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health Funding Authority

Health Funding Authority Special Report 4

The Public Health of the Central Region

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Health Funding Authority Special Report 4

The Public Health of the Central Region

Barry Borman, PhD

Deborah Read, MB, ChB, FAFPHM

Sandy Brinsdon, BSc, DPH

Public Health Group, Central Office, Health Funding Authority

IJealth Funding Authority Published by the Health Funding Authority (Central Office) Wellington New Zealand. September 1998

ISBN 0-478-20278-4 I

Acknowledgements 2

Introduction 3

Highlights 6

Determinants of Health 13

Physical environment 14

Emergent public health issues 17

Demographic structure 23

Socio-economic factors 42

Tobacco 57

Patterns of health 67

Communicable disease 68

Non communicable disease 73

Age groups 99

Under 1 year 99

1-4 years 112

5-14 years 118

15-24 years 124

25-44 years 131

45-64 years 139

65-74 years 148

75+ years 154

Special Health Issues 163

Cervical cancer 164

Sexually transmitted diseases 166

Unintentional injury 170

Hearing 183

Abuse notifications 185

Mental health 190

Appendix tables 195

The Public Health of the Central Region - Page 1 Acknowledgements

We would like to thank a number of people, who contributed to the production of this report. Cynthia Malmg, Manager, Public Health Group, Central Office, Health Funding Authority (HFA), gave constant support and encouragement and provided the environment for the authors to bring the project to fruition.

Jim Fraser and Tracey Stewart, NZHIS, were most generous in their time and effort in fulfilling our almost constant requests for data. We also had tremendous cooperation in the provision of data from Paul Graham, LTSA, Josephine Ryan, Statistics New Zealand, Yvonne Galloway, ESR:Kenepuru Science Centre, Michael Parkin, Ministry of Education, Annalisa Manaton, ACC, Di Best, Philip Saysell and Sandi Matcham, National Cervical Screening Register, Andy Elvey, CYPFS, and Peter Crampton, Health Services Research Centre

Rachel Lamb, Public Health Group, Central Office, HFA, and Jo Harvey, assisted us in collating, entering and checking data.

Page 2 - The Public Health of the Central Region I

The report has two aims. Firstly, to describe the state of public health in the Central region, and secondly, to provide public health providers and others involved in the design and delivery of public health programmes with a compendium of public health. Attempts have been made to include the most up-to-date data available from a variety of sources. It is intended to provide regular updates of these data.

The publication has three sections. The first section, determinants of health, provides data on factors in the physical environment (eg, drinking and recreational water, food quality and safety, and emergent public health issues), hazardous substances, the demographic structure (eg, age, gender, ethnicity), socio-economic environment (eg, levels of education, income, employment, household characteristics) and tobacco consumption which influence the public health status of Hawkes Bay, Wanganui, Manawatu, Wellington, Wairarapa, and Nelson/Marlborough subregions.

The second section, patterns of public health, presents numbers and rates of communicable disease and deaths, hospitalisations and cancer registration in the subregions by age groups.

The third section, special health issues, includes data on cervical cancer, sexually transmitted diseases, unintentional injury, hearing loss, abuse notifications and mental health.

A perennial problem associated with data from a variety of sources is that the geographical boundaries of individual areas/regions are not always consistent. We have indicated when boundaries are different from those used to demarcate the areas within the Central region.

Under the new locality management structure of the HFA, the Central Office, based in Wellington will cover the Tairawhiti, Hawkes Bay, Wanganui, Manawatu, Wellington, and Wairarapa areas. Nelson/Marlborough, included in this report as part of the region covered by the previous Central Regional Health Authority, will be managed from the Christchurch office of the HFA.

The Public Health of the Central Region - Page 3 U Areas covered by the Central region

In this report the areas encompassed by the Central region are:

Subregion Territorial local authority

Hawkes Bay Wairoa District Hastings District 11 Napier City Central Hawkes Bay District Chatham Islands District

Wanganui Waimarino Ward2 Waiouru Ward Wanganui District Rangitikei District

Manawatu Manawatu District Palmerston North City Tararua District Horowhenua District

Wellington Kapiti Coast District Porirua City Upper Huff City 1] Lower Huff City Wellington City

Wairarapa Masterton District Carterton District LI South Wairarapa District

Nelson/Marlborough Tasman District Nelson City [} Marlborough District LI Some data sources do not distinguish the Waimarino Ward and Waiouru Ward, which are included in the Central region, from the other constituent areas (Ohura Ward, Taumarunui Ward, National park Ward) of the Ruapehu District.

ci U

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Sources and analyses of health data

Mortality data Mortality data for the Central Region for the period 1990 to 1994 were obtained from the New Zealand Health Information Service (NZHIS). Cumulative rates for the five-year period - not averaged rates - were calculated using the 1991 Census usually resident population for the region and subregions.

Morbidity data Morbidity data for the Central Region for 1995 and 1996 were obtained from NZHIS. Throughout the text these discharges from hospitals are referred to as hospitalisations. Cumulative rates for the two years were calculated.

For purposes of comparison, tables of hospitalisations by subregion and ethnicity show the leading causes of hospitalisation for Maori, and these may not be the main leading causes for nonMaori. For this reason, the tables for nonMaori males and females have been labeled Selected leading causes of hospitalisation.....

Injury data Morbidity data were obtained from NZHIS for the years 1995 and 1996, giving the external cause (E code) for cases of injury and poisoning. These were classified into two groups, intentional injury (E950-E969) and unintentional injury (E800-E949, which includes adverse effects from therapeutic use of drugs, medicinal and biological substances). Cumulative rates for the two years were calculated.

Cancer data Cancer registration data from NZHIS Cancer Registry for the years 1990 to 1993 were used to calculate cumulative rates for the 4-year period. Populations used were the 1991 Census usually resident populations for the region and subregions.

Mental health data Inpatient mental health care data for 1992 and 1993 were obtained from NZHIS and used to calculate cumulative rates for the two-year period. Populations used were the 1991 Census usually resident populations for the region and subregions.

Small numbers Rates have not been calculated where numbers for a particular category are less than five.

The Public Health of the Central Region - Page 5 Environment • 49 percent of the population in the Central region (excluding Wairarapa) are served by a registered supply receive drinking water with at least a Bb grading

• in the Wellington/Hutt area about 15,000 people receive water with an A grading for its source and treatment, but only a d grading for its distribution

• Nelson and Wanganui have unsatisfactory water supplies In 1996-97 there were:

• 31 disease outbreaks reported to the Public Health Group, Central Health

• outbreaks of viral gastroenteritis reported in two rest homes

• an outbreak of salmonellosis in a prison, and four outbreaks of campylobacteriosis

• 9 of the 16 foodbome disease outbreaks associated with food premises

• 595 food complaints reported to CHEs

• 27 chemical incidents were reported with lead the most common hazardous substance reported

Population • the population in the Central region at the 1996 Census was 892,302, almost a 4 percent increase from the 1991 Census

• 42 percent of the regional population resides in the Wellington subregion and 30 percent are aged 25-44 years

• Maori comprise 14 percent of the total regional population, but 25 percent of the Hawkes Bay population

• almost 4 percent of the Central regions population are Pacific Islanders with 30 percent living in the Porirua/Kapiti area

• between 1996-2010 the population in the region is expected to increase by more than 4 percent with the largest increases in the 45-64 years age group and in the Kapiti Coast District and Nelson/Marlborough region

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Social-economic

Income there are wide disparities in income levels within the Central region

• the median income for males and females in Wellington City is at least 30 percent higher than the respective national medians

• more than half the population in Horowhenua District are receiving income support

Education • the proportion of the populations in Wellington City, Palmerston North City and Lower Huff City with a university qualification is higher than the national average

• at least 40 percent of the populations in the districts of Wairoa, Horowhenua and Tararua have no academic qualifications

• more than half the schools in Wairoa District, Horowhenua District and Porirua City have low socio-economic status

Employment • less than 40 percent of the population in the districts ofKapiti Coast, Horowhenua, Wanganui and Wairoa are in fulltime employment

• more than seven percent of the population in Wairoa District and Porirua City are unemployed and actively seeking work, compared to a national average of 5 percent

• professionals comprised almost 22 percent of the workforce in Wellington City and 16 percent in Palmerston North City, compared to a national average of 12 percent

• a quarter of the employed population in Ruapehu District were service and sales workers

Households • more than 20 percent of households in Wairoa District, Porirua City, Wanganui District and Hastings District are at least one sole parent families

• in Wellington City 32 percent of households were non-family households and one in every two households had an annual income exceeding $50,000

• 80 percent of households in the districts of Horowhenua, Wairoa, Wanganui, and the Wairarapa had an income less than $50,000

• in the Central region, the estimated average household expenditure on alcohol ($892.81) is almost three times higher than expenditure on fresh fruit and vegetables, milk, cream, and yoghurt

Determinants of Health - Page 7 Tobacco • almost 37 percent of Maori males aged 15 years and over smoke regularly compared to 22 percent of nonMaori males

• about 46 percent of Maori females aged 15 years and over smoke regularly compared to 19 percent of nonMaori females

• in the Central region, smoking prevalence is highest in Wairarapa and lowest in Wellington and Nelson/Marlborough subregions

• in Porirua City, the proportion of deaths from the major tobacco-related cancers and respiratory disease is four and five percent higher than the respective averages for the Central region

Communicable disease In 1996:

• campylobacteriosis, salmonellosis, and hepatitis Awere the most frequently notified diseases • there are high rates of pertussis in all subregions except Wanganui

• notifications of campylobacteriosis have increased since 1990 and the highest rates in the Central region occur in the Wellington area and among those aged 15-24 years • Hutt had a high rate of tuberculosis

• 36 cases of foodbome hepatitis A were reported following hepatitis Ain a food handler

• there was a high rate of meningococcal disease in Nelson/Marlborough

• there was the start of a measles epidemic in the Central region; eventually there would be 39 confirmed cases during August 1996-August 1997

• two cases of typhoid fever were reported in the Wellington region

Non-communicable disease All ages:

• during 1990-1994, half of all deaths in the Central region were due to either ischaemic heart disease or cancer

• male mortality rates are higher than female rates, but the highest rates for both sexes occurred in Wanganui and Wairarapa subregion

• the third leading cause of death for Maori males was unintentional injury compared to cerebrovascular disease for nonMaori males

• females had higher hospitalisation rates than males

• Maori males had higher hospitalisation rates than nonMaori in Hawkes Bay, Wanganui, and Wairarapa

• female hospitalisation rates were highest in Wanganui for Maori, and in Wairarapa for nonMaori

• the leading cause of hospitalisation for males was injury and poisoning and for females it was pregnancy, labour, delivery and their complications

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• falls were the most common cause of hospitalisation because of injury for both males and females

• the most common site for cancer registration for Maori males was lung, compared to prostate and large bowel for nonMaori males

in all subregions a quarter of all female cancer registrations were for cancer of the breast

Infants • Maori infant mortality rates are generally twice as high as nonMaori rates; the highest Maori rates occurred in Hastings District, Napier City and Lower Hurt City

• the major causes of infant mortality were sudden death and birth defects

• the nonMaori late fetal death rate in the Central region is almost 19 percent greater than the New Zealand rate

• the Maori postneonatal mortality rate is more than three times higher than the nonMaori rate

• about 60 births out every 1,000 livebirths in the Central region had a birthweight under 2500g; the Maori rate was 67.8 per 1,000 livebirths compared to the nonMaori rate of 57.6 per 1,000

• the highest rates of sudden infant death syndrome occurred in Wanganui and PorirualKapiti

1-4 year olds • 40 percent of all deaths were due to unintentional injury of which 49 percent were due to motor vehicle crashes

• diseases of the respiratory system and injury and poisoning were the leading cause of hospitalisation

• Maori rates of hospitalisation for asthma were about 1.5 times higher than the nonMaori rates

• falls and poisoning were the most common injuries requiring hospitalisation

• Hawkes Bay had high rates of hospitalisation for males and Wanganui for females

5-14 year olds • 41 percent of deaths among 5-14 year olds were due to unintentional injuries, with males having higher death rates than females

• the major causes of hospitalisation were due to injury and poisoning, specifically fractures and intracranial injury, and diseases of the respiratory system

• the highest rates of hospitalisation occurred in Hawkes Bay and Wanganui

• falls accounted for 45 percent of all hospitalisations for unintentional injury with the male rate 1.5 times higher than the female rate

• lymphomas, leukaemia, and brain cancer accounted for 71 percent of all cancer registrations

Determinants of Health - Page 9 15-24 year olds • unintentional injuries, primarily motor vehicle crashes, were the major cause of death for both sexes; the highest death rates for males occurred in Wairarapa and for females in PorirualKaptiti; the lowest death rates were in Wellington

• 48 percent of male hospitalisations were due to injury and poisoning; Maori rates were lower than nonMaori rates for most causes

• 58 percent of the female hospitalisations were for pregnancy, childbirth and complications; generally, the rates of hospitalisation for Maori females were higher than the rates for nonMaori females

• motor vehicle crashes and falls were the leading causes of male and female hospitalisations for unintentional injuries

• for both sexes Maori had the highest hospitalisation rates for homicide and injury inflicted by others and nonMaori the highest rates for suicide and self-inflicted injury

melanoma was the most common cancer site for female cancer registrations

25-44 year olds • in all subregions unintentional injuries were the leading cause of death for males; the majority of these deaths were due to motor vehicle crashes

• cancer accounted for 39 percent of all female deaths; the highest rates were in Wanganui and among nonMaori

• for most causes of hospitalisation Maori rates generally exceeded the nonMaori rates

• injury and poisoning was the leading cause of hospitalisation in each subregion

• for males, falls, motor vehicle crashes and cutting/piercing accounted for 45 percent of all hospitalisations from unintentional injuries; 61 percent of hospitalisations from intentional injuries were due to homicide

• cancer registration rates for males were highest in PoriruaiKapiti and for females in Wairarapa

45-64 year olds • ischaemic heart disease and cancer were the leading causes of male mortality in each subregion; the highest rates occurred in PorirualKapiti

• cancer accounted for about half of all female deaths in the subregions

• diseases of the circulatory system were the leading cause of hospitalisations for males

• diseases of the circulatory system were the major causes of hospitalisation for Maori females, compared to diseases of the digestive system for nonMaori females

• Maori rates of hospitalisation from diseases of the respiratory system were more than twice as high as the nonMaori rates; cancer rates were highest for nonMaon

• 31 percent of male and 39 percent of female hospitalisations for unintentional injury were due to medical and surgical complications

• for Maori males lung cancer was the leading cause of cancer registration compared to large bowel cancer among nonMaori males

Page 10- The Public Health of the Central Region I

• breast cancer was the leading cause of female cancer registrations

• the highest large bowel cancer rates were in the Wairarapa and lung cancer rates in Porirual Kapiti

65-74 year olds 48 percent of male and 43 percent of female deaths were due to diseases of the circulatory system

• for males, Maori had higher death rates from ischaemic heart disease than nonMaori, but lower rates from cerebrovascular disease

• death rates from cancer were highest for nonMaori

• generally, rates of hospitalisation were highest for Maori and males

• late effects of injury accounted for 42 percent of male Maori hospitalisations for unintentional injuries, but only 3 percent of nonMaori hospitalisations

• for Maori males, the most common cancer registrations were of lung compared to the large bowel and prostate for nonMaori

• Manawatu had the highest rates of cancer registration in the Central region

75 years and older • ischaemic heart disease was the most common cause of death in this age group followed by cerebrovascular disease for females and cancer for males

• diseases of the circulatory and respiratory systems were the major causes of hospitalisation

• falls accounted for 54 percent of the hospitalisations for unintentional injuries with the highest rates for males in Hawkes Bay and for females in Hutt

• 58 percent of cancer registrations among males were for cancers of the prostate, large bowel and lung

• large bowel cancer and breast cancer were the most common sites for female cancer registration

Cervical cancer • up to May 1998, 88 percent of eligible women in the Central region were enrolled on the National Cervical Screening Register

• the highest enrolment rates are in Wellington, Nelson/Marlborough; the lowest enrolment rate is in Hawkes Bay

• with the exception of Hawkes Bay, at least 75 percent of women in the region have had at least one smear result on the Register in the previous three years

Sexually transmitted diseases - .• in the Central region, generally the highest rates of gonorrhoea, chlamydia, herpes and warts occur in the Hastings and Napier areas

Determinants of Health - Page 11 Unintentional injury • the highest rates of motor vehicle crashes were in the districts of Rangitikei, Tararua, Ruapehu and Central Hawkes Bay

• the cities ofWellington, Palmerston North and Nelson had the highest rates of pedestrian accidents

• there were high rates of accidents involving motorcyclists in Palmerston North City, Hastings District, Napier City, and Wanganui and Manawatu districts

• the rate of pedal cyclist accidents in Nelson City was more than double the New Zealand average

• the approximate social cost of all road crashes in the Central region is about $792 million per year

• the average per-capita social costs of crashes in the country areas is more than twice as high as the cost in either towns or cities

• the average social costs of crashes per road kilometre per year was highest in the cities of Porirura, Wellington, Lower Hutt, and Nelson

• during 1994-1997 all new entitlement claims to the ACC from the Central region cost $184 million, while the cost of motor-vehicle-related injury accidents on a public road was $19 million, new work related entitlement claims $35 million, new claims for non-work injuries $64 million, and new sport and recreation claims $24 million

Hearing • the highest hearing failure rates for new school entrants were for Pacific Island children and in the Hutt Valley area

among three year olds, the highest failure rate occurred in the area covered by Wairarapa Health

Abuse notifications • more than 30 percent of abuse notifications to the Wairoa and Dannevirke CYPFS Units were for behaviour/relationship problems

• 10-15 percent of notifications to the Dannevirke, Hastings, Porirua, Palmerston North and Napier Units were for neglect

17 percent of notifications to the Porirua Unit were concerned with physical abuse

Mental health • of all mental health first admission in the Central region in 1992-1993, 53 percent were male and 72 percent were aged 15-44 years

admission rates were highest in Wanganui and lowest in Manawatu and Wairarapa

• generally, in all age groups up to 65 years, the most common cause of admission for males was alcohol dependence or abuse and for females it was affective psychoses and stress and adjustment

• over the aged of 65 years, senile and presenile organic psychoses was the most common cause of admission

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Determinants of Health

Determinants of Health - Page 13 WATER

Drinking water

Public health grading Community drinking water supplies are graded according to the quality of the source water, its treatment and the distribution system. Source water and its treatment are graded from A to E. The distribution system is graded a to e. Lower gradings do not mean the water is contaminated but indicate a high level of risk as the treatment and /or quality control systems are not adequate to protect against contamination.

Larger communities eg Wellington may have several distribution zones delivering water from different sources or treatment plants, each with a different grade. The lowest of those grades has been used in this assessment.

Definition of public health grading of community drinking water supplies: • A or a completely satisfactory, very low level of risk

• B or b satisfactory, low level of risk

• C or c marginal, moderate level of risk, may be acceptable in small communities

• D or d unsatisfactory, high level of risk

• E or e completely unsatisfactory, very high level of risk

A C grading provides protection against bacteria, viruses and Giardia but not against Ciyptosporidium.

Registration and grading began in 1993 and is carried out by CHE public health units.

At the start of 1997 at least 783,033 people (88% of the population) in the Central region were receiving drinking water from a registered community supply (excluding school supplies). A community drinking water supply is defined as a supply that serves 25 or more people for at least 60 days a year. This figure is conservative as some small supplies on the Register of Community Drinking- Water Supplies in New Zealand have no population data recorded. About 40,000 were receiving water from supplies that were listed as ungraded. Except for Masterton, these were small supplies.

There were 380,334 people receiving water from a supply with at least a Bb grading. This represents 49 percent of the population served by a registered supply. No grading results were available for Wairarapa. For the other CHE areas the proportion of the population known to be receiving Aa, Ab, Ba, or Bb drinking water ranged from five percent in Wanganui to 67 percent in Wellington! Hurt health districts.

In the Wellington/Hurt area about 15,000 people receive water with an A grading for its source and treatment but only a d grading for its distribution.

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There are four New Zealand cities with a population of over 20,000 that have unsatisfactory water supplies. Two - Nelson (Ed) and Wanganui (Da) - are in the Central region.

There are an additional seven zones in the region covering a population of about 93,000 that although they have a C grading indicating the quality of the water delivered is variable the distribution grading is satisfactory.

A grading below Cc is unsatisfactory. The reasons for low grades include poor water quality, unknown water quality due to inadequate monitoring, and inadequate protection against contamination (Mattingley and Ferguson 1996).

Monitoring of drinking water It is the water suppliers responsibility to carry out monitoring of Priority 1 and Priority 2 (P2) determinands to show compliance with the Drinking- Water Standardsfor New Zealand 1995. Priority 1 determinands are microbiological and apply to all supplies. Priority 2 determinands may be microbiological, chemical or radiological and are supply specific. Priority 2 chemical determinands are chemicals known to have significant health effects.

Microbiological quality is more important for public health than chemical quality unless there is a major chemical spillage. In general poor microbiological water quality results from inadequate water treatment (Ball 1998).

Microbiological quality

A survey of microbiological quality in 1996 was based on information for 1452 of the 1558 distribution zones registered at January 1997 supplying about 3,110,000 people.

The discrepancy between this figure and the Census total of of 3,618,300 is due to missing population data for some supplies, some supplies that are not yet registered and households that have private water supplies (Ball 1998).

Adequacy of microbiological monitoring is determined by whether a sufficient number of samples was taken for the population supplied in the zone and whether the interval between successive samples was satisfactory.

In 1996 44 percent of zones supplying 95 percent of the surveyed New Zealand population were monitored. Although the percentage of zones monitored decreased compared with those monitored in 1995 and 1994 this is largely due to increases in the number of registered supplies. Most of these are small supplies eg schools, campsites.

The percentage of zones complying decreased from 1994 to 1996 for the same reason. Lack of monitoring is the main reason for non-compliance. Monitoring receives less attention in small supplies than large supplies, both in terms of the percentage of zones monitored and the percentage adequately monitored.

In 1996 Wanganui (83%) and Northland (54%) had the lowest percentages of the population living in monitored zones. There were no zones in the Central region of 5,000 population or greater that were not monitored.

Faecal coliforms were found in CHE surveillance samples from eight zones - including Himatangi Beach (Manawatu), Havelock and Okiwa Park (Nelson/Marlborough) that were reported by the water supplier as complying. This indicates that the sampling and analysis practices used by the supplier in monitoring these zones need to be investigated (Ball 1998).

Determinants of Health - Page 15 Chemical quality The Ministry of Health started a national programme in July 1995 to identify whether P2 chemicals are present or not in community drinking water supplies. To date not all supplies, in particular small supplies, have been sampled, or have had their results listed in the Register. At the start of 1997 there were few supplies in the region that had P2 determinands listed. With the exception of fluoride for supplies in the Wellington, Hutt and Manawatu health districts, arsenic was listed for Napier (Hawkes Bay), boron and copper for Bulls (Wanganui), lead for Picton! Waikawa and nitrate for Richmond (Nelson/Marlborough). The population served by fluoridated supplies was 411,331(53% of the total population); this is conservative as the P2 identification programme is still in progress.

Recreational water quality Oversight of swimming pools is a responsibility of territorial local authorities. In some health districts the CHE public health unit runs swimming pool maintenance seminars for pool operators and audits compliance with standards.

It is important that chlorine levels in swimming pools are maintained at a level that allows adequate disinfection of the water.

Of 50 school, public and institutional swimming pools in Nelson that were tested for free available chlorine, pH, alkalinity and cyanuric acid in March 1997, 33 (66%) were satisfactory and 17 (34%) were outside the public health guidelines. The percentage of satisfactory pools declined slightly from the 1995-96 results (75%). Of the pools tested that were outside public health guidelines most were due to a lack of cyanuric acid. Cyanuric acid is used to prevent chlorine loss due to sunlight.

The number of pools recommended for closure until appropriate chemical levels were obtained declined from six (11%) in 1994-95 to three (5%) in 1995-96 and two (4%) in 1996-97. Storage of pool chemicals, in particular chlorine, and storage and quality of safety equipment was unsatisfactory in some pools (Molloy 1997).

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Central Healths Public Health Group is notified by providers whenever significant actual or potential emergent issues arise. The threshold for reporting varies among providers so the following information is incomplete. Most of these issues concern health protection, in particular communicable disease control.

Natural hazards

Mt Ruapehu eruption Volcanic ash from the 1995 and 1996 eruptions had effects on air quality with implications for individuals with respiratory conditions, and drinking water sourced from roofs and surface water. Affected health districts in the region were Wanganui, Manawatu, Hawkes Bay, and Wairarapa.

Flooding A state of emergency was declared in Wairoa District in June 1997 due to flooding.

Marine biotoxins Shellfish have been monitored for the presence of marine biotoxins since January 1993 when an outbreak ofneurotoxic shellfish poisoning occurred in New Zealand. Some areas of New Zealand coastline have been more commonly associated with elevated toxin levels. In the Central region these areas are the Marlborough Sounds (paralytic shellfish poisoning and amnesic shellfish poisoning toxins) and Queen Charlotte Sound (diarrhoeic shellfish poisoning toxin).

Disease outbreaks

There were 31 outbreaks reported to the Public Health Group in 1996-97. This is likely to be an under-estimate of the actual number. Information about the type of outbreak was reported for 27 and about the source for 17. Sixteen were reported as foodborne and one as waterborne.

Viral gastroenteritis Outbreaks were reported in two rest homes and a public hospital medical ward. The latter affected staff and patients and resulted in temporary closure of the ward to admissions.

Salmonellosis An outbreak of salmonellosis occurred in a prison with five confirmed and 15 suspected cases. Chicken was thought to be the most likely source.

Cam pylobacte rios is There were four outbreaks of campylobacteriosis reported.

Marlborough 1997 - Nineteen cases were notified associated with a school camp. The water supply was identifed as the most likely source of infection.

Determinants of Health - Page 17 Havelock North 1997 - Thirty-three cases were notified in Hawkes Bay during a week in June, 24 of whom lived in Havelock North. Epidemiological investigation was highly suggestive of a common source outbreak with a food outlet as the most likely source of infection.

During 1996-97 two other smaller outbreaks of campylobacteriosis were reported in the Manawatu and Wellington health districts. The latter involved a food premise.

