210.260.025.013.4Not specifiedMale39.725.19.128.95.77.9Female40.531.09.430.96.313.7Total40.128.49.230.06.011.1Source: Statistics New Zealand
Note: Where a person reported more than one source of personal income, they have been counted in each applicable group.
Appendix 4: Tables of Data
Table A4-1: Crude rate (per 100,000) of avoidable mortality, by duration of residence in New Zealand, Asian ethnic group and sex
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemale< 5 years72.1(54.593.6)39.2(27.354.5)116(87.2151.4)61.2(4187.8)93.6(71.6120.2)37.4(25.253.4)59 years96.2(69.9129.1)60.9(41.985.5)230.1(160.3320)114.7(71175.3)112.8(80.6153.6)67.7(45.497.3)> 10 years and NewZealand born148.2(124.7174.9)75.1(58.694.7)148.4(122.4178.2)92.7(71.7117.9)142.5(110.9180.3)92.0(69.5119.4)Source: New Zealand Health Information Service, Ministry of Health
Table A4-2: Age-standardised rate (per 100,000) of avoidable mortality, by duration of residence in New Zealand, Asian ethnic group and sex
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemale< 5 years71.6(54.192.9)45.4(31.663.1)181.6(136.4237)110.4(74158.6)181.4(138.8233)67.9(45.896.9)59 years129.3(93.9173.5)64.1(44.190.1)293.2(204.2407.8)127.1(78.7194.2)262.7(187.7357.7)114.4(76.6164.3)> 10 years and NewZealand born163.4(137.5192.8)82.5(64.4104)200.5(165.4240.9)135.0(104.4171.8)227.7(177.1288.1)131.0(99170.1)Source: New Zealand Health Information Service, Ministry of Health
Table A4-3: Age-standardised mean SF- 36 scores (Mental Health, Social Functioning scales and Vitality), by Asian ethnic groups and total New Zealand population and sex, 2003
ChineseIndianOther AsianTotal populationMaleFemaleMaleFemaleMaleFemaleMaleFemaleSF-36 Mental Health85.5(82.688.4)84.1(81.686.6)80.8(75.885.7)80.3(74.286.3)85.8(8388.5)79.4(74.784.1)84.4(83.885.0)81.6(8182.2)SF-36 Vitality scale75.1(71.678.6)70.3(66.574.1)70.2(63.377.1)68.1(63.472.8)78.0(74.182)66.4(59.373.5)67.8(66.968.7)62.4(61.663.1)SF-36 Social Functioning95.0(91.099.0)93.9(90.697.1)94.0(90.397.7)94.4(91.097.9)91.6(86.996.4)88.2(78.697.7)91.7(90.892.6)89.4(88.590.2)Source: 2002/03 New Zealand Health Survey, Ministry of Health
Table A4-4: Crude rate (per 100,000) of total cardiovascular disease mortality, by duration of residence in New Zealand, Asian ethnic group and sex
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemale< 5 years37.0(24.853.1)21.1(12.732.9)68.3(46.796.4)44.1(27.367.3)22.9(12.837.7)14. 9 ( 7 . 7 2 6 . 0 ) 5 9 y e a r s 4 7 . 6 ( 2 9 . 8 7 2 ) 3 4 . 5 ( 2 0 . 8 5 3 . 9 ) 1 3 0 . 0 ( 7 9 . 4 2 0 0 . 7 ) 5 9 . 6 ( 2 9 . 8 1 0 6 . 7 ) 4 7 . 7 ( 2 7 . 8 7 6 . 4 ) 2 0 . 9 ( 9 . 6 3 9 . 7 ) e" 1 0 y e a r s a n d N e w Z e a l a n d b o r n 1 0 2 . 9 ( 8 3 . 6 1 2 5 . 3 ) 9 5 . 6 ( 7 7 . 2 1 1 7 . 2 ) 1 0 1 . 9 ( 8 0 . 7 1 2 7 ) 8 6 . 0 ( 6 6 . 0 1 1 0 . 3 ) 7 3 . 8 ( 5 1 . 7 1 0 2 . 2 ) 6 6 . 7 ( 47.890.4)Source: New Zealand Health Information Service, Ministry of Health