Food quality and safety

Sixteen foodbome disease outbreaks were reported in 1996-97. Nine outbreaks were associated with food premises eg restaurant, sandwich bar and four with function catering. One of the latter four outbreaks involved an unlicensed caterer manufacturing food from domestic premises. The other three foodborne outbreaks were associated with a private club, a school camp and a prison.

There were 595 food complaints reported to CHEs in 1996-97 (table 3). Four food recalls were reported to the Public Health Group. Information was available for three.

Ham was recalled in the South Island following detection by the Marlborough manufacturer of contamination with the bacteria Listeria. This was found during the manufacturers routine food safety testing.

Meat was recalled in Nelson, Blenheim and Christchurch following detection of a rural slaughterhouse selling uninspected meat.

Cooked Christmas hams from a butchery in the Wellington region were recalled as a result of an outbreak of Staphylococcal food poisoning.

In the Wellington region, packaged biscuits were detained under the Food Act and tested in case of contamination following a spill of phosphoric acid during transportation. No contamination was found. This incident also was a violation of transport requirements that prohibit packing of food and toxic substances in the same consignment.

Hazardous substances

Public opposition to the use of 1080 for possum control as part of the bovine TB control programme by district councils has occurred in several areas. In 1995 an alleged cluster of miscarriages in Wairarapa was attributed by the public to 1080 use. Investigation did not support the existence of a cluster.

Twenty-seven chemical incidents were reported (table 4). Where details were given, lead was the most common hazardous substance reported.

Incidents included:

• Copper chrome arsenic (CCA) contamination from a timber treatment site of stormwater that drained through a residential area (Manawatu)

• Temporary closure of two early childhood centres following lead contamination from lead based paint during renovations (Manawatu, Nelson). In one instance Occupational Safety and Health are prosecuting the contractor responsible.

• Lead contamination of a home and the adjoining property by a contractor using inappropriate lead based paint removal practices (Wanganui)

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• Industrial burning of 1080 pellets and alleged health effects among people in nearby industries (Wanganui) • Agrichemical spraydrift from an adjacent vineyard and alleged health effects related to chronic exposure of the propertys owners to the spraydrift (Marlborough)

• Three chemical incidents of unexplained odours at Kenepuru and Wellington Hospitals. Some staff from the affected Nuclear Medicine Department at Wellington Hospital were seen at the Emergency Department with acute symptoms.

• Industrial burning of tertiary butyl mercaptan resulted in reports of an odour nuisance (Hutt). One medical centre reported increased respiratoryillness but there was no evidence that this was the direct result of the bumoff.

• Chemical spillage from a truck and trailer carrying a mixed goods consignment following a crash on State Highway 2 (Hutt)

• Spillage of paraquat at rail yards (Wellington)

• Leakage of organophosphate from a container (Wellington) • Spillage of organophosphate resulting in five people being taken to hospital for observation after possible inhalation (Manawatu)

Elevated blood lead level notifications to ESR were five in 1994, six in 1995 and six in 1996. The notification level reduced from 25 to 15 mg/dl from June 1996 and all six cases reported were at this revised level. Use of the ESR EpiSurv database for lead notifications is however incomplete as 20 cases of elevated blood lead levels were investigated in 1996-97 by Hutt Valley Health alone. Investigation of a child with elevated blood lead levels in Nelson suggested that the most likely cause was renovations involving lead based paint at a creche. Four health districts reported cases of poisonings that attended hospital emergency departments (table 5). The rate of poisonings among those aged under five years was 1281.4 cases per 100 000 in Hawkes Bay, 1081.3 cases per 100 000 in Marlborough and 916.9 cases per 100000 in Manawatu.

Drinking water contamination incidents

Contamination of the Te Awanga water supply in Hawkes Bay with faecal coliforms was reported on two occasions in November 1996. The likely causes were farms near the reservoir that were not fitted with backflow preventers and inadequate supply to the distribution system caused by inadequate capacity of the supply main. (This was thought to result in negative pressures in areas of the distribution system during periods of maximum demand). Emergency chlorination and flushing, inspection of the town for potential backflow and installation of backflow prevention on to the farm supplies was carried out. Planned fitting of a new supply main to the distribution to prevent negative pressures being developed has been brought forward by Hastings District Council.

A boil water notice was issued to Te Horo beach in 1997 (Wellington).

Determinants of Health— Page 19 A Li References 11 Ball A. 1996. Microbiological Quality of Drinking Water in New Zealand 1995. Unpublished report for the Ministry of Health. 9 Ball A. 1998. Annual Review of the Microbiological Quality of Drinking Water in New Zealand. Wellington: Ministry of Health.

Lewis S, Hales S, Slater T, Pearce N et al. 1997. Geographical variation in the prevalence of asthma symptoms in New Zealand. NZ Med J 110: 286-9.

Mattingley B, Ferguson A. 1996. Register of Community Drinking-water Supplies in New Zealand. 51 ed. Wellington: Ministry of Health. Molloy M. 1997. School and Public Swimming Pool Inspections 1996-1997 Swimming Season. 9 Unpublished report for Nelson/Marlborough Health Services. 0 I

II Eli I Ii ii I I I LII II ii Page 20 - The Public Health of the Central Region 9 Li

Table 1: Public health grading of community drinking water supplies 1996

Population Population Population % total with supplies with graded with ungraded population with graded: supplies supplies satisfactory water

A B Health district a b a b Hawkes Bay 5000 500 0 59956 111894 1791 57.6 Wanganui 0 0 2800 0 60470 842 4.6 Manawatu 3500 68300 0 0 139160 490 51.4 Wellington &Hutt 101108 65560 2070 66660 353036 620 66.6 Wairarapa 0 30825 Nelson/Marlborough 3680 0 0 1200 78493 5412 5.8 Central region 113288 134360 4870 127816 743053 39980 48.6 Source: ESR

Table 2: Microbiological quality of community drinking water supplies 1995 & 1996

Population supplied by: Complying zones Adequately monitored zones 1995 1996 1995 1996

Health district n % n n % n

Hawkes Bay 18411 16 104317 89 34251 29 105419 90

Wanganui 12270 20 49820 82 14090 22 50120 83

Manawatu 113145 79 113020 79 114330 80 113790 80

Wellington & Hutt 303811 86 347334 98 315971 89 355034 100

Wairarapa 28412 92 29301 94 30621 100 30915 100

Nelson/Marlborough 43143 50 83823 89 76043 88 85303 91

Central region 519192 66 727615 91 585306 74 740581 92

New Zealand 2119588 70 2682064 86 2288250 76 2742309 88 Source: Ball 1996; Ball 1998 Source: ESR

Table 3: Food complaints by health district 1996-97

Health district n Hawkes Bay 92 Wanganui 50 Manawatu 142 Wairarapa 21 Wellington & Hutt 251 Nelson/Marlborough 39 Central region 595 Source: Central region provider quarterly reports

Determinants of Health - Page 21 Ii Table 4: Chemical incidents by health district 1996-1997

Health district n Hawkes Bay 2 Wanganui 2 Manawatu 4 Wairarapa 1 Wellington & Hutt 17 Nelson/Marlborough 1 Central region 27 Source: Central region provider quarterly reports £1 Table 5: Poisonings by health district 1996-97

Number Health district 0-4 years Total population Hawkes Bay 148 nr Manawatu 104 231 Wairarapa nr 11 Marlborough 29 61 nr not reported Source: Central region provider quarterly reports

9 9 £1 0 9 11 U U U U

Page 22 - The Public Health of the Central Region I

At the 1996 Census, there were 892,302 people usually resident in the Central region, an increase of 3.9 percent from the 1991 Census (table 6).

Forty-two percent of the regional population resided in the Porirua-Kapiti (9.5%), Hutt Valley (14.9%) and Wellington (17.7%) areas. The Manawatu (16.9%) was the second most populous region, followed by Hawkes Bay (16.1%), Nelson-Marlborough (13.1%), and Wanganui (7.6%). In all regions, there were more females than males.

Population change since 1991 Census

The largest population increases since the 1991 Census have occurred in Tasman District (11.9%), Kapiti Coast District (10.7%), Nelson City (10.6%), and Marlborough District (9.3%) (table 7).

The population declined between 1991-1996 in Tararua District (-4.0%), South Wairarapa District (-2.4%), Wairoa District (-2.2%), and Rangitikei District (-1.3%).

Population projections

Based on the assumptions of medium fertility, medium mortality and medium migration, the population in the Central region is projected to increase by 4.5 percent between 1996-2010 (table 8). There will be an increase of 38.1 percent in the 45-64 year age group and 18.5 percent in the 65+ age group. In contrast, the population in the 0-4 year age group is projected to decline by 17.4 percent.

In the age group 15-24 years, the male population will increase by 4.8 percent, but there will be little change in the female population. Females will have the greatest increase in the 45-64 age group (41.4% compared to 34.8% for males), while in the 65+ age group the number of males will increase by 23.2 percent compared to 14.8 percent for females.

Kapiti Coast (17.7%), Nelson/Marlborough (15.5%), Wellington (8.15%), Manawatu (5.6%), and Hawkes Bay (2.2%) will experience increases in their populations to 2010. However, the populations will decline in Upper Huff (6.3%), Wairarapa (5.5%), Wanganui (3.9%), Porirua (2.2%), and Lower Huff (1.3%).

Between 1996-2010, the populations in the respective 65+ and 45-64 year age groups of Porirua and Nelson/Marlborough are projected to increase by about 50 percent.

Age distributions

At the time of 1996 Census, 8.0 percent of the population in the Central region were aged 0-4 years, 15.9 percent were 5-14 years, 15.0 percent were 15-24 years, 30.4 percent were in the age group 25-44 years, 20.4 percent were aged 45-64 years, and 10.4 percent over 65+ years of age (table 6).

Determinants of Health - Page 23 Wairoa District (29.6%), Waimarino Ward (29.0%), Waiouru Ward (28.4%), Porirua City (27.9%), Rangitikei District (26.7%), and Tararua District (26.5%) had higher proportions of people under the age of 15 years than the New Zealand average (23.0%). In contrast, only Wellington City (183%), Nelson City (20.6%), Palmerston North City (20.7%), Napier City (22.1%), Marlborough District (22.1%), Kapiti Coast District (21.4%), had fewer under 15 year olds than the national mean.

In the Waiouru Ward (28.3%), and the cities of Palmerston North (22.2%), Wellington (16.9%), Upper Hurt (15.6%) and Ponrua (14.9%) the proportion of the population in the 15-24 year age group was greater than the New Zealand average (14.8%). The Nelson/Marlborough and Wairarapa regions and Kapiti Coast District had proportionally fewer people in this age group (15-24 years) than the national average.

Almost 40 percent of the population in the Waiouru Ward (38.4%) was aged 25-44 years, compared to the New Zealand average of 30.6 percent. More than one-third of Wellington Citys population (36.8%) were in this age group.

In Kapiti Coast District (21.3%), Horowhenua District (17.3%), Wanganui District (15.1%), and Napier City (14.7%), Nelson City (14.3%) and Marlborough District (14.2%), the proportion of the population in the 65+ year age group was considerably higher than the New Zealand average (11.7%). In Waiouru Ward, only 0.6 percent of the population was aged 65+ years.

Born overseas

Porirua City (28.2%), Wellington City (27.8%), and Lower Hurt City (1.5%) were the only areas in the Central region where the proportion of the population born overseas is higher than the New Zealand average (21.3%) (table 9). In the districts of Central Hawkes Bay (-9.1%), Tararua (-9.1%), Chatham Islands (9.7%), and Wairoa (-10.3%) and Waiouru Ward (-10.2%), the proportion of overseas born in the populations was less than the national average.

Ethnicity

At the 1996 Census, Maori comprised 14.3 percent and Pacific Islanders 3.7 percent of the population of the Central region (table 6). About one in every four Maori (25.1%) of the Central region resided in the Hawkes Bay subregion, compared to 7.5 percent in the Nelson/Marlborough subregion and 4.6 percent in the Wairarapa subregion.

The proportion of Maori in the populations of the Wairoa District (57.8%), Chatham Islands District (61.1%), the Wards of Waimarino (39.2%) and Waiouru (39.5%), Rangitikei District (24.5%) and Hastings District (23.9%) were markedly higher than the national average (15.1%). In contrast, there were fewer Maori than the New Zealand average in the populations of Palmerston North City (13.1%), Manawatu District (12.6%), Carterton District (11.1%), Kapiti Coast District (11.4%), Upper Hurt (13.0%) and Wellington (8.0%) cities, Tasman District (7.1%), Nelson City (7.8%), and Marlborough District (10.6%).

Thirty percent of Pacific Island people in the Central region were living in the PorirualKapiti area at the time of the 1996 Census. Specifically, 21.6 percent of the population of Porirua City were of Pacific Island ethnicity. Lower Hurt City (7.3%) was the only other area in the Central region with a higher proportion of Pacific Island people than the national average (5.0%).

Nine percent of the population in Wellington City were ofAsian ethnicity compared to the national average of 4.6 percent. The populations of Lower Hurt City (5.4%) and Palmerston North City (5.2%) also had above average proportions of Asians.

Page 24— The Public Health of the Central Region I

Life expectancy

Life expectancy is an accepted measure of the health status of a population (table 10). At birth, males in the Central region have a life expectancy of 72.7 years, and females 78.6 years. While there is little variation between the subregions, Nelson/Marlborough has the highest, and Wanganui the lowest, life expectancy in the Central region.

Number of children

Table 11 clearly shows that the trend for younger mothers to have fewer children. However, in all maternal age groups, the average number of children born to mothers in Wairoa district and the Chatham Islands exceeds the national average.

The average number of children is less than the New Zealand average in the cities of Palmerston North, Wellington, Lower and Upper Hutt, Nelson, and Napier. Porirua City is the only area within the Wellington region where the number of liveborn children is higher than the New Zealand average.

Determinants of Health - Page 25 Ii Table 6: Population by subregion, age, sex and ethnicity, 1996 Census 111 HAWKES BAY Ethnicity 9 sex age group (yrs) Maori Pacific Island Other Not specified Total Males 0-4 2298 177 3396 126 5997 5-14 3942 288 7317 573 12120 15-24 2856 240 6003 606 9705 25-44 4032 414 14277 1041 19764 621 14769 9 45-64 1965 165 12018 65+ 489 42 6906 288 7725 Total 15582 1326 49917 3255 70080

Females 0-4 2073 168 3189 108 5538 5-14 3936 264 6822 495 11517 15-24 2928 234 5916 480 9558 25-44 4773 381 15081 990 21225 9 45-64 2133 159 12183 531 15006 65+ 633 33 9390 417 10473 Total 16476 1239 52581 3021 73317

Both sexes 0-4 4371 345 6585 234 11535 5-14 7878 552 14139 1068 23637 15-24 5784 474 11919 1086 19263 25-44 8805 795 29358 2031 40989 45-64 4098 324 24201 1152 29775 65+ 1122 75 16296 705 18198 Total 32058 2565 102498 6276 143397 B ID U ID U ID ID 9

Page 26- The Public Health of the Central Region I

Table 6: Population by subregion, age, sex and ethnicity, 1996 Census, continued...

WANGANUI Ethnicity sex age group (yrs) Maori Pacific Island Other Not specified Total Males 0-4 1041 63 1722 54 2880 5-14 1839 99 3600 255 5793 15-24 1287 87 3129 276 4779 25-44 1938 150 6999 549 9636 45-64 771 42 5238 351 6402 65+ 225 15 3411 177 3828 Total 7101 456 24099 1662 33318

Females 0-4 987 57 1599 51 2694

5-14 1782 99 3489 219 5589

15-24 1353 63 2850 228 4494

25-44 2181 138 7203 426 9948

45-64 882 45 5451 264 6642

65+ 258 9 4668 261 5196

Total 7443 411 25260 1449 34563

Both sexes 0-4 2028 120 3321 105 5574

5-14 3621 198 7089 474 11382

15-24 2640 150 5979 504 9273

25-44 4119 288 14202 975 19584

45-64 1653 87 10689 615 13044

65+ 483 24 8079 438 9024

Total 14544 867 49359 3111 67881

Determinants of Health - Page 27

Table 6: Population by subregion, age, sex and ethnicity, 1996 Census, continued...

MANAWATU Ethnicity sex age group (yrs) Maori Pacific Island Other Not specified Total Males 0-4 1569 168 3960 96 5793 5-14 2715 291 8457 387 11850 15-24 2196 285 10134 426 13041 25-44 2901 384 17208 729 21222 45-64 1128 153 12348 393 14022 65+ 288 15 7248 201 7752 Total 10797 1296 59355 2232 73680

Females 0-4 1482 144 3873 93 5592

5-14 2550 300 8037 345 11232

15-24 2286 291 9936 357 12870

25-44 3066 351 18204 618 22239

45-64 1179 141 12747 363 14430

65+ 324 42 9681 321 10368

Total 10887 1269 62478 2097 76731

Both sexes 0-4 3051 312 7833 189 11385

5-14 5265 591 16494 732 23082

15-24 4482 576 20070 783 25911

25-44 5967 735 35412 1347 43461

45-64 2307 294 25095 756 28452

65+ 612 57 16929 522 18120

Total 21684 2565 121833 4329 150411

Page 28- The Public Health of the Central Region I

Table 6: Population by subregion, age, sex and ethnicity, 1996 Census, continued...

PORIRUAIKAPITI

sex age group (yrs) Maori Pacific Island Other Not specified Total Ethnicity Males 0-4 1032 678 1848 96 3654 5-14 1728 1179 4014 432 7353 15-24 1107 903 3009 399 5418 25-44 1644 1248 7689 807 11388 45-64 756 651 6618 600 8625 65+ 144 132 4401 312 4989 Total 6411 4791 27579 2646 41427

Females 0-4 942 630 1755 99 3426 5-14 1650 1065 3756 339 6810 15-24 1185 945 2892 330 5352 25-44 1953 1500 8532 747 12732 45-64 801 672 6969 519 8961 65+ 192 201 5682 417 6492 Total 6723 5013 29586 2451 43773

Both sexes 0-4 1974 1308 3603 195 7080 5-14 3378 2244 7770 771 14163 15-24 2292 1848 5901 729 10770 25-44 3597 2748 16221 1554 24120 45-64 1557 1323 13587 1119 17586 65+ 336 333 10083 729 11481 Total 13134 9804 57165 5097 85200

Determinants of Health - Page 29 U

Table 6: Population by subregion, age, sex and ethnicity, 1996 Census, continued... fl HUTT fl Ethnicity sex age group (yrs) Maori Pacific Island Other Not specified Total Males 0-4 1308 522 3639 84 5553 5-14 2214 864 7071 408 10557 15-24 1929 798 6639 384 9750 25-44 2733 1137 15702 765 20337 45-64 1014 498 11349 423 13284 65+ 141 90 5385 249 5865 Total 9339 3909 49785 2313 65346

Females 0-4 1239 432 3465 78 5214 5-14 2070 837 6726 330 9963 15-24 1929 816 6654 360 9759 25-44 2904 1170 16287 603 20964 45-64 933 501 11412 381 13227 65+ 195 132 7422 396 8145 Total 9270 3888 51966 2148 67272

Both sexes 0-4 2547 954 7104 162 10767 5-14 4284 1701 13797 738 20520 15-24 3858 1614 13293 744 19509 25-44 5637 2307 31989 1368 41301 45-64 1947 999 22761 804 26511 65+ 336 222 12807 645 14010 Total 18609 7797 101751 4461 132618 U ci 0 U U El El

Page 30 - .The Public Health of the Central Region I

Table 6: Population by subregion, age, sex and ethnicity, 1996 Census, continued...

WELLINGTON Ethnicity sex age group (yrs) Maori Pacific Island Other Not specified Total Males 0-4 708 417 4224 75 5424 5-14 1062 708 7380 525 9675 15-24 1284 741 9963 645 12633 25-44 2070 1128 24015 1116 28329 45-64 708 516 13227 588 15039 65+ 84 69 5358 366 5877 Total 5916 3579 64167 3315 76977

Females 0-4 645 408 4089 72 5214 5-14 1047 648 7011 438 9144 15-24 1482 771 11142 597 13992 25-44 2163 1362 25107 990 29622 45-64 696 519 13086 483 14784 65+ 129 114 7281 411 7935 Total 6162 3822 67716 2991 80691

Both sexes 0-4 1353 825 8313 147 10638 5-14 2109 1356 14391 963 18819 15-24 2766 1512 21105 1242 26625 25-44 4233 2490 49122 2106 57951 45-64 1404 1035 26313 1071 29823 65+ 213 183 12639 777 13812 Total 12078 7401 131883 6306 157668

Determinants of Health - Page 31 Ii

Table 6: Population by subregion, age, sex and ethnicity, 1996 Census, continued... 9

WAIRARAPA [1 Ethnicity sex age group (yrs) Maori Pacific Island Other Not specified Total Males 0-4 438 51 996 15 1500 5-14 744 87 2370 111 3312 15-24 513 75 1737 87 2412 25-44 699 96 4152 189 5136 45-64 351 45 3663 120 4179 65+ 75 12 2172 81 2340 Total 2820 366 15090 603 18879

Females 0-4 393 33 1017 24 1467 5-14 771 72 2238 96 3177 15-24 558 51 1662 78 2349 25-44 810 102 4404 177 5493 45-64 372 27 3651 105 4155 65+ 105 21 2778 114 3018 Total 3009 306 15750 594 19659 9 Both sexes 0-4 831 84 2013 39 2967 5-14 1515 159 4608 207 6489 15-24 1071 126 3399 165 4761 25-44 1509 198 8556 366 10629 45-64 723 72 7314 225 8334 65+ 180 33 4950 195 —__5358 Total 5829 672 30840 1197 38538

0 Eli Eli 0 ED 9 0 Page 32 - The Public Health of the Central Region 9 U

Table 6: Population by subregion, age, sex and ethnicity, 1996 Census, continued...

NELSON/MARLBOROUGH Ethnicity sex age group (yrs) Maori Pacific Island Other Not specified Iota Males 0-4 666 57 3453 54 4230 5-14 1173 102 7335 333 8943 15-24 909 102 6492 363 7866 25-44 1389 144 14880 753 17166 45-64 546 48 11760 447 12801 65+ 123 24 6597 243 6987 Total 4806 477 50517 2193 57993

Females 0-4 603 51 3216 69 3939 5-14 1113 99 7008 294 8514 15-24 879 45 5913 309 7146 25-44 1389 129 15498 570 17586 45-64 594 42 11517 336 12489 65+ 147 15 8454 306 8922 Total 4725 381 51606 1884 58596

Both sexes 0-4 1269 108 6669 123 8169

5-14 2286 201 14343 627 17457

15-24 1788 147 12405 672 15012

25-44 2778 273 30378 1323 34752

45-64 1140 90 23277 783 25290

65+ 270 39 15051 549 15909

Total 9531 858 102123 4077 116589

Determinants of Health - Page 33

El

Table 6: Population by subregion, age, sex and ethnicity, 1996 Census, continued... fl

CENTRAL REGION Ethnicity [I sex age group (yrs) Maori Pacific Island Other Not specified Total. Males 0-4 9060 2133 23238 600 35031 5-14 15417 3618 47544 3024 69603 15-24 12081 3231 47106 3186 65604 25-44 17406 4701 104922 5949 132978 fl 45-64 7239 2118 76221 3543 89121 65+ 1569 399 41478 1917 45363 Total 62772 16200 340509 18219 437700

Females 0-4 8364 1923 22203 594 33084 5-14 14919 3384 45087 2556 65946 15-24 12600 3216 46965 2739 65520 25-44 19239 5133 110316 5121 139809 45-64 7590 2106 77016 2982 89694 65+ 1983 567 55356 2643 60549 Total 64695 16329 356943 16635 454602

Both sexes 0-4 17424 4056 45441 1194 68115 5-14 30336 7002 92631 5580 135549 15-24 24681 6447 94071 5925 131124 25-44 36645 9834 215238 11070 272787 45-64 14829 4224 153237 6525 178815 65+ 3552 966 96834 4560 105912 Total 127467 32529 697452 34854 892302 Source: 1996 Census fl U U ci ci ci ci ci Page 34- The Public Health of the Central Region ci I

Table 7: Population change by area, 1991-1996 Censuses

Area % change Tasman District 11.6 Kapiti Coast District 10.4 Nelson City 10.4 Marlborough District 9.3 Wellington City 6.2 Waiouru Ward 6.0 Palmerston North City 5.1 Napier City 4.2 Hastings District 3.5 Manawatu District 3.5 Waimanno Ward 2.5 Central Hawkes Bay District 1.7 Horowhenua District 1.1 Lower Hutt City 1.0 Masterton District 0.8 Wanganui District 0.8 Porirua City 0.2 Upper Hun City -0.4 Carterton District -0.8 Rangitikei District -1.3 Wairoa District South Wairarapa District -2.4 Tararua District -4.0 Central region 3.9 Source: 1996 Census

tr,,in,r,fc t- ili - -U Table 8: Population projections by area, 2000, 2005, 2010 a a w LA MALES- Projected populations Age Year Hawkes Wanganui Manawatu Kapiti Porirua Upper Lower Wellington Wairarapa Nelson! Central group Bay Coast Hutt Hutt Marlborough region C a- 0-4 2000 5855 2740 5600 1310 2250 1300 3880 5360 1430 4210 33935 2005 5240 2470 5270 1280 2000 1180 3500 4980 1270 3920 31110 a 2010 4775 2290 4980 1290 1790 1080 3190 4580 1160 3730 28865 a- a 5-14 2000 12270 5780 11850 3080 4400 2970 7850 10080 3130 9480 70890 4170 2730 7630 10160 2890 9530 68935 rD 2005 11985 5320 11470 3050

rDI 2010 11100 4860 10790 2930 3740 2340 6930 9580 2620 9060 63950 a 15-24 2000 9205 4630 13060 1960 3260 2760 6350 12420 2380 7630 63655 8400 66945 a 2005 9565 5000 13720 2370 3360 2740 6570 12760 2460 a 3 2010 9780 5000 13760 2640 3370 2770 7000 13210 2250 8960 68740 a 25-44 2000 19600 9240 21490 4700 6840 5460 14720 29350 4730 18020 134150 2005 18255 8270 20880 4770 6440 5010 13770 29000 4200 17430 128025 2010 16865 7410 20550 4840 6050 4520 12540 27720 3900 17040 121435 45-64 2000 16155 6840 15280 4550 4890 3850 10020 16260 4580 14570 96995 2005 18155 7670 17180 5150 5340 4200 11170 18600 4980 16990 109435 2010 19525 8340 18950 5690 5590 4480 12150 21490 5160 18800 120175 65+ 2000 8165 3900 8120 3770 1640 1790 4290 6050 2430 7590 47745 2005 8790 4020 8590 4000 1880 1850 4320 6070 2580 8390 50490 2010 9950 4230 9440 4400 2280 1960 4710 6500 2800 9660 55930 All Ages 2000 71230 33100 75400 19400 23300 18100 47100 79500 18700 61500 447330 2005 71850 32700 77200 20600 23200 17700 47000 81600 18400 64600 454850 2010 72070 32100 78500 21800 22800 17200 46500 83100 17900 67300 459270 Assuming ,nediuui ferlility, ,,iediuni mortality, medium migration Source: Statistics NZ

I ------Table 8: Population projections by area, 2000, 2005, 2010, continued...

FEMALES- Projected populations Age Year Hawkes Wanganui Manawatu Kapiti Porirua Upper Lower Wellington Wairarapa Nelson/ Central group Bay Coast Hutt Hutt Marlborough region 0-4 2000 5475 2600 5310 1220 2040 1240 3700 5200 1310 3950 32045 2005 5005 2380 4960 1210 1840 1100 3360 4760 1180 3730 29525 2010 4560 2210 4720 1210 1640 1010 3060 4380 1090 3550 27430 5-14 2000 11640 5430 11540 2970 4040 2740 7370 9620 3100 9080 67530 2005 11270 5020 11070 2900 3780 2540 7130 9820 2840 8980 65350 2010 10465 4670 10340 2780 3280 - 2180 6530 9300 2460 8580 60585 15-24 2000 8470 4290 12340 1880 3100 2580 6240 13020 2230 6620 60770 2005 8720 4530 12850 2170 3120 2440 6310 13190 2260 7420 63010 2010 8960 4400 13140 2490 3180 2450 6540 13760 2180 8050 65150 25-44 2000 21035 9660 22440 5300 7500 5400 15620 31190 5180 18380 141705 2005 19295 8720 21360 5290 6860 4980 14730 30850 4510 17590 134185 2010 17225 7740 20090 5070 6150 4380 13340 29090 4040 16620 123745 45-64 2000 16655 6990 15780 5060 4880 3860 10080 16450 4520 14460 98735 2005 18915 7810 18020 5750 5450 4260 11280 19280 5040 17070 112875 - 2010 20885 8650 20180 6500 5910 4610 12530 22810 5370 19350 126795 65+ 2000 10890 5210 10580 4920 1950 2350 5920 7890 3090 9430 62230 2005 11530 5230 11020 5230 2220 2470 5890 7760 3180 10130 64660 2010 12535 5400 11770 5610 2600 2630 6120 8130 3370 11320 69485 0

0 All Ages 2000 74230 34200 78000 21400 23500 18200 48900 83400 19400 62000 463230 3 2005 74650 33600 79200 22500 23300 17800 48700 85700 19100 64900 469450 1) 2010 74660 33100 80200 23700 22800 17300 48100 87500 18600 67400 473360 1

-I, Assuming ,nediu,n fertility. medium mortality, medium migration Source:Statis,ics NZ

-4

0

0

-AJ -J Table 8: Population projections by area, 2000, 2005, 2010, continued...

BOTH SEXES - Projected populations Age Year Hawkes Wanganui Manawatu Kapiti Porirua Upper Lower Wellington Wairarapa Nelson/ Central group Bay Coast Hutt Hutt Marlborough region 0-4 2000 11350 5330 10920 2540 4290 2540 7580 10560 2740 8170 66020 2005 10255 4840 10210 2490 3830 2290 6860 9740 2460 7640 60615 2010 9330 4480 9680 2500 3440 2070 6250 8960 2250 7280 56240 5-14 2000 23915 11220 23400 6050 8440 5710 15230 19700 6250 18540 138455 2005 23240 10340 22580 5950 7930 5270 14750 19980 5730 18510 134280 2010 21570 9540 21140 5710 7020 4530 13460 18870 5090 17660 124590 15-24 2000 17665 8910 25420 3840 6350 5350 12590 25450 4620 14240 124435 2005 18275 9540 26560 4550 6480 5180 12880 25950 4720 15840 129975 2010 18770 9400 26870 5130 6550 5240 13530 26970 4440 17000 133900 25-44 2000 40635 18890 43910 9980 14340 10860 30350 60540 9940 36370 275815 2005 37570 16950 42220 10060 13310 10000 28490 59840 8730 35010 262180 2010 34070 15140 40660 9910 12190 8910 25870 56820 7940 33650 245160 45-64 2000 32780 13840 31070 9600 9770 7710 20120 32690 9110 29050 195740 2005 37025 15460 35190 10880 10780 8430 22460 37880 10050 34060 222215 2010 40395 16990 39120 12180 11510 9080 24680 44300 10550 38140 246945 65+ 2000 19070 9090 18710 8700 3570 4150 10210 13940 5520 17010 109970 2005 20280 9260 19630 9220 4110 4320 10210 13820 5770 18510 115130 2010 22470 9640 21230 10020 4880 4600 10830 14630 6190 21020 125510 All Ages 2000 145460 67200 153400 40700 46800 36300 96100 162900 38200 123300 910360 2005 146600 66400 156400 43200 46400 35500 95700 167200 37400 129500 924300 2010 146620 65200 158800 45400 45600 34400 94600 170500 36400 134700 932220

Assuming medium fertility, medium mortality, medium migration Source: Statistics NZ

I= - - - - - mm .------

Table 9: Ethnic composition of population, 1996 Census

4- U 4- U 4- 6 • In >.. 4- 6 . • (C 4- - JA >,> 4- aj D - > 6 LA .i Z - (C (C 4- 13 13 13 .0 (C 4- 0> -ø 6 6 >n M CC (C Lfl (C a> ° 6 IJ 2 - 6 E 2 0 a> 0>(C (C - c > (C a) I.. - 0 a) E 0 4- 2 in . E (C . 0. (C (C - 0 0 CC 0 0. (C C) . ( 2 5 -J j! z 2 z

Percentage of People Born Ovcrseas(UR) 10.3 15.5 16.6 9.1 9.7 12.2 10.2 14.8 10.9 10.5 17.4 9.1 14.3 11.8 13.5 15.0 22.1 28.2 19.6 22.7 27.8 15.0 18.5 12.8 21.3

Percentage of People of European Ethnicity - Only(UR) 41.0 72,0 79.8 77.4 37.3 58.7 55.7 77.8 73.9 85.7 78.7 80.5 76.5 79.4 87.0 82.2 85.6 54.7 80.9 71.8 76.9 91.6 89.0 87.9 74.9 Percentage of People of Maori Ethnicity (UR) 57.8 23.9 16.5 21.1 61.1 39.2 39.5 19.3 24.5 12.6 13.1 18.0 19.3 17.1 11.1 15.4 11.4 20.7 13.0 15.1 8.0 7.1 7.8 10.6 15.1

Percentage ofPeople of Pacific Island Ethnicity (Excluding Maori)(IJR) 0.6 2.7 1.4 0.9 0.7 0.4 3.1 1.4 0.9 0.8 2.3 0.6 2.0 2.2 1.1 1.3 1.4 21.6 3.0 7.3 4.9 0.5 1.0 0.7 5.0

Percentage of People of Asian Ethnicity OUR) 0.6 1.2 2.2 0.5 0.9 1.6 1.6 1.4 0.6 0.8 5.2 0.8 2.1 1.2 0.7 0.9 1.5 2.8 3.0 5.4 9.0 0.6 2.0 0.6 4.6

UR = usual residence Source. 1996 Census

D 0

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Table 10: Life expectancy, by sex and region, 1990-92

Expected number of years of life remaining at age Actual Central Hawkes Manawatu Wanganui Porirua/ Hutt Wellington Wairarapa Nelson! Age-Males Region Bay Kapiti Marlborough 0 72.7 71.6 73.1 71.1 72.3 72.9 73.6 71.3 74.3

1 72.5 71.4 72.7 71.1 72.2 72.6 73.4 71.0 73.8 5 68.6 67.6 68.8 67.3 68.5 68.7 69.6 67.3 70.0 10 63.7 62.7 63.9 62.5 63.6 63.8 64.7 62.5 65.1

15 58.8 57.8 59.0 57.6 58.7 58.9 59.8 57.6 60.2

20 54.2 53.1 54.4 53.1 54.1 54.4 55.0 53.0 55.4

25 49.7 48.6 49.8 48.7 49.5 49.8 50.5 48.6 50.9 30 45.0 44.1 45.1 44.2 44.8 45.1 45.7 440 46.4

35 40.3 39.5 40.4 39.6 40.0 40.3 40.9 39.4 41.6

40 35.6 34.9 35.7 35.0 35.3 35.5 36.2 34.8 36.9 45 30.9 30.3 31.0 30.3 30.7 30.8 31.5 30.2 32.2

50 26.4 25.7 26.5 25.8 26.4 26.3 26.9 25.8 27.7

55 22.1 21.5 22.1 21.4 22.2 22.1 22.7 21.6 23.3 60 18.1 17.7 18.0 17.6 18.2 18.2 18.6 17.6 19.1

65 14.6 14.2 14.3 14.3 14.9 14.7 15.1 14.0 15.4 70 11.5 11.1 11.0 11.3 12.1 11.8 12.0 11.0 12.1

75 8.9 8.5 8.5 8.9 9.5 9.3 9.1 8.3 9.3

80 6.7 6.5 6.1 6.6 7.3 7.1 7.2 6.5 7.0

85 5.1 4.5 4.9 4.9 5.4 6.3 5.3 5.1 5.3 Source: Statistics NZ, Life tables 1990-1992

Expected number of years of life remaining at age Actual Central Hawkes Manawatu Wanganui Porirua/ Hutt Wellington Wairarapa Nelson/ Age -FnaIes Region Bay Kapiti Marlborough 79.30 78.6 78.1 78.2 77.1 78.7 78.5 78.0 80.3 1 78.1 77.7 77.8 76.6 78.1 78.1 78.8 77.4 79.7 5 74.3 73.8 73.9 72.8 74.2 74.2 75.0 73.6 75.8 10 69.4 68.9 69.0 67.9 69.3 69.3 70.1 68.6 70.8 15 64.4 64.0 64.0 62.9 64.3 64.3 65.2 63.7 65.9 20 59.6 59.2 59.3 58.1 59.6 59.4 60.3 58.9 61.0 25 54.7 54.4 54.5 53.3 54.8 54.5 55.4 54.0 56.2 30 49.9 49.6 49.6 48.5 50.0 49.7 50.5 49.2 51.3

35 45.1 44.8 44.8 43.7 45.3 44.9 45.6 44.4 46.5 40 40.3 40.0 40.1 39.0 40.5 40.1 40.8 39.6 41.7 45 35.6 35.3 35.4 34.4 35.8 35.4 36.0 34.9 36.9

50 31.1 30.8 30.9 29.9 31.3 30.8 31.4 30.4 32.3

55 26.7 26.4 26.5 25.7 26.9 26.2 27.0 26.0 27.8

60 22.5 22.4 22.4 21.5 22.9 22.0 22.8 21.8 23.5 65 18.5 18.6 18.4 17.6 19.0 18.0 18.7 17.8 19.4 70 14.9 15.0 14.8 14.1 15.6 14.4 15.0 14.0 15.6

75 11.6 11.8 11.7 11.0 12.2 11.2 11.4 11.0 12.2

80 8.8 8.9 9.0 8.3 9.3 8.4 8.6 8.0 9.3

85 6.6 6.6 6.8 6.3 7.1 6.2 6.4 6.3 6.9 Source: Statistics NZ, Life tables 1990-1992

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Table 11: Average number of children born alive, by maternal age and area, 1996 Census

Age group (years)

Area 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

2.3Wairoa District 1.1 1.7 2.8 3.2 71 3.2 3.9 4.3 4.6

Hastings District 1.2 1.6 2.1 2.5 2.8 18 2.9 3.0 3.4 3.7

Napier City 1.2 1.5 1.9 2.3 2.6 2.6 2.7 3.0 3.3 3.6

Central Hawkes Bay District 1.0 1.6 2.1 2.5 2.8 3.0 3.0 3.3 3.5 3.9

Chatham Island District 1.0 1.6 1.7 2.8 3.4 3.1 3.4 4.2 3.9 5.8

Ruapehu District 1.2 1.6 2.1 2.5 3.0 3.0 3.2 3.4 3.8 4.3

Wanganui District 1.1 1.6 2.1 2.4 2.7 2.7 2.9 3.0 3.4 3.8

Rangitikei District 1.2 1.5 2.1 2.5 2.8 2.9 3.1 3.3 3.5 4.0

Manawatu District 1.1 1.4 1.9 2.4 2.7 2.8 2.9 3.1 3.5 3.6

Palmerston North City 1.1 1.4 1.8 2.2 2.5 2.7 2.7 3.0 3.3 3.6

Tararua District 1.1 1.5 2.1 2.7 2.9 3.1 3.1 3.5 3.7 4.1

Horowhenua District 1.1 1.6 2.0 2.4 2.8 2.9 3.0 3.2 3.5 3.7

Kapiti Coast District 1.2 1.4 1.9 2.3 2.6 2.6 2.7 2.9 3.2 3.3

Porirua City 1.3 1.6 2.1 2.5 2.7 2.9 3.1 3.3 3.8 4.1

Upper Hun City 1.2 1.4 1.8 2.3 2.6 2.7 2.7 2.9 3.1 3.4

Lower Hutt City 1.1 1.5 1.8 2.2 2.6 2.7 2.8 3.0 3.2 3.4

Wellington City 1.1 1.4 1.6 1.9 2.3 2.5 2.5 2.7 3.0 3.2

Masterton District 1.2 1.6 2.0 2.4 2.7 2.8 3.0 3.3 3.4 3.6

Carterton District 1.2 1.6 2.0 2.3 2.7 2.8 3.0 3.1 3.2 3.7

South Wairarapa District 1.1 1.6 2.1 2.5 2.8 2.9 3.0 3.1 3.5 3.7

Tasman District 1.1 1.4 1.8 2.3 2.6 2.6 2.7 3.0 3.3 3.6

Nelson City 1.1 1.4 1.8 2.1 2.4 2.5 2.6 2.8 3.1 3.3

Marlborough District 1.0 1.5 1.9 2.3 2.5 2.7 2.7 2.9 3.4 3.7

New Zealand 1.1 1.5 1.9 2.3 2.6 23 2.8 3.0 3.4 3.6

includes all constituent areas of Ruapehu District Source: 1996 Census INTRODUCTION

Socio-economic factors have long been accepted as being major determinants of public health. In this section, a variety of indicators of socio-economic status are described in relation to the areas of the Central region.

MARITAL STATUS

At the time of the 1996 Census, 61.7 percent of the New Zealand population were married (or in other partnerships) (table 12). In the Central region the areas with the lowest proportion of married people are Waiouru Ward (54.9%), Wellington City (56.6%) and Palmerston North City (54.3%). Areas with above average proportions of married people in the population were outside the main urban areas: Marlborough District (68.0%), Tasman District (68.6%), Kapiti Coast District (66.8%), South Wairarapa District (67.1%), Carterton District (67.2%), Rangitikei District (66.6%), and Tararua District (65.9%).

INCOME

In New Zealand generally, 23.8 percent of the population earn more than $30,000 per year (table 12). There are wide disparities in income levels within the Central region. In Wellington City, 37.8 percent of the population have an income over $30,000 per year, with above average percentages also in the contiguous cities of Lower Hutt (28.6%), Porirua (27.0%) and Upper Hurt (27.0%). Waiouru Ward (25.7%) was the only other area with a higher than average number of people earning over $30,000.

Conversely, only 13.8 percent of the population in Horowhenua District had an income in excess of $30,000, 14.8 percent in Wairoa District, 16.7 percent in Wanganui District, 16.9 percent in Carterton District, 17.2 percent in Masterton District, and 17.9 percent in South Wairarapa District.

Income by gender

The median income for males in the districts of Horowhenua ($15,853), Wairoa ($17,419), Wanganui ($18,126), Chatham Islands ($18,500), and South Wairarapa ($18,666) was at least $3000 less than the median income for all New Zealand males ($22,040) (table 13).

The median income for males in Wellington City ($28,849) was 30.9 percent higher than the national median for males. There were also high incomes for males in Lower Hurt City ($25,694) and Upper Hutt City ($25,016). The median income for females in Wellington City ($18,006) was the highest in the Central region, 42.8 percent above the national median ($12,609). The lowest median incomes for females occurred in the districts of Wairoa ($10,457), Ruapehu ($10,770), and Chatham Islands ($8,587).

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In New Zealand there is a difference of $9,431 between the male and female median incomes. In the Central region, this disparity is greatest in Lower Huff City (difference of $11,828), Lower Huff City ($11,694), Wellington City ($10,843), Chatham Islands District ($9,913), and Porirua City ($9,777). The difference between the median incomes for males and females is least in Horowhenua District (difference of $4,357).

Income support

At the time of the 1996 Census, 37.5 percent of the New Zealand population were receiving income support (table 12). In the Central region, 51.6 percent of the population in Horowhenua District were receiving income support with high levels also in Wanganui District (49.0%), Kapiti Coast District (47.2%), and Wairoa District (46.5%). The areas with the lowest proportions of the population receiving income support were Waiouru District (15.2%), Chatham Islands District (26.3%), and Wellington City (29.3%).

VEHICLES

Chatham Islands District (21.0%), Porirua City (17.7%), Wellington City (16.6%), Wanganui District (16.0%) and Lower Huff City (15.5%) had an above average proportion (12.0%) of households without a motor vehicle (table 14). However, this does not necessarily mean a lack of access to public transport.

Areas where the proportion of households with two cars was greater than the national average (33.4%) were Central Hawkes Bay District (37.5%), Manawatu District (37.3%), and Tasman District (36.7%). In the latter two areas, about 14 percent of households had three or more motor vehicles compared to the national average of 11.7 percent.

SOCIAL DEPRIVATION

Salmond et al (1998) have developed an index of deprivation,NZDep96, which combines nine variables from the 1996 Census which reflect material and social deprivation (ie, two income variables, transport, living space, home ownership, employment, education qualifications, support, communication).

In the Central region, the areas with a deprivation index above national mean index (1000) include: Wairoa District, Ruapehu District, Porirua City, Horowhenua District, Wanganui District, and Hastings District (table 15).

Areas with a low NZDep96 index include: Wellington City, Upper I-luff City, Marlborough District, Tasman District, Manawatu District, and Kapiti Coast District.

EDUCATION

Almost one in four people in Wellington City (24.8%) had a university qualification compared to a national average of 8.7% (table 16). Palmerston North City (12.2%) and Lower Hutt City (9.8%), were the only others areas in the Central region where the proportion of the population with university qualifications exceeded the New Zealand mean. These three areas are the centres of major tertiary education institutions.

£-I,!4, - 4) Nelson City (29.5%), Marlborough District (28.5%), Kaptiti Coast District (28.8%), and Upper Hutt City (28.4%) had a greater than average proportion of the population gaining the highest qualification at other non-university tertiary institutions.

Half of the population in Wairoa District (50.7%) had no academic qualifications, with similar high proportions in Chatham Islands District (49.2%), Horowhenua District (48.2%) Waimarino Ward (45.7%) and Tararua District (45.2%).

Schools

The Ministry of Education has developed a socio-economic indicator for schools based on household income, parents occupation, household crowding, parents educational qualifications, income support payments received by parents, and Maori and Pacific Islands ethnicity of a schools catchment area (Norris et al 1994). Schools are ranked in deciles which were combined into three socio-economic groups.

In New Zealand, about 30 percent of schools have a low socio-economic status, 40 percent have a high status, and 30 percent a low status. There is a similar general pattern in the Central region (table 17).

At the local level, 79.2 percent of schools in Wairoa District, 71.4 percent in Porirua City, and 50.0 percent in Horowhenua District have a low socio-economic status. Conversely, Palmerston North City (42.1%), Kaptiti Coast District (42.9%), Upper Hull City (45.5%), and especially Wellington City (63.9%) have an above average number of schools in the high status group.

LABOUR FORCE AND EMPLOYMENT

Although nationally 46.4 percent of the population is gainfully employed in the fulltime labour force, there is greater level of employment in Waiouru Ward (75.8%), Wellington City (54.6%), Lower Hull City (49.8%), Upper Hull City (47.8%), Tararua (48.0%), Central Hawkes Bay District (51.7%), and Chatham Islands District (56.0%) (table 18). Conversely, less than 40 percent of the population in the districts of Kapiti Coast (37.3%), Horowhenua (37.4%), Wanganui (38.3%), and Wairoa (40.4%) are in full-time employment.

The areas with the highest proportion of part-time employees are Chatham Islands District (16.5%), Manawatu District (15.8%), Tararua District (15.7%), and Masterton District (15.7%). More than 7 percent of the population in Wairoa District (7.6%) and Porirua City (7.3%) were unemployed and actively seeking work compared to the national average of 5.1 percent. The lowest percentages of unemployment in the Central region were in the Waiouru (3.0%), Tasman (2.9%) and Marlborough (13.7%) districts.

More than 40 percent of the populations in the Horowhenua (45.1%), Kapiti Coast (44.8%) and Wanganui (41.6%) districts were not in the labour force compared to the New Zealand average of 34.6 percent. The areas with the highest proportion of their population in the labour force were: Waiouru Ward (87.8%), Chatham Islands District (76.4%), Wellington City (73.5%), and Central Hawkes Bay District (70.3%).

Women comprised 45.7 percent of the national labour force, but 40.6 percent in Waimarino Ward, 38.3 percent in Chatham Islands District and 30.6 percent in Waiouru District.

41— The Pufr,Iir -Ifth nftF)o Cnfr,l P, I

Occupations

More than half of the total number of legislators and administrators (54.3%) and professionals (55.2%) in the Central region are usually resident in the Wellington region (table 19). Professionals comprised 21.8 percent of the work force in Wellington City and 15.8 percent in Palmerston North City. The New Zealand average at the time of the 1996 Census was 12.3 percent. The proportion of the population employed as technicians and associate professionals and clerks was also above average in these two areas. Fifteen percent of the workforce in Kapiti Coast District were legislators and administrators.

In Ruapehu District, 25 percent of the employed population were service and sales workers, the highest proportion in the Central region (national average was 15%).

Areas with at least 20 percent of the workforce employed in agricultural and fisheries were the districts of Wairoa (25.7%), Hastings (20.5%), Central Hawkes Bay (35.3%), Chatham Islands (41.6%), Ruapehu (21.8%), Rangitikei (27.8%), Manawatu (22.3%), Tararua (34.8%), Carterton (26.6%), South Wairarapa (31.1%), and Tasman (29.5%). In the Wairoa District (16.8%) and Central Hawkes Bay District (15.3%), the proportion of the population employed as plant and machine operators and assemblers was above the national average (8.7%).

HOUSEHOLDS

Ownership

More than 40 percent of dwellings in Porinia City (44.7%), Upper Hurt City (43.4%) Manawatu District (41.6%), Carterton District (41.1%), Lower Huff (40.4%) were owned with a mortgage, compared to the national average of 37.9 percent (table 20). Less than 30 percent of the dwellings in Waimarino Ward (30.0%), Wairoa District (29.7%), Chatham Islands District (29.5%) and Waiouru Ward (4.5%) were owned by a mortgage. Ninety percent of the dwellings in Waiouru Ward (90.9%) were rented or leased and at least 30 percent in Waimarino Ward (33.7%), Palmerston North City (32.2%), Wellington City (31.7%) and Porirua City (30.3%). The New Zealand average was 24.7 percent of all dwellings.

In New Zealand about one-third of dwellings are owned without a mortgage compared to 46.5 percent and 40.6 percent, respectively, in the districts of Kapiti Coast and Horowhenua. The national average is also exceeded in the Tasman District (38.8%), Marlborough District (38.3%), and South Wairarapa District (37.9%).

Composition

Almost 40 percent of the households in Waiouru Ward (38.5%) and one in five households in Porirua City (22.5%), Chatham Islands District (21.0%), Wairoa District (20.8%) and Waimarino Ward (20.4%) had children under five years of age (table 20). The national average was 16.0 percent of households.

Areas with the highest proportion of households with at least one superannuitant were Kapiti Coast District (36.4%), Horowhenua District (32.1%) and Wanganui District (28.4%). These were also the areas in the Central region with the highest proportion of one person households.

,,f W.nlffi - More than one in five households in Wairoa District (23.5%), Waimarino Ward (22.7%), Porirua City (22.6%), Wanganui District (22.1%), and Hastings District (21.2%) are at least one sole parent families. The national average is 17.4 percent of all households.

In Wellington City, 32.1 percent of households were non-family households, compared to the New Zealand average of 25.1 percent. In contrast, only 16.1 percent of households in Porirua City, and 17.5 percent in Waiouru Ward were non-family households.

Income

In Wellington City, 50.8 percent of households had an income exceeding $50,000 compared to the New Zealand average of 32.8 percent (table 20). Porirua City (43.3%), Lower Hutt City (39.4%), and Upper Hutt City (37.6%) were the only other areas in the Central region where the national average was exceeded.

In contrast, about 80 percent of households in the districts of Horowhenua (82.0%), Wairoa (81.3%), Wanganui (79.7%), Carterton (79.4%), Rangitikei (79.1%), Masterton (78.2%), and South Wairarapa (78.3%) and Waimarino Ward (78.6%), had an income less than $50,000.

Expenditure

The Household Expenditure Survey provides data on a households expenditure of a variety of items, including foodstuffs. However, there are some caveats associated with using these data. For example, the data may not reflect all sources of all foodstuffs which are consumed. People who live in rural areas may have access to foodstuffs which those living in cities have to buy and they may reflect a price differential between areas.

In the Central region, the estimated average annual household expenditure on alcohol ($892.81) is almost three times higher than expenditure on fresh fruit, fresh vegetables, milk, cream, yoghurt, and tobacco products (table 20).

References Norris M, Bathgate M, Parkin M. 1994. Development of a socio-economic indicator for schools. Presented to the NZARE conference.