Table A4-5: Age-standardised rate (per 100,000) of total cardiovascular disease mortality, by duration of residence in New Zealand, Asian ethnic group and sex
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemale< 5 years63.3(42.490.9)52.6(31.682.1)200.0(136.8282.4)136.4(84.4208.5)78.6(44.0129.7)69.1(35.7120.7)59 years104.7(65.6158.5)67.7(40.8105.7)253.1(154.6390.9)191.2(95.4342.1)2 0 4 . 5 ( 1 1 9 . 1 3 2 7 . 4 ) 7 8 . 5 ( 3 5 . 9 1 4 8 . 9 ) e" 1 0 y e a r s a n d N e w Z e a l a n d b o r n 1 4 1 . 6 ( 1 1 5 . 1 1 7 2 . 4 ) 1 0 1 . 0 ( 8 1 . 5 1 2 3 . 7 ) 2 3 9 . 0 ( 1 8 9 . 2 2 9 7 . 9 ) 1 9 7 . 9 ( 1 5 1 . 8 2 5 3 . 8 ) 2 0 4 . 4 ( 1 4 3 . 1 2 8 2 . 9 ) 1 8 9 . 0 ( 1 3 5 . 6 2 5 6 . 3 ) S o u r c e : N e w Z e a l a n d H e a l t h I n f o r m a t i o n S e r v i c e , M i n i s t r y o f H e a l t h
Table A4-6: Crude rate (per 100,000) of all cancer mortality, by duration of residence in New Zealand, Asian ethnic groups and sex
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemale< 5 years38.3(25.854.6)26.6(17.139.6)38.4(22.860.7)21.0(10.138.6)25.9(15.141.5)23.5(14.236.8)59 years64.9(43.892.6)56.3(38.380.0)39.0(14.384.9)65.0(33.6113.6)67.3(43.1100.2)51.1(3277.4) e" 1 0 y e a r s a n d N e w Z e a l a n d b o r n 7 5 . 9 ( 5 9 . 5 9 5 . 4 ) 7 1 . 0 ( 5 5 . 2 8 9 . 8 ) 4 3 . 9 ( 3 0 . 4 6 1 . 3 ) 4 7 . 2 ( 3 2 . 7 6 5 . 9 ) 6 5 . 6 ( 4 4 . 9 9 2 . 7 ) 6 5 . 0 ( 4 6 . 5 8 8 . 6 ) S o u r c e : N e w Z e a l a n d H e a l t h I n f o r m a t i o n S e r v i c e , M i n i s t r y o f H e a l t h
T a b l e A 4 - 7 : A g e - s t a n d a r d i s e d r a t e ( p e r 1 0 0 , 0 0 0 ) o f a l l cancer mortality, by duration of residence in New Zealand, Asian ethnic group and sex
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemale< 5 years61.5(41.587.8)37.3(23.955.4)78.5(46.5124.1)41.0(19.675.3)83.8(48.8134.1)57.3(34.589.5)59 years113.5(76.6162)66.3(45.094.1)49.7(18.3108.3)98.2(50.7171.6)353.5(226.5526)165.8(103.9251) e" 1 0 y e a r s a n d N e w Z e a l a n d b o r n 9 5 . 7 ( 7 5 . 0 1 2 0 . 3 ) 7 7 . 1 ( 6 0 . 0 9 7 . 6 ) 8 9 . 3 ( 6 1 . 8 1 2 4 . 7 ) 8 2 . 7 ( 5 7 . 3 1 1 5 . 5 ) 1 9 4 . 9 ( 1 3 3 . 3 2 7 5 . 1 ) 1 2 7 ( 9 0 . 7 1 7 2 . 9 ) S o u r c e : N e w Z e a l a n d H e a l t h I n f o r m a t i o n S e r v i c e , M i n i s t r y o f H e a l t h
T a b l e A 4 - 8 : C r u d e r a t e ( p e r 1 0 0 , 0 0 0 ) o f n o n - t o b acco-related cancer mortality, by duration of residence in New Zealand, Asian ethnic group and sex