Salmond C, Crampton P, Sutton F. 1998. NZDep96: Index of Deprivation. Wellington: Health Services Research Centre.

Pane 46— The Public Health of the Central Reoion Table12: Marital status and income, by area, 1996 Census

U

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CC 4- 4- U a. vs 41 Cu E W 0 LA 41 vs 1A vs . -c D Cu z D a 0 vs cu 41 C C CC o C ° C) Cu 4- C) 0 0 ij . ° 0 2 J E . 2 c Cu Os C) cu 12 CC - o cu . cu cC C)2 t° Cu g • - . E o tm a E 2 i.. 2 a • • 2 E c v a. a. - vs 0 CC 0 a. C) I Z .J L) a. i- i a. z z Marital status - Percentage of People who are Married (Including Other Partnerships) (UR) 62.1 61.3 60.8 65.8 64.7 63.8 54.9 59.2 66.6 65.8 54.3 65.9 62.3 64.0 67.2 67.1 66.8 61.8 61.8 61.4 56.6 68.6 61.6 68.0 61.7

Income- People with Personal Income in Excess of $30000(UR) 918 8295 7542 1578 102 474 444 5223 1860 4083 11805 2529 2991 2745 798 1092 6192 7827 7188 19188 44919 4719 6162 4872 Percentage of People with Personal Income in Excess of $30000(UR) 14.8 18.8 19.6 17.3 21.3 20.3 25.7 16.7 17.3 20.6 21.8 19.5 13.8 17.2 16917.9 22.5 27.0 27.0 28.6 37.8 17.5 20.9 18.1 23.8 Percentage of People Receiving Income Support(UR) 46.5 43.1 44.2 39.3 26.3 36.6 15.2 49.0 39.5 36.8 39.1 37.4 51.6 43.6 41.2 43.7 47.2 36.7 34.9 34.6 29.3 39.6 41.7 39.2 37.5 UR usual residence Source: 1996 Census

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4 Table 13: Median personal income for usually resident population, 15+ years of age, by area and sex, 1996 census

Median Income ($)

Area Male Female Difference between male and female Wairoa District 17419 10457 6962 Hastings District 19473 11994 7479 Napier City 20744 12173 8571 Central Hawkes Bay District 20485 11673 8812 Chatham Islands District 18500 8587 9913 Ruapehu District 20462 10770 9692 Wanganui District 18126 11726 6400 Rangitikei District 20447 11279 9168 Manawatu District 21697 12429 9268 Palmerston North City 20966 12143 8823 Tararua District 21020 11889 9131 Horowhenua District 15853 11496 4357 Kapiti Coast District 21646 12631 9015 Porirua City 23303 13526 9777 Upper Hutt City 25016 13188 11828 Lower Hurt City 25694 14000 11694 Wellington City 28849 18006 10843 Masterton District 19472 12110 7362 Carterton District 19919 11342 8577 South Wairarapa District 18666 11454 7212 Tasman District 19646 11276 8370 Nelson City 21835 12479 9356 Marlborough District 20577 11771 8806 New Zealand 22040 12609 9431 includes all constituent areas of Ruapehu District Source: 1996 Census

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Table 14: Number of motor vehicles for households in private dwellings, by area, 1996 Census

Number of motor vehicles for households in private dwelings Area 0 1 2 3+ Not specified Total WairoaDistnct 507 1413 939 228 201 3285 Hastings District 2592 9336 7494 2667 1107 23196 Napier City 2487 8829 6171 1914 645 20046 Central Hawkes Bay District 372 1836 1668 570 108 4557 Chatham Islands District 51 114 63 15 21 264 Ruapehu District 717 2496 1464 447 384 5508 Wanganui District 2553 7755 4425 1233 804 16773 Rangitikei District 630 2451 1881 615 267 5841 Manawatu District 807 3786 3561 1395 213 9762 Palmerston North City 2994 10992 7656 2718 876 25236 Tararua District 723 2859 2253 738 192 6762 Horowhenua District 1500 5310 3021 894 396 11124 Kapiti Coast District 1632 7431 4524 1074 681 15342 Porirua City 2307 5463 4098 1173 1008 14049 Upper Hutt City 1560 5688 3954 1242 351 12792 Lower Hutt City 5067 14508 10098 3009 1371 34053 Wellington City 9438 26718 15912 4536 2415 59016 Masterton District 1065 3744 2595 702 291 8397 Carterton District 252 1029 828 282 108 2499 South Wairarapa District 318 1455 1068 351 198 3393 Tasman District 1092 5682 4989 1833 567 14163 Nelson City 1698 6771 4767 1503 540 15279 Marlborough District 1266 5940 4788 1569 744 14310 - Central region 41628 141606 98217 30708 13488 325647 New Zealand 146757 522333 408213 143172 55854 1276332 includes all constituent areas of Ruapehu District Source: 1996 Census

"F LI—IfA - D,,0 Table 15: Index of deprivation (NZDep96) by area, 1996

Index of deprivation Area (NZDep96) Wairoa District 1093 Ruapehu District 1058 Porirua District 1058 Horowhenua District 1049 Wanganui District 1041 Hastings District 1025 Masterton District 1017 Napier City 1015 Rangitikei District 1010 South Wairarapa District 1006 Tararua District 1003 Central Hawkes Bay District 998 Lower Huff City 995 Carterton District 995 Palmerston North City 992 Nelson City 986 Kapiti Coast District 980 Manawatu District 979 Tasman District 977 Marlborough District 975 Upper Huff City 970 Wellington City 952 includes all constituent areas of Ruapehu District no index calculated for Chat/jam Islands District Source: Salmond eta! 1998

I

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Table 16: Educational status by area, 1996 Census

4- I 4- 4- 41) 4- 41) 4- (S U •t 1_ 4 (5 4- e • 41) 4- a) D • U- LI z (5 4- at C C C (I) C C (5 0 CS 2 E aJ o 0 Ui 2 • E 0 (.1 I Ui 2 - (5 at C C 0 CS CS 5 a) a) CS o -a) - E -2 2 . 4- o - 2 E E . . (5 CS 2 CU . 5 a) a) 0 - Z LI 0- D . Z 2 Z Education - Percentage of People Gaining 1-ugliest - Qualification at University (UR) 2.4 5.1 5.6 4.0 1.9 3.8 3.5 4.7 4.1 5.3 12.2 3.6 3.7 5.0 3.7 5.1 7.8 8.0 6.8 9.8 24.8 5.5 7.4 4.6 8.7

Percentage of People Gaining Highest Qualification at Other Tertialy Institution (IJR) 21925.4 26.6 23.8 25.4 24.1 27.5 25.9 24.2 24.3 24.4 23.0 22.9 25.5 25.4 24.5 28.8 24.7 28.4 26.8 25.6 28.2 29.3 28.5 26.1 Percentage of People Gaining Highest Qualification at Secondary School (UR) 25.0 29.1 28.6 30.2 23.6 26.3 49.9 27.7 29.8 30.0 34.9 28.2 25.2 28.0 27.8 28.3 29.7 30.0 32.2 30.1 31.1 30.0 29.5 30.0 30.5 Percentage of People with No Academic Qualifications (Uk) 50.7 40.4 39.3 42.0 49.2 45.7 19.2 41.7 41.9 40.4 28.4 45.2 48.2 41.5 43.1 42.1 33.7 37.4 32.7 33.3 18.5 36.4 33.7 37.0 34.7 UR = usual residence Source: 1996 census

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•1. 3-

U 3 a I Table 17: Number of schools in Ministry of Education socio-economic groups

Socio-economic group

Area Low Medium High Not known Total

Wairoa District 19 5 0 L 24 Hastings District 27 18 18 I 64 Napier District 11 17 7 I 36 Central Hawkes Bay District 7 10 5 I 22 Chatham Islands District 0 4 0 I 4 Ruapehu District 3 3 1 I 7 Wanganui District 17 18 9 45 Rangitikei District 6 17 6 30 Manawatu District 2 21 I 10 33 Palmerston North City 6 15 16 38 Tararua District 4 - 23 9 I I 36 Horowhenua District 12 11 I 24 Carterton District 6 1 I 8 Masterton District 7 11 10 I 29 South Wairarapa District 2 7 0 I 9 Kapiti Coast District 3 8 9 I 21 Ponnia City 25 9 I 35 Upper Hutt City 2 10 10 I 22 Hutt City 23 21 19 I 65 Wellington City 8 22 53 I 83 Tasman District 23 12 I 37 Nelson City 2 9 8 I 22 Marlborough District 5 20 8 I 33 Central region 193 300 221 727 New Zealand 808 1077 841 2764 includes all constituent areas of Ruapehu District Source: Ministry of Education

Pri 2 - Th P,,hfir -Iit1, r,fth p CnfrI Porijr,r,

Table 18: Profile of labour force, by area, 1996 Census

U 1 6 IZJ > (U (U

VI to 6 4 I.. 6 - z .. lJ • - D 666 (U . (U D 0 C (U C (U o 0 2 1,3 I 4 •C C 01- E U - (U (U (U w • .0 UI 2 E - 2 0 E U (U I a % 2

Number of People in the Labour Force (U R) 4,128 31,371 25,359 6,642 387 1,860 1,596 19,254 7,791 14,043 36,612 9,291 12,456 10,587 3,168 4,008 16,275 20,952 18,576 48,042 91,464 19,551 19,839 19,227

Percentage of People Gainfully Employed in the Full-time Labour Force (UR) 40.4 46.2 42.9 51.7 56.0 50.5 75.8 38.3 46.7 48.6 43.5 48.0 37.4 41.8 43.6 42.8 37.3 46.4 47.8 49.0 54.6 50.4 45.0 47.6 46.4

Percentage of People Gainfully Employed in the Part-time Labour Force(Uk) 13.8 14.7 14.4 14.7 16.5 15.0 9.1 14.0 14.7 15.8 14.9 15.7 12.7 15.7 15.3 14.0 13.7 13.0 13.9 13.1 14.3 15.4 14.7 14.6 14.0

Percentage of People Unemployed and Actively Seeking Work(Uk) 7.6 5.0 5.3 4.0 3.9 5.5 3.0 6.2 5.0 4.2 5.9 3.9 4.9 5.1 4.0 4.8 4.2 7.3 5.2 5.4 4.7 2.9 3.9 3.7 5.1

Percentage of People not in the Labour Force (U R) 38.2 34.2 37.4 29.7 23.6 29.0 12.2 41.6 33.6 31.4 35.7 32.5 45.1 37.5 37.1 38.5 44.8 33.3 33.1 32.5 26.5 31.4 36.4 34.2 34.6

Women as a Percentage of the Labour Force (Uk) 43.4 45.7 46.4 43.7 38.3 40.6 30.6 46.5 43,6 444 47.0 43.2 46.2 45.7 44.7 44.1 46.7 46.6 45.1 46.1 48.2 44.4 45.5 44.1 45.7 D Professionals as a Percentage 3 of the Work Force (Uk) 9.2 10.6 11.7 7.5 4.7 7.2 4.5 12.9 9.0 9.6 15.9 7.0 9.8 11.5 8.2 8.5 12.4 13.9 12.2 13.8 21.8 8.2 12.0 8.7 12.3 U

-4 l Drove a car; Truck or Van ) (Company or Private) to Workplace (Uk) z 1,764 16,986 1077 3,102 129 768 438 10,020 3,486 7,431 19,122 3,864 6,186 5,391 1,491 1,617 8,508 10,131 9,882 25,149 40,404 9,537 10,770 9,258 0 U -4 Percentage of People who Drove a car; Truck or Van (Company or Private) to Workplace a 57.0 67.2 72.3 55.5 43.6 51.8 31.2 67.6 55.5 63.7 66.2 50.0 62.7 63.9 57.1 50.2 66.1 63.1 65.8 64.9 53.3 58.4 66.8 58.7 65.6 U

0 DR = usual J1 residence Pi Source: 1996 Census I

Table 19: Employment of usually resident population aged 15+ years, by occupation (major group) by area, 1996 Census I

Occupation group VI I a, 0 VI 4- VI Ga IC U MU 0a U 0 IC a, ca Ew .2 • 4- 0 0 41 S ! VI IC (C VI VI VI 0 U 0. VI I kA - a, E a, . 0 VI • Q) U E (C 0 U VI 5(5 U 0 C VI 0. Area -JC 0. I_ V(VI 0.0(5 WO Z I Wairoa District 258 315 225 291 369 873 225 570 267 219 3,618 Hastings District 2604 2880 2337 3012 3687 5604 2253 2619 2361 1659 29016 Napier City 2478 2625 2412 3066 3564 1689 202 2124 2133 939 23 Central Hawkes Bay District 381 456 354 435 585 2145 375 930 411 201 6270 Chatham Islands District 24 21 18 18 21 141 18 51 27 30 3 RuapehuDistrict 531 534 432 579 1755 1512 507 621 465 342 7281 Wanganui District 1758 2127 1686 2145 2817 1383 1596 1668 1233 807 17233 Rangitikei District 549 612 519 669 1023 1890 447 633 462 396 7200 Manawatu District 1077 1236 1233 1476 1662 2853 1143 1275 834 390 13191 Palmerston North City 3462 5061 4083 4950 5880 1179 2775 2139 2262 1455 33246 Tararua District 552 597 540 669 876 2943 615 1089 570 303 8754 Horowhenua District 1074 1053 894 1161 1869 1680 1035 1230 810 549 11349 Kapiti Coast District 2,133 1773 1788 2028 2376 918 1575 942 789 732 15048 Ponrua City 2358 2418 2295 354 2667 228 1590 1308 1299 1128 18648 Upper Hutt City 2016 2007 2166 3198 2763 318 1776 1161 1095 636 17133 Lower Hutt City 5823 5829 5727 8148 5709 447 4335 3078 3060 2046 44202 Wellington City .13254 17973 13716 14367 10935 723 4686 2526 3606 3879 85662 Masterton District 921 1071 816 1065 1422 1467 891 783 783 510 9729 Carterton District 273 231 210 306 336 756 261 285 183 126 2967 South Wairarapa District 327 300 261 345 393 1098 276 282 246 171 3696 Tasman District 1587 1509 1332 1515 1983 5286 1470 1752 1506. 789 18729 Nelson City 2016 2151 2151 2196 2796 1047 1683 1875 1863 861 18636 Malborough District 1683 1542 1584 1752 2751 3297 1668 1575 1476 816 18147 Central region 47139 54321 46779 56745 58239 39477 33402 30516 27741 18984 413356 New Zealand 188979 191466 177597 216468 226077 153603 148974 135627 111285 80736 1630809 includes all constituent areas of Ruapehu District Source: 1996 Census

Pa p 54- The Public Health of the Central Rection

Table 20: Profile of households, by area, 1996 Census

VI U $ 0 4, Q (5 .5 .5 at $ $ (5 %A Vt (50 $ .5 (5 z . D • - 0 (5 0 0 = -0 . E .E - I D 2 •; (5 (5 (5 Dt at (5 at 2 p - E a 2 2 us - CL C E 2 t a • . E m m0(0 0 10 0 . 0 0. 15 ls D -

Total Number of Private Dwellings 3285 23196 20049 4557 261 1356 621 16770 5841 9762 25233 6762 11121 8394 2502 3393 15339 14049 12792 34053 59,019 14,163 15279 14310

Penwologe of Dwnllit.g Owned with Mor(gage(CN) 29.7 37.2 36.1 36.1 29.5 30.0 4.5 35.4 34.3 41.6 35.7 36,6 34.7 36.7 41.1 37.3 35.0 44.7 43.4 40.4 36.4 38.5 37.0 36.7 37.9 Percentage of Dwellings Owned without Mortgagr(CN) 34.2 34.6 36.3 32.7 30.0 27.3 2.3 36.6 33.3 33.0 30.1 34.6 40.6 35.8 35.9 37.9 46.5 22.8 34.4 30.7 29.2 38.8 35.7 38.3 33.4 Percentage of Dwellings Rented or Leaoed(Cff) 25.0 24.0 25.4 22.1 25.3 33.7 90.9 24.7 24.0 19.8 32.2 20.0 20.8 22.9 16.1 16.0 15.7 30.3 20.2 26.6 31.7 18.1 25.4 21.2 24.7 Total Number of Non-Private DwellingoCNt 48 117 123 39 9 21 39 93 54 39 126 45 42 51 12 18 75 33 42 87 231 210 lii 192 7,659 Households with ChildxenAgcd Less than5YcarntCN 684 3972 2913 729 54 276 240 2490 1005 1623 3852 1167 1,740 1314 360 513 1908 3159 2085 5922 7992 2058 2058 1950 lIouwhold6 with 0. . Mo. Supcmnnuit 705 5517 5532 1080 24 219 18 4770 1,386 2280 5370 1632 3570 2289 678 894 5580 2037 2793 7236 9588 3390 3933 3747 llouoot,olds with l\vo or Morn People olboLatrourForco 1272 9912 8079 2160 117 564 282 5937 2478 4698 11325 3069 3900 3378 1020 1284 5124 6636 5835 15372 28644 6477 6339 6168 One Person Households ca> 648 4743 4491 936 54 246 87 4146 1242 1884 4986 1428 2625 1968 543 762 3771 1836 2550 7131 13491 2757 3381 2916 Houoeholdo with a, Least One Sole parent Fa.oily(CN) 579 3636 3015 534 24 222 45 2535 702 1101 3327 804 1587 1068 258 360 1629 2562 1536 4542 5,508 1308 1818 1269 Noo.Family Households . (Ct>) 705 5469 5235 1050 66 285 108 4716 1374 2151 7134 1578 2826 2190 597 840 4077 2136 2952 8280 18,363 3195 4155 3318 Powoatage of lloraad,otdr with Children Aged Lmsth.5nSYosrn(CN) 20.8 17.1 14.5 16.0 21.0 20.4 38.5 14.9 17.2 16.6 15.3 17.2 15.6 15.7 14.4 15.2 12.4 22.5 16.3 17.4 13.5 14.5 13.5 13.6 16.0 Por000tagr of l(ousd,otd. with Oar or 21.5 23.8 27.6 23.7 9.9 16.1 3.1 28.4 23.7 23.3 21.3 24.2 311 27.3 27.2 26.4 36.4 14.5 21.8 21.3 16.3 23.9 25.7 26.2 22.8 Po,coutago of llouad,old. will, Two or 4 38742.7 40.3 47.4 44.3 41.5 45.4 35.4 42.4 48.1 44.9 45.4 35.1 40.2 40.8 37.9 33.4 47,2 45.6 45.2 48.5 45.7 41.5 43.1 44.1 Pcweuitagc of One Person Households (CN) 20.7 21.2 22.9 21.0 22.0 19.6 14.1 25.6 21.8 19.5 20.1 21.5 24.1 23.8 22.2 23.3 25.4 13.8 20.3 21.5 23.6 20.2 22.7 21.2 20.7 Percentag, of Hoardold, with at Lame 4 OooSokPmon(Farn.JyCN) 23.5 21.4 20.9 15.5 14.3 22.7 9.2 22.1 16.2 14.7 39.0 16.0 19.6 17.6 13.9 15.0 15.1 22.6 15.9 18.2 14.3 12.6 17.0 12.2 17.4 Pnmentagc of Non.Earnily Households (cN) 22.5 24.4 26.7 23.4 26.8 22.7 17.5 29.1 24.1 22.3 28.8 23.8 25.9 26.5 24.3. 25.7 27.4 16.1 23.5 25.0 32.1 23.4 27.9 24.1 25.3 Households with Household Irworne 5 480 4659 4443 873 54 225 153 2898 975 2451 6,921 1356 1749 1584 435 609 3528 4773 4209 11406 25527 2715 3552 2673 .4 iii Excess of$50000 (cm 3- Percentage of Households with Household Income in liners. of 18.7 24.5 25.7 22.0 25.5 21.4 33.1 20.3 20.9 27.9 32.2 23.5 18.0 21.8 20.6 21.7 27.3 43.4 37.6 39.4 50.8 23.0 27.4 23.2 318

.5 $50000 bit CN = census night I UR w usual residence I Source. 1996 Census

Table 21: Estimated average annual household expenditure for selected products, by area, year ended March 1996

Annual Expenditure

Fresh Fresh Ready-to-eat Milk, Cream, Tobacco Alcohol Area Fruit Vegetables Foods Yoghurt Products Wairoa District 199.80 319.16 501.67 362.36 334.06 706.00 Napier City 191.78 323.09 473.65 316.61 346.00 755.15 Hastings District 209.44 330.68 519.85 349.76 352.61 782.87 Central Hawkes Bay District 210.03 313.27 435.37 353.29 347.17 768.28 Ruapehu District (part) 255.11 329.23 650.26 380.57 377.60 888.72 Wanganui District 248.04 352.92 657.38 357.36 360.77 875.27 Rangitikei District 252.14 295.90 363.62 366.80 359.67 874.28 Manawatu District 266.35 326.30 489.87 374.03 373.90 935.27 Pamerston North City 267.33 375.86 782.79 369.71 376.37 956.93 Tararua District 256.52 321.23 469.17 372.73 364.66 882.59 Horowhenua District 258.79 362.04 667.29 364.96 368.08 909.21 Kapiti Coast District 264.11 352.88 565.98 357.44 372.51 901.75 Porirua City 280.83 408.41 812.08 391.43 389.77 957.05 Upper Hutt City 278.54 383.61 736.61 379.06 385.95 969.98 Lower Hutt City 266.87 380.64 782.61 361.09 374.49 946.43 Wellington City 278.66 385.38 865.61 341.07 380.82 1003.97 Masterton District 252.82 342.54 641.27 364.58 362.62 878.83 Carterton District 269.83 315.29 379.69 376.56 380.73 955.12 South Wairarapa District 250.85 313.07 519.56 355.69 364.15 877.23 Tasman District 237.04 344.46 559.54 367.74 352.15 987.95 Nelson City 230.73 336.94 559.18 343.43 347.22 877.36 Marlborough District 233.10 335.57 551.56 355.65 340.42 951.64 includes areas only in Central region Source: Statistics NZ, Regional Household Expenditure Estimates

Pane 56 - The Public Health of the Central Pection U

Tobacco remains one of the major determinants of public health status. It has been estimated that one in six of all deaths (17%) in the period 1989-93 were caused by cigarette smoking (Cancer Society 1966). Cigarettes caused 25 percent of deaths due to cancer, 12 percent of circulatory deaths (mainly heart attacks and strokes) and 41 percent of respiratory deaths. Twenty-two percent of male deaths and 12 percent of female deaths were attributed to cigarette smoking with almost half of these deaths occurred in middle age.

In 1994 it was estimated that about 18 percent of hospitalisations for 35-39 year old males and about 25 percent of male and female hospitalisations at age 60-64 were attributable to tobacco (Laugenson M, personal communication, 1998).

Parental tobacco smoking is a major risk factor for sudden infant death syndrome (SIDS) (Mitchell et al 1994). Environmental tobacco smoke increases the childhood risk of croup, pneumonia, bronchitis and bronchiolitis, asthma and glue ear (NHMRC Working Party 1995). Section 30(1) of the Smoke-free Environments Act 1990 prohibits the sale of tobacco to any person under the age of 16 years. It was amended on 28 July 1997 to increase the age at which people can legally be sold tobacco products to 18 years. Controlled purchase operations (CPOs) were introduced as part of the enforcement strategy because of the high rates of smoking among young people, many of whom start smoking before 16. They involve a child under 16 years attempting to purchase cigarettes from a retailer (table 22).

InAugust 1995 the Ministry of Health, in conjunction with Hutt Valley Health, ran a CPO in the Wellington region. This resulted in five prosecutions in 1996, four of which resulted in convictions.

During 1996-97 there were two successful prosecutions for sale of tobacco products to minors in the Manawatu health district and one in Wellington as a result of CPOs.

There are a small number of sales to minors from other CPOs in the region where the outcome is not yet known.

A Hawkes Bay retailer was prosecuted for advertising cheap cigarettes on a sandwich board outside a shop. The retailer pleaded guilty but was discharged without conviction in April 1997.

1996 Census

In the 1996 Census, 47.4 percent of Maori female population aged 15 years and over, who responded to the question on smoking, stated they were regular smokers (table 23). This compares to 19.3 percent of nonMaori females, 39.7 percent of Maori males, and 22.7 percent of nonMaori males.

Almost 60 percent of Maori females aged 15-24 years in the South Wairarapa (58.3%) and Central Hawkes Bay (58.2%) districts were smokers (table 23). There was also a high prevalence of smoking among nonMaori males (36.7%) and females (36.8%) in South Wairarapa District..

In the 25-44 year age group, the highest prevalences of smoking among Maori males were in Wairoa (51.1%) , Central Hawkes Bay (50.9%) and Masterton (50.0%) and among Maori females in Masterton (63.7%) and Horowhenua (59.2%) districts. The Wairarapa districts also had the highest smoking rates for nonMaori.

In all age groups, there were generally low rates of smoking in Palmerston North City, Wellington City, and the Nelson/Marlborough subregion.

r.-.4- ,,.f 1 The Big Kill (Cancer Society 1996) shows that 25 percent of 15 year olds had smoked, with 14 percent smoking daily (table 24). These levels are well exceeded in the Manawatu district, while in the adjacent Palmerston North City, the smoking levels are below the regional average.

In all age groups older than 40 years of age, Porirua City has a higher percentage of deaths due to cigarettes than the Central region average (table 25). Males and females aged 40-49 years in Napier City and Rangitilcei District also have an excess mortality from cigarettes.

In Porirua City the proportion of deaths from the major tobacco-related cancers and respiratory disease is four and five percent higher than the respective averages for the Central region (table 26). There is also an above average proportion of tobacco-related cancer deaths in Wairoa District and Central Hawkes Bay District.

School survey

Bandaranayake and McCool (1998) recently reported on a survey of 2691 fourth and sixth form students in 14 secondary schools in the Wellington area. The principal findings were:

Amongfourthformers: • 42 percent of female and 25 percent of male students describe themselves as current smokers

• 17 percent of females and 11 percent of males smoked on a daily basis

• a three percent increase in female students who were smoking daily and a one percent decrease in male students who were smoking daily

• both female and male believed that smoking looks bad, is a waste of money, reduces fitness, tastes bad, is hard to stop and affects the health of nonsmokers. Female students, however, tended to believe that smoking helps them relax and reduces weight, attitudes which had not changed over three previous surveys (1991, 1993 and 1995).

Among sixth formers: 46 percent of females and 27 percent of males were current smokers 19 percent of females and 16 percent of males smoked on a daily basis

Paoe 58- The Public Health of the Central Peion U

Table 22: Controlled purchase operations (CPO) by CHE

1996/1997 1997/1998 CHE Visits Sales Visits Sales Healthcare Hawkes Bay 65 1 0 0 Midcentral Health 32 4 14 1 Hutt Valley Health 28 5 21 0 Nelson/Marlborough 13 0 0 0 to March 1998 Source: Ministiy ofHealth

References Bandaranayake M, McCool J. 1998. Smoking Amongst Wellington Fourth and Sixth Form Students: Results of the 1997 Smoking Survey. Wellington: Cancer Society of New Zealand Inc.

Cancer Society. 1996. The Big Kill. Wellington: Cancer Society of New Zealand Inc.

NHMRC Working Party. 1995. The Health Effects of Passive Smoking. Canberra: National Health and Medical Research Council Working Party Draft Report.

Mitchell E A. 1994. Monitoring of the New Zealand SIDS Prevention Programme. Unpublished report to the Public Health Commission.

tdr,ritc rf -ialtl, -

Table 23: Smoking prevalence, by, sex, ethnicity, and area,1996 Census

% of respondents who regularly smoked Age group (yrs) Area Ethnic group 15-24 25-44 45-64 65+ total Wairoa District Maori males 35.7 51.1 39.0 22.0 41.6 NonMaori males 30.5 31.4 23.0 14.9 25.5 Maori females 50.4 56.7 42.6 16.9 48.2 NonMaori females 20.4 28.5 23.5 9.2 21.8

Hastings District Maori males 39.4 47.2 38.3 17.9 41.5 NonMacri males 26.3 29.8 22.2 12.8 24.2 Maori females 49.0 54.8 41.8 15.8 48.7 NonMaori females 28.4 25.7 18.2 8.7 20.5

Napier City Maori males 35.3 45.2 34.4 24.2 39.2 NonMaori males 25.9 29.6 23.6 12.3 24.0 Maori females 50.7 55.9 42.4 20.9 50.1 NonMaori females 30.5 26.7 19.8 10.2 21.5

Central Hawkes Maori males 31.3 50.9 34.8 18.2 39.8 Bay District NonMaori males 25.1 32.4 25.3 11.5 25.9 Maori females 58.2 57.6 44.2 14.3 52.9 NonMaori females 29.8 28.7 18.5 9.6 22.4

Chatham Islands Maori males 54.5 47.6 47.1 25.0 46.2

District NonMaori males 25.0 31.6 35.7 0 29.7

Maori females 40.0 52.9 37.5 33.3 43.6

NonMaori females 0 27.8 45.5 29.0

Ruapehu District Maori males 39.1 45.8 38.0 25.8 41.1

NonMaori males 32.7 32.1 28.8 13.7 29.1

Maori females 54.1 57.9 39.0 21.9 51.6

NonMaori females 28.8 28.4 20.1 12.4 24.1

Wanganui District Maori males 39.7 47.3 40.9 28.2 42.6

NonMaori males 25.3 31.2 25.3 12.5 24.9

Maori females 50.6 55.6 44.4 21.3 50.1

26.4NonMaori females 27.7 20.4 10.3 21.3

Rangitikei District Maori males 42.9 47.1 41.7 16.7 43.1

NonMaori males 27.2 27.5 26.3 14.1 24.8

Maori females 50.9 57.0 45.0 17.4 50.8

NonMacri females 24.2 27.4 19.6 10.0 21.4

Manawatu District Maori males 38.1 41.0 33.9 27.8 37.5

NonMaori males 24.1 28.9 21.7 11.1 23.5

Maori females 51.6 51.3 31.0 26.7 46.2

NonMaori females 25.8 27.1 17.5 6.8 20.8

Pine 450- The Public Hp Ith nf the Central Re,iic,r I

Table 23: Smoking prevalence, by, sex, ethnicity, and area,1996 Census, continued...

% of respondents who regularly smoked Age group (yrs) Area Ethnic group 15.24 25-44 45-64 65+ total Palmerston North Maori males 29.8 40.3 35.8 14.8 34.9 City NonMaori males 18.5 24.2 19.8 11.0 20.1 Maori females 44.6 51.3 40.6 11.1 46.0 Non.Maori females 19.6 22.1 16.7 7.2 17.9

Tararua District Maori males 34.8 43.8 41.8 6.3 39.2 NonMacrimaies 28.9 32.0 24.2 15.5 26.4 Maori females 52.0 54.5 40.6 12.5 49.5 NonMaori females 31.0 29.6 19.4 8.3 22.6

Horowhenua District Maori males 33.8 45.7 35.9 20.0 38.8 NonMaori males 23.6 32.2 24.5 14.8 24.6 Maori females 46.5 59.2 44.8 22.0 50.4 NonMaori females 26.4 29.8 21.5 11.0 22.0

Carterton District Maori males 29.4 46.2 42.1 16.7 40.0 NonMaori males 28.3 33.7 22.4 16.8 26.2 Maori females 50.0 48.4 37.5 16.7 46.2 NonMacri females 26,9 31.0 23.9 14.3 24,9

Masterton District Maori males 50.5 50.0 32.4 25.0 45.5 NonMacri males 27.3 34.0 24.9 12.4 26.2 Maori females 50.4 63.7 37.7 16,7 52.7 NonMaori females 29.5 29.9 19.6 9.5 22.4

South Wairarapa Maori males 44.4 48,9 50.0 18.2 46.0

District NonMacri males 36,7 36.4 22.8 17.7 28.3

Maori females 58.3 54,4 44.4 14.3 51.5

NonMaori females 36.8 33.6 22.5 9.8 25.7

Kapiti Coast District Maori males 34.0 41.7 30.4 22.7 35,5

NonMacri males 25.1 30.0 19.9 9.8 21.0

Maori females 45.9 51.2 38.4 16.1 45.0

NonMacri females 25.7 27.8 18.9 9.0 19.3

Porirua City Maori males 36.0 45.2 37.1 21.7 39.9

NonMacri males 26.2 29.5 25.4 19.1 26.7

Maori females 50.7 53,3 39.1 26.7 48.7

NonMaori females 27.2 28.0 20.9 13,0 24.3

Upper Hutt City Maori males 37.4 41,3 32.5 18.8 38.2

NonMacri males 24.7 28.5 22.5 13.5 24.1

Maori females 46.6 52.3 45.6 30.0 48.0

NcnMaori females 25.5 26.8 20.2 9.7 22.0

.-.tU-.-fL •4

Table 23: Smoking prevalence, by, sex, ethnicity, and area,1996 Census, continued...

% of respondents who regularly smoked Age group (yrs) Area Ethnic group 15-24 25-44 45-64 65+ total

Lower Hutt City Maori males 36.7 44.2 32.9 17.9 39.2 NonMaori males 23.2 27.8 23.0 12.7 23.6 Maori females 50.0 54.5 43.0 26.5 50.1 NonMaori females 24.9 25.0 18.9 10.0 20.8

Wellington City Maori males 30.1 37.0 31.3 24.0 33.7

NonMaori males 20.0 21.7 19.8 12.9 20.0

Maori females 41.2 45.0 37.3 18.6 41.7

NonMacri females 20.4 18.4 15.8 9.1 17.1

Tasman District Maori males 40.0 41.8 34.8 20.0 39.0

NonMaori males 29.0 27.8 20.0 11.0 23.0

Maori females 41.4 46.1 31.7 20.0 40.2

NonMaon females 28.0 23.5 15.8 7.9 19.1

Nelson City Maori males 38.9 42.9 27.9 9.1 38.2 NonMaori males 27.6 28.1 19.7 9.1 22.6 Maori females 47.1 45.6 23.5 7.7 41.1 NonMaori females 29.7 24.5 14.9 7.1 19.1

Marlborough District Maori males 35.4 41.7 33.7 16.7 36.9 NonMaori males 26.3 27.5 20.9 9.6 22.2 Maori females 45.4 47.8 39.5 13.6 43.5 NonMaon females 26.2 22.5 17.0 8.8 18.5

Total New Zealand Maori males 36.8 45.3 35.7 20.5 39.7

NonMaon males 23.1 27.2 21.7 12.1 22.7

Maori females 47.1 53.4 40.3 19.0 47.4

NonMaori females 23.2 23.5 17.8 8.7 19.3 includes all constituent areas of Ruapehu District source: 1996 Census

p t_ , - Th Of;, rftf,o CfI I

Table 24: Proportion of 15 year olds who smoked, by area, 1992

15 year olds who smoked (1992) Area Daily Weekly Monthly Ever Wairoa District n/a n/a n/a n/a Hastings District 12 6 7 25 Napier City 14 6 8 29 Central Hawkes Bay District n/a n/a n/a n/a Ruapehu District n/a n/a n/a n/a Wanganui District 17 5 3 25 Rangitikei District n/a n/a n/a n/a Manawatu District 24 6 2 32 Palmerston North City 7 3 2 12 Tararua District n/a n/a n/a n/a Horowhenua District n/a n/a n/a n/a Kapiti District n/a n/a n/a n/a Porirua City 12 11 4 27 Upper Hutt City 15 4 4 23 Lower Hutt City 11 7 6 24 Wellington City 15 5 5 25 Masterton District n/a n/a n/a n/a Tasman District 8 7 6 20 Nelson City 15 12 9 36 Marlborough District n/a n/a n/a n/a Central region 14 6 5 25 New Zealand 13 7 6 25 n/a = not available includes all constituent areas of Ruapeizu District Source: Cancer Society 1996

Ll-!#, - D-.-.,, Table 25: Proportion of deaths caused by cigarettes, by area, 1989-93

Cigarettes as a % cause of all deaths. 1989-93 Area Annual Circulatory cigarette-

Cancer of the deaths, mainly caused

lung, throat, heart attacks, Respiratory Other deaths

mouth, lips etc. strokes deaths diseases total

Wairoa District 28 15 42 - 13 19

Hastings District 26 12 45 9 17

Napier City 25 12 42 10 18

Central Hawkes Bay District 32 13 40 10 18

Ruapehu District 26 14 57 9 18

Wanganui District 26 12 38 9 17

Rangitikei District 23 13 48 10 17

Manawatu District 23 12 36 9 16

Palmerston North City 25 12 35 9 16

Tararua District 24 12 43 8 17

Horowhenua District 25 12 38 11 18

Kapiti District 25 12 44 11 18

Porirua City 29 14 46 10 21

Upper Hutt City 25 13 42 10 18

Lower Huff City 24 12 38 10 18

Wellington City 23 12 38 10 17

Masterton District 22 12 37 10 16

Tasman District 22 13 47 10 17

Nelson City 21 11 35 9 15

Marlborough District 25 12 42 9 17

Central region 25 12 41 11 17

New Zealand 25 12 41 11 17 includes all constituent areas of Ruapehu District Source: Cancer Society 1996

Pina Ad - Tfl p Ptjhlir t-1s?lth rf th p Cntrl Pa-ijr)n I

Table 26: Proportion of deaths due to cigarettes, by sex, age group and area, 1989-93

% Deaths Due to Cigarettes 40-49 years 50-59 years 60-69 years 70-79 80+ Area Males Females Males Females Males Females Males Females Males Females Wairoa District 23 21 28 20 25 25 25 16 23 7 Hastings District 18 13 29 19 29 24 24 15 17 6 Napier City 29 18 28 15 30 24 25 14 18 7 Central Hawkes Bay Dis. 19 12 21 30 30 25 21 17 21 7 RuapehuDistrict 16 21 24 28 32 37 25 18 16 5 Wanganui District 20 28 30 18 30 27 24 13 17 8 Rangitikei District 29 23 25 20 31 22 22 16 19 8 Manawatu District 19 7 27 24 30 23 22 15 15 7 Palmerston North City 19 10 27 24 29 26 25 14 17 6 Tararua District 16 21 26 14 30 26 26 11 20 8 Horowhenua District 14 18 26 23 30 23 23 16 20 7 Kapiti District 20 19 22 20 29 21 23 17 20 7 Porirua City 29 26 33 26 33 29 28 17 22 8 Upper Hutt City 22 17 22 29 31 21 26 16 22 8 Lower Hutt City 22 18 31 17 29 23 26 16 17 8 Wellington City 22 14 29 14 29 23 24 15 18 8 Masterton District 18 8 30 21 29 25 22 13 16 6 Tasman District 10 10 26 20 33 25 23 13 16 7 Nelson City 22 9 26 25 27 19 22 11 17 6 Marlborough District 18 11 22 14 30 26 23 12 21 6 Central region 19 17 26 22 28 23 23 16 17 8 New Zealand 20 15 28 19 30 24 24 14 18 7

includes all constituent areas of Ruapehu District Source: Cancer Society 1996 -

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Patterns of Health

Pffrnc of Health - Pan p c7 For the diseases that were also notifiable prior to the change in the notifiable diseases schedule that occurred from 1 June 1996, the most frequently reported notifiable infectious diseases in New Zealand in 1996 were campylobacteriosis, salmonellosis, meningococcal disease and tuberculosis.

In the Central region campylobacteriosis, salmonellosis and hepatitis A were the most frequently notified diseases. Giardiasis notifications were voluntary up to June 1996. Although the data are therefore incomplete, the rate was second to that of campylobacteriosis. These four diseases were also among the top five notifiable diseases in 1995 and are food and waterborne.

National rates for campylobacteriosis, salmonellosis, tuberculosis and meningococcal disease exceed those for the Central region (table 27).

Table 27: Notifiable infectious diseases by area, rates, 1996

infectious disease

meningococcal Health districts campylobacteriosis giardiasis pertussis salmonellosis hepatitis A tuberculosis yersiniosis disease Hawkes Bay 200.8 24.4 53.0 24.4 3.5 10.5 3.5 7.0 Wanganui 131.2 19.2 4.4 25.1 7.4 8.8 2.9 5.9 Manawatu 133.0 16.0 14.6 19.3 8.6 8.0 4.7 8.6 Hutt 180.3 45.3 21.9 26.4 13.6 17.3 9.1 7.5 Wellington 307.5 58.5 26.8 33.3 24.7 10.3 16.5 4.5 Wairarapa 88.3 18.2 33.8 26.0 7.8 5.2 7,8 Nelson/Marlborough 92.6 6.0 37.7 25.7 2.6 3.4 0.9 10.3 Central region 191.1 32.3 28.2 26.6 12.0 9.7 7.5 7.1 rate per 100,000 Giardiasis notification was voluntary until 1 June 1996 Pertussis data includes non-laboratory confirmed cases Pertussis and yersiniosis data are incomplete as not notifiable until 1 June 1996 Source: ESR

Among the health districts in 1996 high rates of pertussis were reported in all districts except Wanganui. Other commonly reported diseases were hepatitis B (7.7 per 100,000) and rheumatic fever (7.7 per 100,000) in Hawkes Bay, acute gastroenteritis in Hutt (9.8 per 100,000) and Wellington (7.8 per 100,000), rubella in Hutt (13.6 per 100,000) and Wellington (11.5 per 100,000), malaria (7.8 per 100,000) in Wellington, food poisoning (28.6 per 100,000) in Wairarapa and measles in Nelson/Marlborough (7.7 per 100,000) and Wairarapa (10.4 per 100,000). The data for acute gastroenteritis, and the vaccine preventable diseases pertussis, Rubella and measles are incomplete as they were not notifiable until June 1996. The vaccine preventable disease notifications include non-laboratory confirmed cases.

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Campylobacteriosis

Campylobacteriosis is the most commonly notified disease in New Zealand and in every health district in the Central region. Fifty-four percent of the 3,181 notifications in the region in 1996 were campylobacteriosis.

Consumption of undercooked chicken has been identifed as a major risk factor.

In the Central region notifications of campylobacteriosis have increased in every health district since 1990. The regional rate peaked in 1993 at 239.5 cases per 100,000. In 1996 the regional rate was 191.1 cases per 100,000 population with the highest rate reported in Wellington (307.5 cases per 100,000). Provisional data for the first six months of 1997 indicate a marked increase in regional notifications. Further investigation into the increase in notifications in the Wellington region is in progress.

The cost per notified case, including time off work, is approximately $596. The true cost of campylobacteriosis may be up to ten times higher (Withington and Chambers 1997). This equates to a cost of at least one million dollars in the Central region in 1996. The regional rate is highest among those aged 15-24 years (281.4 per 100,000) followed by 0-4 years (226.2 per 100,000) and 25-44 years (225.1 per 100,000).

Gi a rd iasi S

Giardiasis became notifiable on 1 June 1996. The national rate of giardiasis (54.8 cases per 100,000) based on the first 12 months notifications is greater than for salmonellosis (33.5 per 100,000) and second only to the rate of campylobacteriosis (236.0 per 100,000) (ESR 1997c).

Hepatitis A

Foodborne hepatitis A outbreak Wellington 1996 Thirty-six cases were reported in early 1996 following hepatitis A in a food handler. One of the 36 cases was also a food handler which resulted in immunoglobulin being administered to 140 individuals who had eaten potentially contaminated food. Immunoglobulin was also administered to a preschool and on the advice of the CHE household contacts of the cases were given immunoglobulin and/or hepatitis A vaccine by their general practitioners. One secondary case was reported.

Two other cases of hepatitis A in food handlers were notified to Hurt Valley Health during 1996-97. Contacts and fellow foodhandlers were advised to have immunoglobulin. One instance involved a workplace cafeteria and those who had eaten potentially contaminated food were advised to have immunoglobulin. No secondary cases were reported.

Increased notifications of hepatitis A to Hurt Valley Health in early 1997 in particular related to male to male sex resulted in a hepatitis A vaccination programme for those most at risk. A similar outbreak had occurred in late 1995.

fl Tuberculosis (TB)

During 1996-97 about six screening programmes were carried out on a large number of contacts of infectious TB cases. The highest number of contacts screened in relation to one case was about 640. Screening programmes included two secondary schools and two rest homes as well as household and community contacts.

Hut health district had the third highest rate of tuberculosis in 1996 (17.3 cases per 100,000) (ESR 1997b).

Meningococcal disease

There has been an epidemic of meningococcal disease in New Zealand since 1991 and the national rate continues to increase. The current rate for the 12 months to the end of June 1997 is 14.0 cases per 100,000 compared with a previous rate of 12.5. There were 12 deaths (case-fatality rate of 6.7 percent) in the first six months of 1997, six of which occurred in June (ESR 1997c).

Children under five years of age are particularly at risk. In 1996 the regional rate for this age group was 27.9 cases per 100,000 followed by 8.4 cases per 100,000 among 15-24 year olds.

In 1996 the rate within the Central region ranged from 4.5 cases per 100,000 in Wellington to 10.3 cases per 100,000 in Nelson/Marlborough.

Two cases of group Cmeningococcal disease occurredinAugust 1996m Poriruainclosegeographic proximity to one another. Vaccination was offered to the close contacts of these cases. Preparatory planning for a community vaccination programme was carried out in the event that a third case may occur within three months. (Three cases within three months is the accepted definition of a community outbreak.) This did not eventuate.

Vaccination is not available for group B meningococcal disease which is the most common type currently occurring in the Central region and New Zealand.

Rheumatic fever

The national rate of rheumatic fever increased in 1996 compared to 1995. Rates were considerably higher among Pacific Islands people and Maori than among Europeans. The third highest rate was in Hawkes Bay (7.7 cases per 100,000) (ESR 1997b).

Pertu ssis

There was an epidemic of pertussis in New Zealand that began in September 1995, peaked in February 1996 and slowly declined.

.7f - .rk,, D,,(-,l;- u,-l+I, I Measles

Mathematical modelling by the Ministry of Health predicted a measles epidemic in 1997 or 1998. The last epidemic was in 1991. In the past epidemics have been a result of accumulation of susceptible children from failure to vaccinate and vaccine failure. In April 1997 the Ministry announced that all children aged two to 10 years would be offered a second dose of MMR (measles- mumps-rubella) vaccine. This coincided with the occurrence of cases in the Auckland and Waikato areas and planning was hastened in order to implement the campaign as soon as sufficient vaccine was available.

The immunisation campaign was carried out in the region during June and July. School aged children were immunised by CHE public health units and preschoolers by general practitioners.

Thirty-nine confirmed cases of measles occurred in the Central region for the 12 months to the end of August 1997. There were four hospitalisations and no deaths. In contrast there were 721 confirmed cases and 93 hospitalisations in the North Health region where the epidemic predominantly occurred. Pacific Islands and Maori children were disproportionately affected.

The highest rate of measles in the region was in the Wanganui health district (16.2 cases per 100,000) (table 28). These cases occurred in one primary school.

Table 28: Measles cases by health district, 1996-1997

Cumulative total 12 months to 31 August 1997 Health district confirmed rate

Hawkes Bay 7 4.9

Wanganui 11 16.2

Manawatu 5 3.3

Wairarapa 2.6

Wellington 8 3.3

Hutt 6 4.5

Nelson/Marlborough 0.9

Central region 39 4.4

New Zealand 841 23.2 rate per 100,000 population Source: ESR

Typhoid fever

Two cases of typhoid fever were reported in 1996, both in the Wellington region. One case was associated with eating raw shellfish from Wellington Harbour.

,.,f £-I Ith - 71 Emerging diseases

Verotoxi genic Escherichia coil (VTEC) Verotoxigenic Escherichia coli (VTEC) infection was first reported in New Zealand in 1993. Up to May 1997 23 cases have been reported, of which 22 were serotype 0157. No source of infection was found for any of the cases. Most of the cases presented with bloody diarrhoea or haemolytic uraemic syndrome. Wanganui health district is the only health district in the Central region where cases have been reported (4 cases) (ESR 1997b).

Listeriosis ESR identified an outbreak of listeriosis beginning in February 1997. The predominance of one serotype among the non-perinatal cases suggested a common source outbreak (ESR 1997a). To date no cause has been identified.

There were three non-perinatal cases of listeriosis reported in the first six months of 1997, two in Hawkes Bay and one in Wellington. No cases were reported in the region in 1996.

Influenza In 1997 influenza immunisation was free to people aged 65 years and over. Fifty percent coverage was achieved in the Central region compared to 46 percent nationally.

References ESR 1997a. Surveillance and control notes. NZ Public Health Rep 4: 29.

ESR 1997b. Surveillance and control notes. NZ Public Health Rep. 4: 44-5.

ESR 1997c. Surveillance and control notes. NZ Public Health Rep. 4: 60-2.

Withington SO, Chambers ST 1997. The cost of campylobacteriosis in New Zealand in 1995 NZ Med J 110: 222-4.

LJ-lL 0- LI

Introduction This section describes various aspects of the death, hospitalisation (particularly injury) and cancer experience of the population in the Central region both generally and in six specific lifecycle periods: under 1 year, ages 1-4 years, ages 5-14 years, ages 15-24 years, 25-44 years, ages 45-64 years, ages 65-74 years, and 75 years and older.

For purposes of comparison, tables of hospitalisations by subregion and ethnicity show the leading causes of hospitalisation for Maori, and these may not be the main leading causes for nonMaori. For this reason, the tables for nonMaori males and females have been labeled Selected leading causes of hospitalisation.

The sources of these data are Statistics NZ and the New Zealand Health Information Service (NZHIS), Ministry of Health. No attempt has been made to relate these data to possible underlying risk factors.

Disease group titles Due to the limited amount of space available in tables, many disease group titles have been abbreviated. Most of these are self-explanatory, but an explanation of a few of these may be helpful:

Abbreviation Explanation Adverse effects drugs Adverse effects from therapeutic use of drugs, medicinal and biological substances Ca Cancer Ca breast Cancer of the breast Ca large bowel Cancer of the large bowel Ca trachea,lung Cancer of the traceha,bronchus and lung Cerebrovascular Cerebrovascular disease CORD Chronic obstructive respiratory disease Dis Disease(s) Dis circulatory Diseases of the circulatory system Dis digestive Diseases of the digestive system Dis female genital Diseases of the female genital system Dis genitourinary Diseases of the genitourinary system Dis musculoskeletal Diseases of the musculoskeletal system Dis nervous Diseases of the nervous system Dis respiratory Diseases of the respiratory system Endocrine, nutr, metabol Endocrine, nutritional and metabolic diseases and immunity disorders Homicide, inj Homicide and injury purposely inflicted by other persons Hot caustic Accident caused by hot object, caustic or corrosive material and steam Infectious,parasitic Infectious and parasitic diseases Inj Injury Ischaemic heart Ischaemic heart disease Late effects Late effects of accidental injury Med surg comps Surgical and medical procedures as a cause of later complications MVCs Motor vehicle crashes ii

Normal delivery, problems Normal delivery and other indications for care in pregnancy, labour and delivery Other heart Other heart disease - Other road Other road vehicle accidents Pneumonia, infi Pneumonia, influenza Preg comps Complications mainly related to pregnancy Preg, childbirth, comps Complications of pregnancy, childbirth and the puerperium Suicide, self-inf Suicide and self-inflicted injury 0 U B B U U Li U U a £1 £1 U U ci B

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Main causes of mortality

From 1990 to 1994, 34,248 people died in the Central region (3.5% were Maori). The leading causes of death were ischaemic heart disease, (8,657 deaths) followed by cancer (8,537), and cerebrovascular disease (3,637).

Age-standardised rates for males exceeded rates for females throughout the region (table 29). The highest rates for males and females were found in Wanganui and Wairarapa with the lowest rates found in Wellington and Nelson/Marlborough.

Ischaemic heart disease was the leading cause of death for both nonMaori and Maori males in the Central region for the 1990 to 1994 period, but proportionately more nonMaori male deaths were from ischaemic heart disease than for Maori males (27% and 25% respectively).

Cancer deaths ranked as the second major cause of death in both ethnic groups, but again proportionately more nonMaori deaths were attributable to this cause (26% of nonMaori male deaths compared with 17% of Maori male deaths) (figs 1-2).

In contrast, the third leading cause of Maori male deaths was unintentional injury, accounting for 10 percent of deaths, whereas cerebrovascular disease was the third leading cause for nonMaori males (8%). Deaths from unintentional injury accounted for 5 percent of nonMaori male deaths.