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemale< 5 years21.9(12.735)20.2(12.031.9)30.1(16.450.5)19.0(8.736.0)12.3(5.324.2)17.5(9.529.3)59 years37.2(21.659.5)48.0(31.370.3)32.9(10.776.7)49.1(22.593.3)42.3(23.769.8)37.4(21.460.7) e" 1 0 y e a r s a n d N e w Z e a l a n d b o r n 4 2 . 4 ( 3 0 . 3 5 7 . 7 ) 3 2 . 8 ( 2 2 . 3 4 6 . 5 ) 2 9 . 9 ( 1 9 . 0 4 4 . 9 ) 3 2 . 3 ( 2 0 . 5 4 8 . 5 ) 3 1 . 0 ( 1 7 . 3 5 1 . 1 ) 4 1 . 1 ( 2 6 . 6 6 0 . 6 ) S o u r c e : N e w Z e a l a n d H e a l t h I n f o r m a t i o n S e r v i c e , M i n i s t r y o f H e a l t h
T a b l e A 4 - 9 : A g e - s t a n d a r d i s e d r a t e ( p e r 1 0 0 , 0 0 0 ) o f n o n-tobacco-related cancer mortality, by duration of residence in New Zealand, Asian ethnic group and sex
ChineseIndianOther AsianMaleFemaleMaleFemaleMaleFemale< 5 years26.2(15.341.9)20.2(12.031.9)53.7(29.490.1)26.0(11.949.3)28.8(12.456.7)31.7(17.353.2)59 years51.1(29.781.8)47.8(31.270.0)42.0(13.698.1)57.7(26.4109.5)93.1(52.1153.6)70.9(40.5115.1) e" 1 0 y e a r s a n d N e w Z e a l a n d b o r n 4 4 . 9 ( 3 2 . 1 6 1 . 2 ) 3 3 . 4 ( 2 2 . 7 4 7 . 4 ) 4 2 . 9 ( 2 7 . 2 6 4 . 4 ) 4 5 . 8 ( 2 9 . 0 6 8 . 7 ) 4 5 . 7 ( 2 5 . 6 7 5 . 4 ) 6 0 . 3 ( 3 9 . 0 8 9 . 1 ) S o u r c e : N e w Z e a l a n d H e a l t h I n f o r m a t i o n S e r v i c e , M i n i s t r y o f H e a l t h
T a b l e A 4 - 1 0 : A g e - s t a n d a r d i s e d r a t e ( p e r 1 0 0 ) o f u p t a k e of cervical screening, by Asian ethnic group
Cervical smear coverage (%)AgeChineseIndianOther AsianTotal population2069 years51.962.643.673.1Source: National Screening Unit, Ministry of Health
References and Further Reading
ADDIN EN.REFLIST Abbott MW, Wong S, Williams M, et al. 2000. Recent Chinese migrants health, adjustment to life in New Zealand and primary health care utilization. Disability and Rehabilitation 22: 4356.
Asher MI, Barry D, Clayton T, et al. 2001. The burden of symptoms of asthma, allergic rhinoconjunctivities and atopic eczema in children and adolescents in six New Zealand centres: ISAAC Phase One. New Zealand Medical Journal 114: 11420.
Bedford R, Didham R. 2001. Who are the 'Pacific peoples'? Ethnic identification and the New Zealand census. In: CMacpherson, PSpoonley, MAnae (eds). Tangata o te Moana Nui: The evolving of Pacific peoples in Aotearoa/New Zealand. Palmerston North: Dunmore Press.
Berry JW. 1990. Acculturation and adaptation: health consequences of culture contact among circumpolar peoples. Arctic Medical Research 49(3): 14250.
Cole TJ, Bellizz MC, Flegal KM, et al. 2000. Establishing a standard definition for child overweight and obesity worldwide: international survey. British Medical Journal 320: 7244.
Harding S. 2003. Mortality of migrants from the Indian subcontinent to England and Wales: effect of duration of residence. Epidemiology 14(3): 28792.
Harris R, Tobias M, Jeffreys M, et al. 2006. Racism and health: t P Q k 6 7 > s t e
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