Cancer was the leading cause of death for females in the Central region for the 1990-1994 period, accounting for 23 percent of all Maori female deaths and 24 percent for nonMaori females (figs 3- 4). Cerebrovascular disease and ischaemic heart disease ranked in second and third place for both Maori (19% and 10% respectively) and nonMaori females (23% and 14% respectively.)

The leading causes of death for males throughout the Central region were ischaemic heart disease and cancer together making up at least 50 percent of all deaths. There were only minor variations among the top six causes of death within the subregions (figs 5-12).

Ischaemic heart disease and cancer remained the leading causes of death for females, comprising just under 50 percent of all female deaths in each subregion (figs 13-20). Cerebrovascular disease accounted for a further 12-15 percent of female deaths in contrast to 7-9 percent of male deaths.

Main causes of morbidity

During 1995 and 1996 there were 261,671 public hospitalisations, of which Maori made up 13 percent. Hospitalisation rates throughout the region were higher for females than for males for both ethnic groups.

For the Central region as a whole, nonMaon male rates were only slightly higher than Maori male rates (26,531 and 26,432 per 100,000 respectively) (table 30). Of the sub-regions, Maori male rates were higher than those for nonMaon only in Hawkes Bay, Wanganui and Wairarapa. In contrast, for females Maori rates were higher than for nonMaori (37,416 and 31,805 per 100,000 respectively). Manawatu, Wellington and Nelson/Marlborough were the only subregions with Maori female hospitalisation rates lower than those for nonMaori.

The highest age standardised rates for males were seen in Wanganui for Maori and in Hawkes Bay for nonMaori, while the lowest rates were in Nelson/Marlborough for both Maori and nonMaori males. Female rates were highest in Wanganui for Maori, and in Wairarapa for nonMaori. The lowest rates for females were found in Nelson/Marlborough for Maori and Wellington for nonMaori. Injury and poisoning was the leading cause of hospitalisation for males accounting for 21 percent of Maori and 17 percent of nonMaori hospitalisations (figs 21-22). Diseases of the respiratory system accounted for proportionately more Maori hospitalisations than nonrvlaori (18% and 10% respectively), ranking in second place for Maori males, but third for nonMaori males after diseases of the digestive system.

Pregnancy, labour and delivery and their complications accounted for the largest proportion of female hospitalisations for both ethnic groups, with 38 percent of Maori and 26 percent ofnonMaori female hospitalisations being due to these conditions (figs 23-24). Injury and poisoning ranked second for nonMaori with 9 percent. Diseases of the respiratory system ranked second for Maori (10 percent) but did not rank in the top six causes of hospitalisation for nonMaori.

The leading cause of hospitalisation for males throughout the Central region was injury and poisoning accounting for between 19 percent (Wanganui) and 15 percent (Wairarapa) of all hospitalisations (figs 25-3 2). The only exception was Nelson/Marlborough, where diseases of the digestive system accounted for 16 percent of hospitalisations and injury and poisoning accounted for 15 percent.

The leading cause of hospitalisation for females was pregnancy, labour, delivery and their complications, accounting for between 25 and 32 percent of all admissions (figs 33-40). Injury and poisoning was the only other condition to be ranked in the top five causes of female hospitalisation in all of the subregions.

Main causes of injury hospitalisations

There were 42,965 hospitalisations due to intentional and unintentional injury in the Central region during 1995 and 1996. Males made up 57 percent of these hospitalisations.

For males of both ethnic groups in the Central region falls were the most common cause of injury followed by motor vehicle crashes for Maori males and medical and surgical complications for nonMaon males (figs 41-42). Homicide made up 10 percent of injury hospitalisations for Maori but did not rank in the top causes for nonMaori.

As with males, falls were the most common cause of injury hospitalisation for females (34% of nonMaori and 21% of Maori) (figs 43-44). The next most common cause was medical and surgical complications followed by motor vehicle crashes.

Generally, in all subregions falls were the leading cause of injury hospitalisation for males, (figs 45-52). The only exception was in Nelson/Marlborough where medical and surgical complications accounted for more injury hospitalisations than falls.

Homicide was in the top five leading causes of injury hospitalisation for males in Wellington, Wairarapa, Wanganui and the Hurt Valley.

In all subregions falls were the leading cause of injury hospitalisation for females (figs 53-61). The proportion of injury from falls ranged from 38 percent in the Hurt Valley to 27 percent in Manawatu. Medical and surgical complications were the second leading cause of injury hospitalisation for all subregions.

Suicide accounted for between 4 percent (Porirua/Kapiti) and 9 percent (Wellington) of all injury hospitalisations for females throughout the subregions.

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Main causes of cancer registrations

From 1990 to 1993 there were 12,455 cancer registrations in the Central region, (5% were Maori and 49% were males).

The leading site for cancer registrations in Maori males was the lung, accounting for 26 percent of total cancer registrations in this group (figs 61-62). In contrast, the most common sites of cancer registration for nonMaori males were the prostate and large bowel. For nonMaori males melanoma ranked in fourth place, but did not rank among the leading sites for Maori males.

The most common site of cancer registration for females of both ethnic groups was the breast, comprising about a quarter of all registrations (figs 63-64). As with males lung cancer made up a larger proportion of registrations for Maori than nonMaori females (19% and 7% respectively). Melanoma, which accounted for 10 percent of registrations for nonMaori, was not among the leading sites for Maori females.

The ranking of major cancer site registrations for males throughout the region varied, though the lung, large bowel and prostate were the top three sites in all subregions (figs 65-72). Without exception breast cancer was the leading cause of cancer registration for females in the subregions accounting for around a quarter of all registrations (figs 73-80). The second leading cause was large bowel cancer.

Table 29: Deaths, numbers and rates, for all causes, by sex and subregion, 1990-1994

Male Female Subregion n rate n rate Hawkes Bay 3204 5169.9 2925 3446.6 Wanganui 1610 5290.5 1523 3566.8 Manawatu 3121 4994.2 2929 3375.3 PorirualKapiti 1845 5186.4 1532 3289.7 Hutt 2406 4819.8 2371 3347.4 Wellington 2420 4527.8 2267 2975.4 Wairarapa 910 5316.0 820 3545.7 Nelson/Marlborough 2293 4449.6 2072 3011.0 Central region 17809 4903.6 16439 3281.7 rate per 100.000 standardised to NZpopulation Source: NZFIIS

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Table 30: Hospitalisations, numbers and rates, for all causes by sex, ethnicity and 11 subregion, 1995/96

Male Female II Maori NonMaori Maori NonMaori Subregion n rate n rate n rate n rate 0 Hawkes Bay 4570 33865.5 17246 31043.0 6862 46284.2 21214 36318.2 Wanganui 2011 34699.0 8279 30429.1 3109 50642.1 10459 37183.0 Manawatu 1937 22826.4 17013 27516.2 3083 31804.6 22380 32435.9 D Porirua/Kapiti 1202 21984.0 9154 25320.0 2106 36198.3 12361 32475.7 Hutt 1658 23030.6 13513 25226.8 2713 31410.6 18372 30797.2 971 18761.1 13973 22430.2 1475 24948.5 20446 26755.2 9 Wellington Wairarapa 734 30388.1 5084 30229.6 1094 42165.7 6411 37429.2 Nelson/Marlborough 585 14127.2 13676 21815.9 888 21815.9 17092 30725.2 Central region 13668 26432.4 97938 26530.6 21330 37416.4 128735 31805.2 rate per 100.000 standardised to NZpopulation

11 11 II 11 Eli II 11 ii 11 H II 0

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Figure 1: Causes of death, Maori, 1990-1994, males ischaemic heart disease 32 cancer unintentional injury intentional injury cerebrovascular disease ".t other heart disease 5(:. . l7 other

6% 10%

Figure 2: Causes of death, nonMaori, 1990-1994, males 27,.; 23. ischaemic heart disease cancer cerebrovascular disease CORD 4( . unintentional injury 5% . . .. . other heart disease 7.• ...... other

N 11/0

Figure 3: Causes of death, Maori, 1990-1994, females 23% cancer 32% ischaemic heart disease cerebrovascular disease CORD / VON unintentional injury W19% symptoms other

5% 10%

Figure 4: Causes of death, nonMaori, 1990-1994, females

24 24 cancer ischaemic heart disease cerebrovascular disease pneumonia, influenza 5 other heart disease 5 . CORD other

14%

, - b-,..,

Figure 5: Causes of death, Hawkes Bay, 1990-1994, males

ischaemic heart disease 23%28 ° cancer cerebrovascular disease unintentional injury CORD 6% other heart disease other 6% 25% 8%

Figure 6: Causes of death, Hutt, 1990-1994, males

ischaemic heart disease 24% 28 ° cancer cerebrovascular disease CORD 4% unintentional injury 5% , pneumonia influenza other 7% -

Figure 7: Causes of death, Manawatu, 1990-1994, males

ischaemic heart disease 24% 27% cancer cerebrovascular disease CORD °° unintentional injury 5% pneumonia, influenza other 7% 25% 8%

Figure 8: Causes of death, Nelson/Marlborough, 1990-1994, males

24%28% ischaemic heart disease cancer cerebrovascular disease CORD 5% unintentional injury 6% other heart disease

I/O other 8% 24%

Dr1c Rfl - Tho P.!-I- 1-J0,1t!nf tho ror,fr! Poe,i, I

Figure 9: Causes of death, Porirua/Kapiti, 1990-1994, males

23% 26% cancer ischaemic heart disease cerebrovascular disease CORD °/° unintentional injury IN other heart disease other

25% 8%

Figure 10: Causes of death, Wairarapa, 1990-1994, males

ischaemic heart disease 24% 27% cancer cerebrovascular disease CORD °° unintentional injury / other heart disease 6% other 6% 9%

Figure 11: Causes of death, Wellington, 1990-1994, males

23% cancer 27% ischaemic heart disease cerebrovascular disease -? / CORD unintentional injury 5%i intentional injury 6% other 26%

Figure 12: Causes of death, Wanganui, 1990-1994, males

24% ischaemic heart disease 27% cancer cerebrovascular disease -/ unintentional injury 0 CORD pneumonia, influenza other 0 9%

- D, QI

Figure 13: Causes of death, Hawkes Bay, 1990-1994, females

26% 24% ischaemic heart disease cancer cerebrovascular disease other heart disease

4% CORD pneumonia influenza other 5% 23% 14%

Figure 14: Causes of death, Hutt, 1990-1994, females

%cancer ischaemic heart disease cerebrovascular disease pneumonia influenza 4% /,/, l CORD 6% 4 other heart disease 6% other 023%% 12%

Figure 15: Causes of death, Manawatu, 1990-1994, females

25% 24% E cancer ischaemic heart disease cerebrovascular disease pneumonia influenza 4% other heart disease 5% CORD other 6% 23% 13%

Figure 16: Causes of death, Nelson/Marlborough, 1990-1994, females

24% 25% cancer ischaemic heart disease cerebrovascular disease pneumonia influenza other heart disease CORD 5% other TO 14%

Prio - J/44-. Dar(t, I

Figure 17: Causes of death, Porirua/Kapiti, 1990-1994, females cancer 25% 26% ischaemic heart disease cerebrovascular disease CORD other heart disease pneumonia influenza other 1% 12%

Figure 18: Causes of death, Wairarapa, 1990-1994, females

24%24% cancer ischaemic heart disease cerebrovascular disease other heart disease °° CORD 5% pneumonia, influenza other 6% 23% 13%

Figure 19: Causes of death, Wellington, 1990-1994, females

cancer ischaemic heart disease cerebrovascular disease pneumonia, influenza 5% CORD 5% other heart disease other 7 % 15%

Figure 20: Causes of death, Wanganui, 1990-1994, females

26% 24% ischaemic heart disease cancer cerebrovascular disease other heart disease CORD 5% digestive other

13%

i 0)

Figure 21: Causes of hospitalisation, Maori, 1995-1996, males

21% injury, poisoning 28% diseases of respiratory system diseases of digestive system A diseases of circulatory system diseases of nervous system 18% symptoms signs V other 7 8% 8% 10%

Figure 22: Causes of hospitalisation, nonMaori, 1995-1996, males

injury, poisoning 39% diseases of digestive system diseases of respiratory system 12% symptoms signs cancer ischaemic heart disease 10% other

6% 9%

Figure 23: Causes of hospitalisation, Maori, 1995-1996, females

24% complications of pregnancy, etc. 38% diseases of respiratory system injury, poisoning diseases of genitourinary system 6% diseases of digestive system symptoms, signs 6% other

9% 10%

Figure 24: Causes of hospitalisation, nonMaori, 1995-1996, females complications of pregnancy, etc. 32% 26% injury, poisoning diseases of digestive diseases of circulatory system diseases of genitourinary system 9% symptoms, signs other

8% 9%

D-,,,, Q,1 TL., U,,l+t, ' 4 +t,.-, I Figure 25: Causes of hospitalisation, Wanganui, 1995-1996, males injury, poisoning diseases of digestive diseases of respiratory system 45% 12? ischaemic heart disease cancer other 12% 8% 4%

Figure 26: Causes of hospitalisation, Manawatu, 1995-1996, males

injury, poisoning diseases of respiratory system diseases of digestive system 46% 11 % symptoms, signs ischaenic heart disease other 11%

6% 8%

Figure 27: Causes of hospitalisation, Hawkes Bay, 1995-1996, males

injury, poisoning ischaemic heart disease 46% diseases of respiratory system IN diseases of digestive system 12% M symptoms, signs other

iJ70 9%

Figure 28: Causes of hospitalisation, Huff, 1995-1996, males injury, poisoning diseases of digestive system 43% diseases of respiratory system 13% symptoms signs 1 ischaemic heart disease other

7% 9%

Patterns of Health - Pane 85

Figure 29: Causes of hospitalisation, Porirua/Kapiti, 1995-1996, males 16% injury, poisoning diseases of respiratory system diseases of digestive system 12% sylriptonis, signs ischaeniic heart disease 9% other

070 6%

Figure 30: Causes of hospitalisation, Wellington, 1995-1996, males

injury, poisoning diseases of respiratory system 10% diseases of digestive system symptoms, signs ischaemic heart disease 48%iipwo other

9 6% %

Figure 31: Causes of hospitalisation, Wairarapa, 1995-1996, males

injury, poisoning diseases of respiratory system 13% diseases of digestive system 47% symptoms,U signs ischaemic heart disease 12% other

5% %8

Figure 32: Causes of hospitalisation, Nelson /Marlborough, 1995-1996, males diseases of digestive system injury, poisoning symptoms signs 45 0 15% diseases of respiratory system ischaemic heart disease 9% ff.: other

7%

- ri-,,-, , ult-, ,.. Dr,.-,

U

Figure 33: Causes of hospitalisation, Hawkes Bay, 1995-1996, females

25; complications of pregnancy, childbirth & the puerperium injury, poisoning diseases of digestive system diseases of respiratory system diseases of circulatory system Ai1.... other

8% 9%

Figure 34: Causes of hospitalisation, Wanganui, 1995-1996, females

5% complications of pregnancy, childbirth & the puerperium 40% injury, poisoning diseases of digestive system diseases of respiratory system diseases of genitourinary system other

8% 9%

Figure 35: Causes of hospitalisation, Manawatu, 1995-1996, females

complications of pregnancy, childbirth & the puerperium diseases of circulatory system 38% injury, poisoning diseases of digestive system diseases of genitourinary system other

8% 9%

Figure 36: Causes of hospitalisation, Porirua/Kapiti, 1995-1996, females complications of pregnancy, childbirth & the puerperium 30( 38% injury, poisoning diseases of circulatory system diseases of respiratory system • diseases of genitourinary system • V .•; other

/70 8%

0

Figure 37: Causes of hospitalisation, Hutt, 1995-1996, females complications of pregnancy, childbirth & the puerperium 30% 36% diseases of digestive system injury, poisoning diseases of circulatory system diseases of genitourinary system J 9% .... other

0 /U 8% 9

Figure 38: Causes of hospitalisation, Wellington, 1995-1996, females

complications of pregnancy, childbirth & the puerperium 32% 36% E injury, poisoning symptoms signs diseases of genitourinary system diseases of respiratory system other I

8% 8%

Figure 39: Causes of hospitalisation, Wairarapa, 1995-1996, females

25% complications of pregnancy, childbirth & the puerperium diseases of circulatory system 39% injury, poisoning diseases of digestive system J10% diseases of respiratory system other

8% 9%

Figure 40: Causes of hospitalisation, Nelson/Marlborough, 1995-1996, females 25% N complications of pregnancy, childbirth & the puerperium diseases of digestive system 38% diseases of genitourinary system diseases of circulatory system mjuxy, poisoning A11% other

/io 9%

Pnna SR_ T Pr,ljr rffhp C.n#r! I

Figure 41: Causes of injury, Maori 1990-1994, males

falls

37% motor vehicle crashes surgical and medical procedures as a cause of later complications homicide and injury purposely inflicted by other persons 13% cutting/piercing j other

Y 70 10%

Figure 42: Causes of injury, nonMaori, 1990-1994, males falls 36% surgical and medical procedures as a cause of later complications motor vehicle crashes s triking/struck late effects of accidental injury 19% . d other

6% 11%

Figure 43: Causes of injury, Maori, 1990-1994, females

21% falls 34% surgical and medical procedures as a cause of later complications motor vehicle crashes suicide and self inflicted injury 18% homicide and injury purposely inflicted by other persons dI other 8% 12%

Figure 44: Causes of injury, nonMaori, 1990-1994, females falls 24% 34 surgical and medical procedures as a cause of later complications motor vehicle crashes 6% ______adverse effects from therapeutic use of drugs medicinal and biological substances suicide and self-inflicted injury other

I IV 22%

Patterns of Health - Page 89

Figure 45: Causes of injury, Hawkes Bay, 1990-1994, males falls 370/v surgical and medical procedures as a cause of later complications z:rl()tc)r vehicle crashes cutting/piercing 15% 0 late effects of accidental injury other

7% 13%

Figure 46: Causes of injury, Wanganui, 1990-1 994, males

falls 35% surgical and medical procedures as a cause of later complications motor vehicle crashes cutting/piercing homicide and injury purposely inflicted by other persons other

8% 11%

Figure 47: Causes of injury, Manawatu, 1990-1994, males

falls surgical and medical procedures as a cause of later complications motor vehicle crashes [] 19% striki

other El 13% S 5 El

Figure 48: Causes of injury, Porirua/Kapiti, 1990-1994, males Eli falls surgical and medical procedures as a cause of later complications motor vehicle crashes late effects of accidental injury cutting/piercing 19% other 6% 10% El

Page 90- The Public Health of the Central Region U

Figure 49: Causes of injury, Hutt, 1990-1994, males falls 35% surgical and medical procedures as a cause of later complications motor vehicle crashes striking/struck .... homicide and injury purposely inflicted by other persons d 18% other

7% 9%

Figure 50: Causes of injury, Wellington, 1990-1994, males

falls 32% surgical and medical procedures as a cause of later complications motor vehicle crashes striking/struck homicide and injury purposely inflicted by other persons other 6%19%. 10%

Figure 51: Causes of injury, Wairarapa, 1990-1994, males

20% falls 36 surgical and medical procedures as a cause of later complications motor vehicle crashes homicide and injury purposely inflicted by other persons 15% late effects of accidental injury other

14% "i 8%

Figure 52: Causes of injury, Nelson/Marlborough, 1990-1994, males 18% U surgical and medical procedures as a cause of later complications 36% falls motor vehicle crashes late effects of accidental injury 17% striking/struck other

IL -to 10%

Patterns of Health - Page 91

Figure 53: Causes of injury, Hawkes Bay, 1990-1994, females falls 27% 33% surgical and medical procedures as a cause of later complications • motor vehicle crashes adverse effects from therapeutic use of drugs medicinal and biological substances 5% suicide and self-inflicted injury

6% other

Figure 54: Causes of injury, Wanganui, 1990-1994, females fl

29 Olt surgical and medical procedures as a cause of later complications motor vehicle crashes adverse effects from therapeutic use of drugs medicinal and biological substances - fl suicide and self inflicted injury fl

7% U Figure 55: Causes of injury, Manawatu, 1990-1994, females

2 falls [I surgical and medical procedures as a cause of later complications motor vehicle crashes adverse effects from therapeutic use of drugs medicinal and biological substances fl suicide and self-inflicted injury

in other 8 •: fl 25% 8%

Figure 56: Causes of injury, Porirua/Kapiti, 1990-1994, females • U 2 falls surgical and medical procedures as a cause of later complications motor vehicle crashes 4% adverse effects from therapeutic use of drugs medicinal and biological substances suicide and self-inflicted injury 7% 9% other 23% • U

Page 92 - The Public Health of the Central Region I

Figure 57: Causes of injury; Hutt, 1990-1994, females falls 26% 38% 0 surgical and medical procedures as a cause of later complications suicide and self-inflicted injury adverse effects from therapeutic use of drugs medicinal and biological substances 5% motor vehicle crashes 5% other

21%

Figure 58: Causes of injury, Wellington, 1990-1994, females

2 falls surgical and medical procedures as a cause of later complications suicide and self-inflicted injury 6% motor vehicle crashes adverse effects from therapeutic use of drugs, medicinal and biological substances 89 other

20%

Figure 59: Causes of injury, Wairarapa, 1990-1994, females

falls 2 surgical and medical procedures as a cause of later complications motor vehicle crashes : suicide, self-inflicted injury 6% adverse effects from therapeutic use of drugs, medicinal and biological substances 76 other

11% 17%

Figure 60: Causes of injury, Nelson/Marlborough, 1990-1994, females falls 31% surgical and medical procedures as a cause of later complications adverse effects from therapeutic use of drugs, medicinal and biological substances motor vehicle crashes 6% suicide and self-inflicted injury 797.:. other

ö7o h.)70

Patterns of Health - Page 93

Figure 61:Causes of cancer registration, Maori, 1990-1993, males trachea, bronchus, lung 26% large bowel 43% prostate stomach A10% testis other

6%7% -

Figure 62: Causes of cancer registration, nonMaori, 1990-1993, males

prostate large bowel 38% trachea, bronchus lung 17% melanoma bladder other

8%

Figure 63: Causes of cancer registration, Maori, 1990-1993, females

26% breast 36% trachea bronchus lung cervix large bowel -ovary J other 9%

Figure 64: Causes of cancer registration, nonMaori, 1990-1993, females

25% breast 36% large bowel melanoma trachea, bronchus lung - ovary 18% other

7 10%

Page 94— The Public Health of the Central Region I

Figure 65: Causes of cancer registration, Hawkes Bay, 1990-1993, males

prostate large bowel 36% trachea bronchus lung bladder melanoma other

7% 1b7o

Figure 66:Causes of cancer registration, Wanganui, 1990-1993, males

large bowel 39% trachea bronchus lung prostate 17% melanoma bladder other

bYo 1370 8%

Figure 67: Causes of cancer registration, Manawatu, 1990-1993, males

prostate large bowel 34qi trachea, bronchus, lung melanoma 16% bladder other ( 9% 15%

Figure 68: Causes of cancer registration, Porirua/Kapiti, 1990-1993, males prostate 39% trachea, bronchus lung large bowel 16% melanoma stomach . other

1370 8%

Patterns of Health - Page 95

Figure 69: Causes of cancer registration, Hutt, 1990-1993, males trachea, bronchus, lung prostate 40% large bowel 149 melanoma Jlymphomas other % 6% 11%

Figure 70 Causes of cancer registration, Wellington, 1990-1993, males

large bowel prostate trachea, bronchus, lung 14% 44% melanoma jlymphomas ...... other 13%

5% 8%

Figure 71: Causes of cancer registration, Wairarapa, 1990-1993, males

23% large bowel 3317,0 prostate trachea bronchus lung melanoma stomach 18% 4%: other

070 14%

Figure 72: Causes of cancer registration, Nelson/Marlborough, 1990-1993, males U 21% 0 large bowel 36% prostate trachea bronchus lung bladder W18°"° melanoma If other 6% 6% 13% 0

11

Page 96- The Public Health of the Central Region I

Figure 73: Causes of cancer registration, Hawkes Bay, 1990-1993, females

25% M breast large bowel trachea, bronchus lung melanoma cervix 16% other

8% 8%

0 Figure 74: Causes of cancer registration, Wanganui, 1990-1993, females

23% breast 38% large bowel trachea, bronchus lung zuielaiioiiia J16% bladder "V other

9% 10%

Figure 75: Causes of cancer registration, Manawatu, 1990-1993, females

breast 36% large bowel trachea, bronchus, lung melanoma ovary [8% other

7% 10%

Figure 76: Causes of cancer registration, Porirua/Kapiti, 1990-1993, females 23% breast large bowel 37% trachea, bronchus lung melanoma 14% lymphomas other

1u7o 10%

Patterns of Health - Page 97 Li

Figure 77: Causes of cancer registration, Hutt, 1990-1993, females

24% breast large bowel melanoma bronchus lung cervix V W19% other fl 11% El Figure 78: Causes of cancer registration, Wellington, 1990-1993, females El 26% breast 38% large melanoma El trachea bronchus lung Jlymphomas El other 4% ...=.... 6% 11% El Figure 79: Causes of cancer registration, Wairarapa, 1990-1993, females

• 24% breast 34% large bowel melanoma trachea bronchus lung U ovary other

Figure 80: Causes of cancer registration, Nelson/Marlborough, 19901993, females U breast 33% 29% large bowel I] melanoma trachea bronchus lung i1tI1.iS other 6% lo% 7% 7% U

Page 98 - The Public Health of the Central Region I

Under 1 year

Livebi rths In the 1994-1996 period, there were 42,476 livebirths in the Central region (24.6% of the national total), of which 19.0 percent were Maori and 5.9 percent were Pacific Island (table 31). Forty-two percent of the livebirths occurred in the Wellington subregion, 17.0 percent in Hawkes Bay subregion, and 16.4 percent in Manawatu subregion.

One in four Maori livebirths occurred in the Hawkes Bay, 13.8 percent were in the Hastings District, and 11.4 percent were in Lower Hutt City. Almost one third of the Pacific Island livebirths in the Central region occurred in Porirua City (31.5%).

Infant mortality Infant mortality, which includes liveborn infants dying before the first year of life is completed, is regarded as a sensitive indicator of the socio-economic environment into which an infant is born. The rates of infant mortality are expressed per 1,000 livebirths.

In 1994-1996, 291 liveborn infants in the Central region died before their first birthday, a rate of 6.9 per 1,000 livebirths (table 32). Except in Wairarapa, the Maori infant mortality rates in the Central region are usually about twice as high as the nonMaori rates.The highest Maori rates occurred in Hastings District (15.2 per 1,000 livebirths), Napier City (17.5/1,000), and Lower Hurt City (14.1/1,000). For nonMaori, the highest infant mortality rates were in the Wairarapa subregion (12.0/1,000).

In 1990-1994, the major causes of infant mortality in the Central region were sudden death (29.7%) and birth defects (24.2%) (table 33). Sudden death accounted for 36.8 percent and 35.5 percent of the respective infant mortalities in the Wanganui subregion and PorirualKapiti area, but only 16.5 percent in Wellington.

There was a comparatively high occurrence of mortality due to respiratory distress syndrome in Wellington (11.4% of infant mortality), and in Nelson/Marlborough due to disorders relating to short gestation and unspecified low birthweight.

Late fetal deaths Up to mid-1995, a late fetal death or stillbirth was defined as a fetal death of 28 completed weeks of gestation and over. However, the definition has now been revised to include a fetal death of 400g or 20 weeks gestation. Intermediate fetal deaths are included in this current definition, but were excluded from the previous definition. Late fetal death rates are expressed per 1,000 total births.

In the Central region generally, the Maori late fetal death rate is higher than the nonMaori rate, but similar to the New Zealand rate for Maori (table 34). However, the nonMaori rate (4.4 per 1,000 total births) in Central is almost 19 percent greater than the New Zealand rate (3.7/1,000). Horowhenua District (8.6/1,000), Wanganui District (7.8/1,000), Wairarapa region (7.8/1,000), and Ponrua City (6.9/1,000) recorded high rates for nonMaori.

Patterns of Health - Page 99 Perinatal mortality Perinatal mortality comprise late fetal deaths and liveborn infants dying within the first seven days of life. Perinatal mortality rates are expressed per 1000 total births.

In the Central region during 1994-1996, there were 335 perinatal deaths, a rate of 7.8 per 1,000 total births (table 35). There were similar overall rates for Maori and nonMaori. The nonMaori rates in Wanganui District (13.0 per 1,000 total births), Wairarapa region (11.9 per 1,000), Hastings District (9.3 per 1,000), and Manawatu region (9.0 per 1,000) were well above the regional and national averages.

The major causes of perinatal mortality in the Central region in 1990-1994 were intrauterine hypoxia and birth asphyxia (22.0%), birth defects (21.8%), and other and ill-defined conditions originating in the perinatal period (21.8%) (table 36).

Hawkes Bay (18.1%), Huff (16.5%), and Manawatu (18.9%) had below average rates of perinatal deaths due to intrauterine hypoxia and birth asphyxia. Birth defects accounted for 29.4 percent of perinatal mortality in the Hutt, and 33.8 percent in Manawatu subregions, but only 11.3 percent in the Wellington subregion.

Postneonatal mortality Postneonatal mortality includes liveborn infants dying between the twenty-eighth day and the first year of life. Rates for postneonatal deaths are expressed per 1,000 livebirths.

The postneonatal mortality rate for Maori (7.8 per 1,000 livebirths) in the Central region is more than three times higher than the rate for nonMaori (2.6 per 1,000) (table 37). The highest Maori rates occurred in Napier City (14.0 per 1,000), Hastings District (9.9 per 1,000), Porirua City (10.7 per 1,000), and Lower Huff City (9.8 per 1,000).

The nonMaori rate in the Wairarapa subregion, (4.9 per 1,000) was almost twice the regional average (2.6 per 1,000).

Half of all postneonatal deaths in the Central region in 1990-1994 were due to sudden death (5 1.9%), with the highest rates in Huff (61.2%), KapitilPorirua (60.0%), and Wanganui (60.0%) regions (table 38). Birth defects accounted for 15.9 percent of the mortality, and unintentional injury 5.8 percent.

Low birthweight Low birthweight (ie, livebom infants weighing under 2,500g at birth) is a major factor in perinatal and neonatal mortality. A low birthweight infant surviving the first year is likely to have an increased risk of a variety of health problems compared to an infant with a normal birthweight.

During 1994-1996, approximately 60 births out of every 1,000 livebirths in the Central region had a birthweight under 2,500g (table 39). The regional Maori rate is 67.8 per 1,000 livebirths compared to the nonMaori rate of 57.6 per 1,000. This pattern is maintained in most of the areas of the Central region, with the highest rates occurring in Wairoa District (72.5/1,000) and Wanganui District (72.9 per 1,000).

In contrast, in the Kapiti Coast District (61.3 per 1,000) and the Wairarapa (49.3 per 1,000) and Nelson/Marlborough (59.5 per 1,000) subregions, the nonMaori rate is considerably higher than Maori rate. There were, however, a small number of Maori low birthweight infants in these areas.

Page 100- The Public Health of the Central Region I

Sudden infant death syndrome During 1993-1996, the rate of sudden infant death syndrome (SIDS) in the Central region (1.8 per 1,000 livebirths) was slightly below the national average (2.1 per 1,000) (table 38). The highest rates in the Central region occurred in Wanganui (3.2 per 1,000 livebirths) and Porirua/Kapiti (2.7 per 1,000), with Wellington (0.2 per 1,000) experiencing a low rate. The change in the method of classifying ethnicity in mid-1995, restricts the calculation of ethnic-specific rates to 1993-1994. In this period, Maori rate in the Central region (4.9 per 1,000) was three times higher than the rate for Other ethnic groups (1.6 per 1,000).

Patterns of Health - Page 101 II

Table 31: Livebirths by ethnicity and area, 1994-1996 II

Area Maori Non Maori Total Wairoa District 324 269 593 Ii Hastings District 1115 2350 3465 Napier City 571 1989 2560 II Central Hawkes Bay District 124 448 572 Chatham Islands District 16 25 41 Hawkes Bay subregion 2150 5081 7231 II RuapehuDisthct 429 618 1047 Wanganui District 560 1606 2166 11 Rangitikei District 223 609 832 Wanganui subregion 1212 2833 4045 Manawatu District 174 1085 1259 II Palmerston North City 584 2768 3352 Tararua District 183 778 961 Horowhenua District 346 1033 1379 Ii Manawatu subregion 1287 5664 6951 Kapiti Coast 228 1239 1467 ii Porirua City 656 2223 2879 Upper Hutt City 241 1412 1653 Lower Hutt City 923 3922 4845 11 Wellington City 606 6427 7033 Wellington subregion 2654 15223 17877 III Masterton District 240 839 1079 Carterton District 48 226 274 South WairarapaDistrict 65 355 420 Eli Wairarapa subregion 353 1420 1773 Tasman District 84 1376 1460 Nelson City 166 1470 1636 A Marlborough District 180 1323 1503 Nelson/Marlborough subregion 430 4169 4599 Eli Central region 8086 34390 42476 Total New Zealand 32237 140423 172660 includes all constituteni areas of Ruapehu District II Source: Statistics NZ 11 II Eli II A

Page 102 - The Public Health of the Central Region 1

Table 32: Infant mortality, numbers and rates by ethnicity and area, 1994-1996

Maori NonMaori Total Area n rate n rate n rate Wairoa District 1 3.1 1 3.7 2 3.4 Hastings District 17 15.2 20 8.5 37 10.7 Napier City 10 17.5 12 6.0 22 8.6 Central Hawkes Bay District 0 - 4 8.9 4 6.0 Chatham Islands District 0 - 1 40.0 1 24.4 Hawkes Bay subregion 28 13.0 38 75 66 9.1 Ruapehu District 7 16.3 3 4.9 10 9.6 Wanganui District 1 4.5 6 9.9 7 8.4 Rangitikei District 4 7.1 10 6.2 14 6.5 Wanganui subregion 12 9.9 19 67 31 77 Manawatu District 4 22.0 8 7.4 12 9.5 Palmerston North City 6 10.3 21 7.6 27 8.1 Horowhenua District 4 11.6 7 6.8 11 7.0 Tararua District 0 - 2 2.6 2 2.1 Manawatu subregion 14 10.9 38 67 52 75 Kapiti Coast 0 - 4 3.2 4 2.7 Porirua City 9 13.7 13 5.8 22 7.6 Upper Hutt City 2 8.3 8 5.7 10 6.0 Lower Hutt City 13 14.1 16 4.1 29 5.0 Wellington City 4 6.6 21 3.3 25 3.6 Wellington subregion 28 10.6 62 4.1 90 5.0 Masterton District 2 8.3 11 13.1 13 12.0 Carterton District 1 20.8 4 17.7 5 18.2 South Wairarapa District 0 - 2 5.6 2 4.8 Wairarapa subregion 3 8.5 17 11.0 20 11.3 Tasman District 3 35.7 9 6.5 12 8.2 Nelson City 1 6.0 12 8.2 13 7.9 Marlborough District 1 5.6 6 4.5 7 4.7 Nelson/Marlborough subregion 5 11.6 27 65 32 60 Central region 90 11.1 201 5.8 291 6.9 New Zealand 360 11.2 739 5.3 1099 6.4 rate per 1000 livebirths includes all constitutent areas of Ruapehu District Source: Statistics NZ

Patterns of Health - Page 103

Table 33: Infant mortality by subregion and cause, numbers, 1990-1994

Cause disorders relating to other respiratory short gestation respiratory distress and unspecified conditions of Subregion sudden death birth defects syndrome low birthweight fetus, newborn other total Hawkes Bay 35 33 5 3 6 31 113 Wanganui 25 14 2 5 2 20 68 Manawatu 27 24 6 2 4 22 85 Porirua/Kapiti 22 13 6 1 1 19 62 Hutt 32 25 7 5 3 20 92 Wellington 13 14 9 4 5 34 79 Wairarapa 6 3 0 2 2 10 23 Nelson/Marlborough 12 14 2 9 4 16 57 Central region 172 140 37 31 27 172 579 Source: NZHIS

11

Page 104- The Public Health of the Central Region 0 1

Table 34: Late fetal deaths (stillbirths), numbers and rates by ethnicity and area, 1994-1996

Maori non Maori Total Area n rate n rate n rate Wairoa District 1 3.1 2 7.4 3 5.0 Hastings District 3 2.7 13 5.5 16 4.6 Napier City 2 3.5 11 5.5 13 5.1 Central Hawkes Bay District 2 15.9 1 2.2 3 5.2 Chatham Islands District 0 - 0 - 0 - Hawkes Bay subregion 8 3.7 27 5.3 35 4.8 RuapehuDistrict 0 - 1 1.6 1 1.0 Wanganui District 4 7.1 13 8.0 17 7.8 Rangitikei District 1 4.5 3 4.9 4 4.8 Wanganui subregion 5 4.1 17 5.0 22 5.4 Manawatu District 2 11.4 6 5.5 8 6.3 Palmerston North City 1 1.7 15 5.4 16 4.8 Horowhenua District 4 11.4 8 7.7 12 8.6 Tararua District 2 10.8 5 6.4 7 7.2 Manawatu subregion 9 69 34 5.0 43 61 Kapiti Coast 1 4.4 2 1.6 3 2.0 Porirua City 2 3.0 18 8.0 20 6.9 Upper Hutt City 2 8.2 4 2.8 6 3.6 Lower Hutt City 6 6.5 19 4.8 25 5.1 Wellington City 3 4.9 37 5.7 40 5.7 Wellington subregion 14 52 80 5.2 94 5.2 Masterton District 4 16.4 4 4.7 8 7.4 Carterton District 1 20.4 1 4.4 2 7.2 South Wairarapa District 0 - 4 11.1 4 9.4 Wairarapa subregion 5 13.0 9 63 14 7.8 Tasman District 2 23.3 7 4.8 9 6.1 Nelson City 1 5.0 7 4.3 8 4.9 Marlborough District 1 5.5 5 3.3 6 3.0 Nelson/Marlborough subregion 4 9.2 19 4.1 23 4.0 Central region 45 5.5 186 4.4 231 5.4 New Zealand 167 5.2 649 3.7 816 4.7 rate per 1000 total births includes all constitutent areas of Ruapehu District Source: Statistics NZ

Patterns of Health - Page 105

Table 35: Perinatal mortality by area and ethnicity, numbers and rates, 1994-1996

Maori non Mao ri Total

Area n rate n rate n rate

2Wairoa District 1 3.1 7.4 3 5.0

22Hastings District 6 5.4 9.3 28 8.0

Napier City 4 7.0 17 8.5 21 8.2

Central Hawkes Bay District 2 15.9 1 2.2 3 5.2 Chatham Islands District 0 0 - 0

Hawkes Bay subregion 13 6.0 42 82 55 7.6

3Ruapehu District 2 4.7 4.8 5 4.8

Wanganui District 5 8.9 21 13.0 26 11.9

Rangitikei District 2 8.9 4 6.5 6 7.2

Wanganui subregion 9 7.4 28 9.8 37 9.1

10Manawatu District 2 11.4 9.2 12 9.5

Palmerston North City 2 3.4 25 9.0 27 8.0

Horowhenua District 5 14.3 11 10.6 16 11.5

Tararua District 2 10.8 5 6.4 7 7.2

Manawatu subregion 11 8.5 51 9.0 62 8.9

4Kapiti Coast District 1 4.4 3.2 5 3.4

Porirua City 4 6.1 22 9.8 26 9.0

Upper Hutt City 2 8.2 5 3.5 7 4.2

Lower Hutt City 9 9.7 26 6.6 35 7.2

Wellington City 3 4.9 49 7.6 52 7.4

Wellington subregion 19 7.1 106 6.9 125 7.0

7Masterton District 4 16.4 8.3 11 10.1

4Carterton District 2 40.8 17.6 6 21.7

South Wairarapa District 0 - 6 16.7 6 14.2

Wairarapa subregion 6 16.8 17 11.9 23 12.9

10Tasman District 2 23.3 7.2 12 8.2

Nelson City 1 6.0 11 7.4 12 7.3

Marlborough District 1 5.5 8 6.0 9 6.0

Nelson/Marlborough subregion 4 9.2 29 6.9 33 7.1

273Central region 62 7.6 7.9 335 7.8

New Zealand 254 7.8 971 6.9 1225 7.1 rate per 1000 total births "includes all constitutent areas of Ruapehu District Source: Statistics NZ

Page 106- The Public Health of the Central Region I

Table 36: Perinatal mortality by subregion and cause, numbers, 1990-1994

Cause other disorders intrauterine and ill-defined relating to hypoxia conditions short gestation respiratory and birth originating in and unspecified distress Subregion asphyxia birth defects perinatal period low birthweight syndrome other total Hawkes Bay 13 17 20 3 2 17 72 Wanganui 14 13 14 6 2 8 57 Manawatu 14 25 12 3 6 14 74 Porirua/Kapiti 13 9 17 1 5 8 53 Hutt 14 25 20 5 5 16 85 Wellington 23 9 11 4 9 24 80 Wairarapa 7 3 6 2 0 7 25 Nelson/Marlborough 12 8 9 9 1 15 54 Central region 110 109 109 33 30 109 500 Source: NZHIS

Patterns of Health - Page 107 LI

Table 37: Postneonatal mortality by area and ethnicity, numbers and rates, 1994-1996 El

Maori NonMaori Total Area n rate n rate n rate Wairoa District 0 - 0 - 0 -

Hastings District 11 9.9 8 3.4 19 5.5

Napier City 8 14.0 5 2.5 13 5.1 Central Hawkes Bay District 0 - 4 8.9 4 7.0 Chatham Islands County 0 - 1 40.0 1 24.4 Hawkes Bay subregion 19 8.8 18 3.5 37 5.1 Ruapehu District 5 11.7 1 1.6 6 5.7 9 Wanganui District 3 5.4 1 0.6 4 1.8 Rangitikei District 0 - 5 8.2 5 6.0 Wanganui subregion 8 6.6 7 2.5 15 3.7 Manawatu District 4 23.0 4 3.7 8 6.4 Palmerston North City 5 8.6 8 2.9 13 3.9 Horowhenua District 1 2.9 4 3.9 5 3.6 Tararua District 0 - 1 1.3 1 1.0 Manawatu subregion 10 7.8 17 3.0 27 3.9 9 Kapiti Coast District 0 - 2 1.6 2 1.4 Porirua City 7 10.7 8 3.6 15 5.2 Upper Hutt City 1 4.1 6 4.2 7 4.2 Lower Hutt City 9 9.8 7 1.8 16 3.3 Wellington City 3 5.0 6 0.9 9 1.3 Wellington subregion 20 7.5 29 1.9 49 2.7 9 Masterton District 2 8.3 6 7.2 8 7.4 Carterton District 0 - 1 4.4 1 3.6 South Wairarapa District 0 - 0 - 0 - Wairarapa subregion 2 5.7 7 4.9 9 5.1 Tasman District 3 35.7 4 2.9 7 4.8 Nelson City 1 6.0 3 2.0 4 2.4 Marlborough District 0 - 3 2.3 3 2.0 11 Nelson/Marlborough subregion 4 9.3 10 2.4 14 3.0 Central region 63 7.8 88 2.6 151 3.6

New Zealand 233 7.2 319 2.3 552 3.2 rate per 1000 livebirths includes all constitutent areas of Ruapehu District Source: Statistics NZ El El H 11

Page 108- The Public Health of the Central Region 9 I

Table 38: Postneonatal mortality by subregion and cause, numbers, 1990-1994

Cause diseases of the nervous unintentional pneumonia systems and Subregion sudden death birth defect injury and influenza sense organs other total Hawkes Bay 32 14 6 1 2 14 69 Wanganui 24 4 1 3 1 7 40 Manawatu 24 7 0 1 4 9 45 Porirua/Kapiti 21 5 2 2 2 3 35 Hutt 30 7 3 4 1 4 49 Wellington 12 5 2 1 1 10 31 Wairarapa 5 1 2 0 1 4 13 Nelson/Marlborough 12 6 2 2 0 4 26 Central region 160 49 18 14 12 55 308 Source: NZHIS

Patterns of Health - Page 109 Table 39: Low birthweight (<2500g), numbers and rates, by ethnicity and area, II 1994-1996

nonMaori Total [II Maori rate Area n rate n rate n Wairoa District 25 77.2 18 66.9 43 72.5 a Hastings District 80 71.7 135 57.4 215 62.0 Napier City 46 80.6 109 54.8 155 60.5 Central Hawkes Bay District 7 56.5 19 42.4 26 45.5 II Chatham Islands District 0 - 0 - 0 - Hawkes Bay subregion 158 73.5 281 55.3 439 60.7 II Ruapehu District 29 67.6 32 51.8 61 58.3 Wanganui District 40 71.4 118 73.5 158 72.9 Rangitikei District 18 80.7 27 44.3 45 54.1 A Wanganui subregion 87 71.8 177 62.5 264 65.3 Manawatu District 13 74.7 65 59.9 78 61.0 39 66.8 158 57.1 197 58.8 II Palmerston North City Tararua District 15 81.0 47 60.4 62 64.5 Horowhenua District 29 83.8 62 60.0 91 65.0 II Manawatu subregion 96 74.6 332 58.6 428 61.6 Kapiti Coast 10 43.9 76 61.3 86 58.6 Porirua City 43 65.5 125 56.2 168 58.4 II Upper Hutt City 16 66.4 86 60.9 102 61.7 Lower Hutt City 59 63.9 225 57.4 284 58.6 56.0 413 58.7 II Wellington City 53 87.5 360 Wellington subregion 181 68.2 872 573 1053 58.9 Masterton District 10 41.7 43 51.3 53 49.1 II Carterton District 2 41.7 12 53.1 14 51.1 South Wairarapa District 1 15.4 15 42.3 16 38.1 Wairarapa subregion 13 368 70 49.3 83 468 II Tasman District 4 47.6 76 55.2 80 54.8 Nelson City 1 6.0 78 53.1 79 48.3 Marlborough District 8 44.4 94 71.1 102 67.9 Nelson/Marlborough subregion 13 30.2 248 59.5 261 568 Central region 548 67.8 1980 57.6 2528 59.5 II New Zealand 2318 71.9 8172 58.2 10490 60.8 rate per 1000 livebirths -includes all constitutent areas of Ruapehu District II Source: Statistics NZ II II II II

Page 11.0 - The Public Health of the Central Region 9 I

Table 40: Sudden infant death syndrome (SIDS), numbers and rates, by ethnicity and area, 1993-1996

1993-1994 1993-1996 Maori Pacific Is Other Total

Area n rate n rate n rate n rate n rate 12 8Hawkes Bay 4 4.1 0 - 2.1 2.5 2.3

9Wanganui 3 7.5 0 - 6 3.1 3.8 15 3.2

Manawatu 1 2.0 2 16.9 7 1.7 10 2.1 18 1.9

Porirua/Kapiti 1 2.6 1 1.9 7 3.3 9 3.0 16 2.7

Hutt 10.5 1 2.7 3 0.8 9 2.0 16 1.8

Wellington 1 3.8 0 - 1 0.2 2 0.4 2 0.2 Wairarapa 0 - 0 - 2 1.9 2 1.6 0.8

Nelson/Marlborough 1 8.3 0 - 5 1.7 6 1.9 10 1.6

Central RHA 16 4.9 4 2.6 39 1.6 59 2.1 101 1.8

New Zealand 105 7.4 29 3.3 112 1.2 246 2.1 476 2.1 rate per 1000 Iivebirths Source: NZHJS

Patterns of Health - Page 111 1-4 year olds

Mortality From 1990 to 1994 there were 132 deaths in the 1-4 year age group in the Central region. Unintentional injury accounted for 40 percent of deaths in this age group followed by birth defects (16% of deaths) and cancer (12% of deaths) (table 41). Almost half of the deaths from unintentional injury were due to motor vehicle crashes (49%).

Male age-specific rates are higher than the female rates for all areas except Wellington and Manawatu (table 42). However, the small number of deaths requires a cautious interpretation of these data.

Hospitalisations During 1995 and 1996, 9523 males and 6,790 females aged 1-4 years were hospitalised (table 43). Diseases of the respiratory system was the leading cause of hospitalisation in the Central region (specifically asthma) followed by injury and poisoning and diseases of the nervous system. Male rates exceeded female rates for all causes shown. All cause Maori rates were slightly lower than nonMaori rates.

Maori rates of hospitalisation for asthma were about 1.5 times higher than the nonMaori rates. In contrast, nonMaori hospitalisations for infectious and parasitic diseases were 1.4 times those for Maori.

The leading causes of hospitalisation throughout the region and for both ethnic groups changed little (tables 44, 45). In Manawatu, Wairarapa and Nelson/Marlborough male age-specific rates of hospitalisation for diseases of the nervous system were higher than the rates for injury and poisoning. Asthma hospitalisation rates for Maori were highest in Hawkes Bay.

Injuries Falls and poisoning were the most common injuries requiring hospitalisation among this age group except for Maori males where hot caustic bums was the second most common cause of injury (table 46). The rates varied across the sexes and ethnic groups with the highest overall rate being for nonMaon males and the lowest for Maori females. Male rates were higher than female rates, and for both sexes, nonMaort rates were higher than Maori.

Hawkes Bay had the highest rates for males in the Central region for all causes shown, except poisoning (table 47). Female rates were generally highest in Wanganui (table 48). Nelson/Marlborough had the lowest rates for all total causes of injuries for both sexes.

Rates varied widely between subregions. For instance, male age-specific rates for unintentional injury in Hawkes Bay were twice that of Nelson/Marlborough. Female age-specific rates for poisoning by drugs, etc. in Wanganui were three times the rates for Nelson/Marlborough.

Cancer In the 1990-1993 period there were 24 male and 21 female cancer registrations in the Central region (tables 49,50).

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Table 41: Leading causes of death, by sex, numbers and rates, ages 1-4 years, 1990-1994

Male Female rate Cause n rate n All causes 72 254.1 60 221.9 Unintentional injury 32 112.9 21 77.7 Inj MVCs 16 56.5 10 37.0 Inj submersion 11 38.8 7 25.9 Birth defects 9 31.8 12 44.4 Cancer 8 28.2 8 29.6 rate per 100,000 Source: NZHIS

Table 42: All causes of death by subregion and sex, numbers and rates, ages 1-4 years, 1990-1994

Male Female Subregion n rate n rate Hawkes Bay 13 271.5 11 237.3 Wanganui 12 473.4 4 - Manawatu 8 166.3 12 260.4 Porirua/Kapiti 13 408.8 8 269.4 Hutt Valley 7 156.8 6 139.7 Wellington 8 199.6 15 398.7 Wairarapa 5 368.7 1 - Nelson/Marlborough 6 187.8 3 - Central region 72 254.1 60 221.9 New Zealand 322 288.2 211 197.6 rate per 100,000 Source: NZHIS

Patterns of Health - Page 113

LI

Table 43: Leading causes of hospitalisation by ethnicity and sex, numbers and rates, ages 1-4 years, 1995-1996 II Males Female 11 Cause Maori NonMaori Maori NonMaori n rate n rate n rate n rate 5271 1519 7267 2256All causes 3208.2 3432.5 2251.4 2637.0 Dis respiratory 744 1058.0 1900 897.5 475 704.0 1230 615,3 Asthma 362 514.8 717 338.7 205 303.8 417 208,6 Acute respiratory 219 311.4 636 300.4 131 194.2 415 207.6 Injury, poisoning 358 509.1 1137 537.1 256 379.4 801 400.7 Dis nervous 334 474.0 1100 519.6 219 324.6 874 437.2 III Otitis media 266 378.3 797 376.5 181 268.3 578 289.2 Dis digestive 204 290.1 611 288.6 126 186,7 499 249.6 198 281.6 684 323.1 140 207.5 530 265.1 II Symptoms, signs Infectious,parasitic 157 223,3 674 318.4 134 198.6 557 278.7 rate per l0,000 Source: NZHIS II Table 44: Leading causes of hospitalisation by subregion, rates, ages 1-4 years, II 1995-1996, males

Cause A Subregion all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 4213.2 1299.9 723.1 624.9 516.2 445.1 Wanganui 4081.3 1266.8 700.4 639.9 501.5 549.1 II Manawatu 2943.8 766.3 496.0 547.0 351.2 461.9 PorirualKapiti 3794.5 956.3 620.5 525.6 410.3 369.6 II Hutt Valley 3040.5 782.5 507.5 431.5 330.9 299.6 Wellington 2984.5 824.7 408.9 360.4 341.9 263.3 Wairarapa 3598.7 1227.2 398.0 522.4 331.7 398.0 II Nelson/Marlborough 2826.1 672.5 344.9 472.5 272.5 292.8 Central region 3376.6 937.5 530.1 508.5 382.6 376.9 rate per 10,000 II Source: NZHIS II II II

II

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Table 45: Leading causes of hospitalisation by subregion, ages 1-4 years, 1995-1996, females

Cause Subregion all causes dis respiratory dis nervous injury, poisoning otitis media infectious,patitic Hawkes Bay 3386.9 992.9 510.9 470.8 350.3 328.0 Wanganui 3045.9 862.3 561.0 556.3 435.8 343.1 Manawatu 2146.6 517.4 446.9 376.5 347.9 198.2 Porirua/Kapiti 2546.1 570.9 333.3 383.0 219.9 432.6 Hutt Valley 2252.4 573.8 314.3 416.7 223.8 197.6 Wellington 2267.8 562.1 334.8 339.7 229.7 227.3 Wairarapa 2630.7 727.1 514.7 400.3 285.9 179.7 Nelson/Marlborough 2255.4 366.6 354.1 261.0 201.9 186.4 Central region 2539.6 637.7 408.8 395.3 283.9 258.5 rate per 10,000 Source: NZHIS

Table 46: Leading causes of unintentional and intentional injury by ethnicity and sex, numbers and rates, ages 1-4 years, 1995-1996

Males Female Maori NonMaori Maori NonMaori

Cause n rate n rate n rate n rate

268 861 1231 383Unintentional injury 5446.5 5814.6 3972.1 4307.4

Falls 117 1663.8 372 1757.1 93 1378.4 303 1515.8

Hot caustic 51 725.3 99 467.6 19 281.6 33 165.1

MVCs 31 440.8 53 250.3 23 340.9 35 175.1

Med surg comps 27 384.0 77 363.7 4 59.3 34 170.1

Poisoning by drugs etc 24 341.3 148 699.1 30 444.6 130 650.4

Submersion etc 19 270.2 94 444.0 18 266.8 59 295.2

Poisoning by solids etc 18 256.0 72 340.1 14 207.5 56 280.2 Intentional injury 6 85.3 4 - 1 6 30.0 rate per 100,000 Source: NZHJS

Patterns of Health - Page 115 Table 47: Leading causes of unintentional and intentional injury by subregion, rates, ages 1-4 years, 1995-1996, males

Cause unintentional poisoning Subregion injury falls by drugs, etc. hot caustic submersion etc Hawkes Bay 7878,8 2298.9 606.1 961.3 835.9 Wanganui 7479.5 2291.4 1080.8 821.4 475.6 Manawatu 5278.8 1532.6 532.1 447.0 276.7 PorirualKapiti 6442.9 2068.5 949.5 576.5 169.5 Hutt Valley 5365.5 1676.7 491.8 447.1 223.6 Wellington 4550.7 1848.0 438.9 323.4 277.2 Wairarapa 4726.4 1409.6 829.2 331.7 82.9 Nelson/Marlborough 3826.1 608.7 405.8 260.9 608.7 Central region 5722.8 1733.9 609.9 531.9 400.7 rate per 100,000 Source: NZHIS

Table 48: Leading causes of unintentional and intentional injury by subregion, rates ages 1-4 years, 1995-1996, females

Cause unintentional poisoning poisoning Subregion injury falls by drugs, etc. hot caustic by solids etc Hawkes Bay 5020.1 1606.4 580.1 401.6 423.9 Wanganui 5841.4 1993.5 1066.3 602.7 139.1 Manawatu 4029.1 1409.1 704.5 198.2 374.3 PorirualKapiti 4042.6 1489.4 602.8 283.7 283.7 Hutt Valley 4285.7 1428.6 404.8 214.3 95.2 Wellington 3787.9 1466.3 684.3 122.2 146.6 Wairarapa 4248.4 1797.4 490.2 326.8 490.2 Nelson/Marlborough 2920.2 1025.2 341.7 341.7 217.5 Central region 4222.8 1481.1 598.4 288.0 261.8 rate per 100,000 Source: NZHIS

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Table 49: Leading sites of cancer registration by sex, numbers and rates, ages 1-4 years, 1990-1993

Male Female

Site n rate n rate

All sites 24 84.7 21 77.7

Leukaemia 9 31.8 7 25.9

Brain 6 21.2

Kidney 0 - 5 18.5 "rate per 100,000 Source: NZHIS

Table 50: All site cancer registrations by subregion, numbers and rates, ages 1-4 years, 1990-1993

All sites Subregion n rate Hawkes Bay 7 74.3 Wanganui 4 - Manawatu 5 53.1 PorirualKapiti 4 - Hutt Valley 6 68.5 Wellington 13 167.3 Wairarapa 3 - Nelson/Marlborough 3 - Central region 45 81.3 rate per 100,000 Source: NZHIS

Patterns of Health - Page 117 5-14 year olds

Mortality Of the 148 deaths among 5-14 year olds in the Central region from 1990-1994,41 percent were due to unintentional injuries. Generally, male rates were higher than female rates (table 51). Although the numbers were small, the highest age-specific rates in the region were in Wairarapa for males (207.4 per 100,000 population) and Wanganui for females (149.6 per 100,000) (table 52).

Hospitalisations During 1995 and 1996 there were 17,361 hospitalisations for 5-14 year olds in the Central region. The major causes ofhospitalisation were injury and poisoning (25% of hospitalisations), specifically fractures and intracranial injury, and diseases of the respiratory system (17% of hospitalisations) (table 53). Male rates were higher than female rates and nonMaori rates were generally higher than Maori.

The highest total rates for the subregions were found in Hawkes Bay, with the exception of Maori males, where the rates were highest in Wanganui (tables 54, 55, 56, 57).

Injuries Falls accounted for 45 percent of all unintentional injury hospitalisations for the Central region. Age-specific rates for falls for males were about 1.5 times higher than the female rates. Motor vehicle crashes accounted for 9 percent of unintentional injuries, with the highest rates for Maori males (510 per 100,000) (tables 58, 59, 59a). For both males and females age-specific rates for unintentional injury were highest in Wanganui.

Cancer Lymphomas, leukaemia and brain cancer together accounted for 71 percent of all cancer registrations for this age group (tables 60, 61).

Numbers are too small to say much about the difference in rates throughout the regions but the table provides some basic description.

Table 51: Leading causes of death, by sex, numbers and rates, ages 5-14 years, 1990-1994 Male Female Cause n rate n rate All causes 87 132.8 61 97.9 Unintentional injury 41 62.6 20 32.1 Inj MVCs 17 26.0 15 24.1 Inj submersion 9 13.7 0 - Intentional injury 14 21.4 4 - Cancer 6 9.2 11 17.7 Nervous 7 10.7 8 12.8 Suicide 7 10.7 2 -

rate per 100,000 Source: NZJTIIS

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Table 52: All causes of death by subregion and sex, numbers and rates, ages 5-14 years, 1990-1994

Male Female Subregion n rate n rate Hawkes Bay 12 103.5 16 144.7 Wanganui 7 125.3 8 149.6 Manawatu 20 178,2 11 102.8 Porirua/Kapiti 13 193.0 3 - Hutt Valley 13 129.4 99 2.8 Wellington 7 77.8 10 119.4 Wairarapa 7 207.4 1 - Nelson/Marlborough 8 100.8 3 - Central region 87 132.8 61 97.9 rate per 100,000 Source: NZHIS

Table 53: Leading causes of hospitalisation by ethnicity and sex, numbers and rates, ages 5-14 years, 1995-1996

Male Female Maori NonMaori Maori NonMaori

Cause n rate n rate n rate n rate

8044 1383All causes 1785 1166.2 1482.4 920.3 6149 1207.6

Dis respiratory 302 197.3 1296 238.8 244 162.4 1175 230.8

Asthma 128 83.6 434 80.0 77 51.2 379 74.4

Injury, poisoning 552 360.6 2161 398.2 339 225.6 1295 254.3

Fractures 230 150.3 959 176.7 150 99.8 632 124.1

Dis nervous 279 182.3 941 173.4 220 146.4 850 166.9

Otitis media 181 118.3 588 108.4 144 95.8 459 90.1

Dis digestive 178 116.3 914 168.4 173 115.1 744 146.1

Intracranial injur 103 67.3 449 82.7 58 38.6 219 43.0 rate per 10,000 Source: NZBIS

Patterns of Health- Page 119 Table 54: Leading causes of hospitalisation by subregion, rates, Maori, ages 5-14 years, 1995-1996, males

Cause

Subregion all causes Injury/poisoning dis respiratory dis nervous fractures otitis media Hawkes Bay 1444.1 452.7 295.9 184.6 166.9 103.7 Wanganui 1526.4 523.2 264.3 226.5 237.3 134.8 Manawatu 960.3 341.1 118.7 170.6 140.9 122.4 Porirua/Kapiti 1134.6 229.3 158.7 170.5 82.3 117.6 Hutt Valley 934.1 288.5 105.3 178.6 174.0 119.0 Wellington 998.1 319.8 164.7 232.6 145.3 193.8 Wairarapa 1184.6 316.8 289.3 137.7 96.4 82.6 Nelson/Marlborough 742.7 224.5 138.2 138.2 69.1 86.4 Central region 1166.2 360.6 197.3 182.3 150.3 118.3 rare per 10,000 Source: NZH!S

Table 55: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 5-14 years, 1995-1996, males

Cause Subregion all causes injury, poisoning dis respiratory dis nervous fractures otitis media Hawkes Bay 1866.4 465,7 364.0 232.8 197.3 110.3 Wanganui 1667.9 524.7 251.0 182.5 261.1 144.5 Manawatu 1486.2 451.9 278.6 165.6 197.4 116.3 .Porirua/Kapiti 1563.3 390.4 212.0 197.8 192.5 114.8 Hutt Valley 1360.2 403.4 184.5 128.5 182.1 67.8 Wellington 1202.9 344.7 166.6 109.9 143.4 69.4 Wairarapa 1567.7 376.4 337.6 194.0 178.5 155.2 Nelson/Marlborough 1335.9 266.9 180.5 210,2 107.0 145.7 Central region 1482.4 398.2 238.8 173.4 176.7 108.4 rate per 10,000 Source: NZHIS

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Table 56: Leading causes of hospitalisation by subregion, rates, Maori, ages 5-14 years, 1995-1996, females

Cause Subregion all causes injury, poisoning dis respiratory dis nervous dis digestive fractures Hawkes Bay 1254.5 327.7 238.1 151.0 140.8 135.7 Wanganui 1213.7 324.8 142.5 199.4 165.2 131.1 Manawatu 618.0 146.8 96.6 115.9 85.0 81.1 Porirua/Kapiti 853.0 175.4 96.8 193.6 114.9 90.7 Hutt Valley 932.0 209.2 209.2 161.7 133.1 99.9 Wellington 639.3 137.0 146.1 118.7 45.7 45.7 Wairarapa 923.1 230.8 205.1 141.0 76.9 102.6 Nelson/Marlborough 357.8 87.3 78.5 52.4 78.5 34.9 Central region 920.3 225.6 162.4 146.4 115.1 99.8 rate per 10,000 Source: NZHJS

Table 57: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 5-14 years, 1995-1996, females

Cause Subregion all causes injury, poisoning dis respiratory dis nervous dis digestive fractures Hawkes Bay 1654.9 311.4 332.3 226.3 171.4 164.8 Wanganui 1389.8 339.6 279.5 195.9 125.4 156.7 Manawatu 1178.2 293.7 268.2 153.8 93.7 157.2 Porirua/Kapiti 1134.5 286.0 206.3 159.6 149.8 126.5 Hutt Valley 965.1 191.5 195.3 123.8 113.6 97.0 Wellington 1075.5 215.9 163.8 137.7 122.8 96.8 Wairarapa 1341.7 260.0 247.4 201.3 113.2 130.0 Nelson/Marlborough 1093.5 189.7 178.9 177.5 260.2 81.3 Central region 1207.6 254.3 230.8 166.9 146.1 124.1 rate per 10,000 Source: NZHIS

Patterns of Health - Page 121 Table 58: Leading causes of unintentional and intentional injury by ethnicity and sex, numbers and rates, ages 5-14 years, 1995-1996

Males Female Maori NonMaori Maori NonMaori Cause n rate n rate n rate n rate Unintentional injury 581 3795.9 2289 4218.3 326 2169.4 1348 2647.3 fl Falls 236 1541.9 1006 1853.9 156 1038.1 632 1241.2 MVCs 78 509.6 174 320.7 33 219.6 103 202.3 Striking/struck 53 346.3 251 462.6 14 93.2 69 135.5 Cutting/piercing 45 294.0 144 265.4 13 86.5 80 157.1 Other road 39 254.8 195 359.4 26 173.0 161 316.2 Medsurgcomps 31 202.5 135 248.8 13 86.5 85 166.9 Intentional injury 15 98.0 67 123.5 34 226.3 55 108.0 Homicide, injury 9 58,8 51 94.0 10 66.5 10 19,6 Suicide, self-inflicted 6 39.2 12 22.1 22 146.4 41 80.5 rate per loo,000 Source: NZHJS

Table 59: Leading causes of unintentional and intentional injury by subregion, El ages 5-14 years, 1995-1996, males

Cause El Subregion unintentional falls striking struck MVCS other road intentional injury Injury Hawkes Bay 4944.7 1989.4 421.0 487.0 577.8 115.6 Wanganui 5380.2 2448.7 569.1 396.6 551.8 224.2 Manawatu 4520.1 1972.2 541.7 474.0 279.3 84.6 Porirua/Kapiti 4007.1 1915.2 285.2 285.2 298.8 95.1 Hutt Valley 3919.9 1709.6 415.6 255.0 255.0 122.8 Wellington 3533.8 1911.6 351.3 227.3 217.0 124.0 Wairarapa 3845.0 1422.9 363.3 454.1 272.5 151.4 Nelson/Marlborough 9030.8 2643.2 1652.0 1064.6 734.2 293.7 Central region 4528.2 1959.6 479,6 397.6 369.2 129.4 rate per 100,000 Source: NZHIS

ci

ci El El 0

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Table 59a: Leading causes of unintentional and intentional injury by subregion rates, ages 5-14 years, 1995-1996, females

Cause unintentional intentional Subregion injury falls other road MVC5 med surg comps injury Hawkes Bay 3186.1 1480.5 294.4 242.4 199.1 199.1 Wanganui 3474.8 1289.6 609.0 232.8 197.0 161.2 Manawatu 2740.7 1290.3 338.1 213.6 195.8 106.8 Porirua/Kapiti 2473.5 1325.1 294.5 279.7 117.8 220.8 Hutt Valley 1952.5 1016.5 100.6 90.6 130.8 110.7 Wellington 2162.5 1059.4 163.8 240.3 109.2 109.2 Wairarapa 2717.2 1390.2 379.1 252.8 - 158.0 Nelson/Marlborough 5800.3 2496.3 881.1 477.2 330.4 - Central region 2783.3 1310.2 310.9 226.1 162.9 148.0 rate per 100,000 Source: NZHIS

Table 60: Leading sites of cancer registrations by sex, numbers and rates, ages 5-14 years, 1990-1993

Male Female

Site n rate n rate

All sites 29 44.3 30 48.2

Leukaemia 8 12.2 7 11.2

Other 7 10.7 8 12.8

Brain 6 9.2 6 9.6 rate per 100,000 Source: NZHIS

Table 61: All site cancer registrations by subregion, numbers and rates, ages 5-14 years, 1990-1993

Subregion n rate

Hawkes Bay 10 44.2

Wanganui 3

Manawatu 9 41.0

PorirualKapiti 5 38.1

Hutt Valley 10 50.6

Wellington 14 80.6

Wairarapa 6 91.0

Nelson/Marlborough 2

Central region 59 46.2 rare per 100,000 Source: NZHIS

Patterns of Health - Page 123 15-24 year olds

Mortality In the Central region from 1990 to 1994, there were 536 male and 197 female deaths in the age group 15-24 years. Male age-specific death rates were higher than for females with unintentional injuries (primarily motor vehicle crashes) the major cause of death for both sexes (tables 62, 63).

Wairarapa had the highest age-specific rates for males and Porirua/Kapiti the highest female rates. The lowest rates in the region were in Wellington (tables 64, 65).

Hospitalisations Of the 9,473 male hospitalisations in this age-group 48 percent were accounted for by injury and poisoning. Maori rates were lower than nonMaori rates for most causes (table 66).

Pregnancy, childbirth and complications accounted for 58 percent of the 23,122 female hospitalisations for this age group. Maori rates generally exceeded nonMaori rates (table 67).

Hawkes Bay had the highest rates for both Maori and nonMaori males and Maori females. NonMaori female rates were highest in Wanganui. While rates varied widely between the subregions, nonMaori male rates were generally higher than Maori male rates whereas for females Maori rates generally exceeded nonMaon rates (tables 68, 69, 70, 71).

Injuries Motor vehicle crashes accounted for 25 percent of unintentional injuries among males and 27 percent of unintentional injuries for females. Falls were the next most common cause of unintentional injury accounting for 19 percent and 17 percent of male and female unintentional injuries respectively (table 72).

Male rates exceeded female rates, except for suicide and self-inflicted injury. Overall unintentional injuries were higher for nonMaori than for Maori, although there was some variation within individual causes.

For both sexes homicide and injury inflicted by others was higher for Maori than nonMaori, but there was a contrary pattern for suicide and self-inflicted injury.

For males the highest rates were found in Hawkes Bay (table 73), and for females the highest rates were in the Wairarapa (table 74).

Cancer There were 67 cancer registrations in the Central region for both males and females during 1990- 1993 (table 75). Melanoma was the most common cancer site for females, while testis and melanoma were the most common sites for males. Overall male and female rates were similar, but female melanoma rates exceeded those of males.

Once again numbers are small but male and female rates for the region overall are similar, with same variation between the subregions (table 76).

Page 124- The Public Health of the Central Region LI

Table 62: Leading causes of death by ethnicity, numbers and rates, ages 15-24 years, 1990-1994, males

Maori NonMaori

Cause n rate n rate

All causes 41 359.7 495 821.5

Unintentional injury 17 149.2 275 456.4

hij MVCs 15 131.6 209 346.9

Intentional injury 19 166.7 146 242.3

Suicide 15 131.6 132 219.1

Cancer I 20 33.2

Nervous 3 15 24.9

Circulatory I 15 24.9 rate per 100,000 Source: NZHIS

Table 63: Leading causes of death by ethnicity, numbers and rates, ages 15-24 years, 1990-1994, females

Maori NonMaori

Cause n rate n rate

All causes 12 100.9 185 314.6

Unintentional injury 4 - 96 163.2

mi MVCs 3 - 79 134.3

Suicide 3 - 20 34.0

Intentional injury 4 - 28 47.6

Cancer 17 28.9

Birth defects 2 - 10 17.0 rate per 100,000 Source: NZHIS

Patterns of Health - Page 125 Table 64: Leading causes of death by subregion, rates, ages 15-24 years, 1990-1994, males Cause Subregion all causes unintentional injury MVCs intentional injury suicide Hawkes Bay 980.7 597.7 495.0 177.5 168.1 Wanganui 851.3 491.9 397.3 227.0 151.3 Manawatu 681.0 384.0 304.3 217.3 181.1 Porirua/Kapiti 790.2 387.0 322.5 241.9 209.6 Hutt Valley 718.9 341.9 245.5 306.9 289.3 Wellington 603.4 305.4 201.1 238.4 230.9 Wairarapa 1126.9 654.3 436.2 363.5 327.2 Nelson/Marlborough 607.0 334.4 260.1 148.6 123.9 Central region 748.1 407.5 312.6 230.3 205.2 rate per 100,000 Source: NZHIS

Table 65: Leading causes of death by subregion, rates, ages 15-24 years, 1990-1994, females

Cause Subregion all causes unintentional injury MVCs Hawkes Bay 348.8 216.8 169.7 Wanganui 335.0 188.4 167.5 Manawatu 295.4 147.7 125.5 PorirualKapiti 418.7 209.3 161.0 Hutt Valley 208.0 81.4 72.3 Wellington 166.0 83.0 76.1 Wairarapa 386.7 - - Nelson/Marlborough 281.4 147.4 107.2 Central region 278.6 141.4 116.0 rate per 100.000 Source: NZHIS Table 66: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 15-24 years, 1995-1996, males

Maori NonMaori Cause n rate n rate All causes 1556 1286.4 7917 1479.6 Injury, poisoning 774 639.9 3741 699.1 Fractures 201 166.2 1210 226.1 Intracranial injury 178 147.2 856 160.0 Dis digestive 144 119.0 840 157.0 Dis respiratory 119 98.4 595 111.2 Mental disorders 119 98.4 357 66.7 Dismusculoskeletal 67 554 430 80.4 Symptoms, signs 64 52.9 474 88.6 rate per 10000 Source: NZH!S

Page 126- The Public Health of the Central Region I

Table 67: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 15-24 years, 1995-1996, females

Maori NonMaori Cause n rate n rate All causes 5883 4713.9 17239 3255.5 Pregnancy, childbirth, comps 4239 3396.6 9207 1738.7 Normal delivery, probs 1459 1169.1 2644 499.3 Preg comps 1250 1001.6 2776 524.2 Complications labour 952 762.8 1935 365.4 Abortive pregnancy 438 351.0 1420 268.2 Injury, poisoning 354 283.7 1478 279.1 Dis genitourinary 304 243.6 1417 267.6 rate per 10,000 Source: NZH1S

Table 68: Leading causes of hospitalisation by subregion, rates, Maori, ages 15-24 years, 1995-1996, males

Cause Subregion all causes injury, poisoning dis digestive dis respiratory fractures intracranial injury Hawkes Bay 1893.2 962.4 108.9 140.5 242.4 231.8 Wanganui 1573.6 868.2 108.5 100.8 178.3 170.5 Manawatu 1060.0 505.2 108.3 112.8 162.4 90.2 Porirua/Kapiti 1007.1 427.8 124.8 62.4 107.0 89.1 Hutt Valley 1038.8 511.6 186.0 51.7 160.2 67.2 Wellington 831.4 373.0 93.2 62.2 139.9 139.9 Wairarapa 1598.4 779.7 175.4 136.5 - 233.9 Nelson/Marlborough 858.8 463.3 - 101.7 90.4 192.1 Central region 1286.4 639.9 119.0 98.4 166.2 147.2 rate per 10,000 Source: NZHIS

Table 69: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 15-24 years, 1995-1996, males

Cause Subregion all causes injury, poisoning dis digestive dis respiratory fractures intracranial injury Hawkes Bay 1864.7 919.2 188.5 105.2 279.1 223.6 Wanganui 1779.7 892.7 168.8 160.2 311.9 171.7 Manawatu 1550.7 767.0 154.3 141.4 235.7 205.2 Porirua/Kapiti 1431.6 679.7 165.3 107.1 211.8 156.0 Hutt Valley 1405.5 619.9 186.1 110,4 218.2 113.0 Wellington 1092.9 468.9 103.1 95.2 146.3 103.1 Wairarapa 1815.3 912,9 208.7 125.2 245.2 250.4 Nelson/Marlborough 1490.2 697.2 160.0 71.4 258.6 144.3 Central region 1479.6 699.1 157.0 111.2 226.1 160.0 rate per 10,000 Source: NZR!S

Patterns of Health - Page 127 Table 70: Leading.causes of hospitalisation by subregion, rates, Maori, ages 15-24 years, 1995-1996, females

Cause all normal delivery, preg complications abortive injury Subregion causes probs comps labour pregnancy poisoning Hawkes Bay 6253.9 1640.9 1296.9 921.9 419.7 402.5 Wanganui 6141.1 1238.7 1629.1 1118.6 217.7 367.9 Manawatu 3819.6 950.5 760.4 627.8 212.2 274.1 Porirua/Kapiti 5146.0 1374.6 1323.0 1082.5 283.5 223.4 Hutt Valley 4036.7 1154.9 671.9 603.7 372.7 136.5 Wellington 2715.5 502.4 577.1 387.0 380.2 190.1 Wairarapa 6117.0 1489.4 1329.8 957.4 638.3 514.2 Nelson/Marlborough 3092.8 733.1 481.1 469.6 492.6 194.7 Central region 4713.9 1169.1 1001.6 762.8 351.0 283.7 rate per 10,000 Source: NZHIS

Table 71: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 15-24 years, 1995-1996, females

Cause all normal delivery, preg complications abortive injury Subregion causes probs comps labour pregnancy poisoning Hawkes Bay 4507.9 712.6 777.5 451.4 289.9 400.1 Wanganui 4519.9 1023.9 682.6 618.8 137.2 401.9 Manawatu 3070.5 576.6 459.8 372.1 133.8 284.5 Porirua/Kapiti 3927.9 723.5 737.8 644.7 243.6 265.0 Hutt Valley 3087.0 482.5 502.9 317.5 281.9 212.1 Wellington 2078.2 286.4 203.2 195.2 207.2 209.6 Wairarapa 4403.2 608.1 810.8 478.6 495.5 540.5 Nelson/Marlborough 3399.0 355.8 519.2 317.3 596.2 238.8 Central region 3255.5 524.2 499.3 365.4 268.2 279.1 rate per 10,000 Source: NZHIS

Page 128- The Public Health of the Central Region fl I

Table 72: Leading causes of unintentional and intentional injuries by ethnicity and sex, ages 15-24 years, 1996

Males Female Maori NonMaori Maori NonMaori

Cause n rate n rate n rate n rate

660 3410 290 1312Unintentional injury 5456.3 6372.9 2323.7 2477.7

163MVCs 1347.6 857 1601.6 88 705.1 351 662.9

Falls 124 1025.1 660 1233.5 45 360.6 220 415.5

Cutting/piercing 98 810.2 300 560.7 23 184.3 59 111.4

Striking/struck 80 661.4 442 826.0 13 104.2 55 103.9

Late effects 54 446.4 273 510.2 14 112.2 71 134.1

Med surg comps 27 223.2 195 364.4 37 296.5 186 351.3

417 131Intentional injury 206 1703.0 712 1330.6 1049.7 787.5

Homicide, injury 163 1347.6 515 962.5 60 480.8 74 139.7

Suicide, self inflicted 36 297.6 172 321.4 69 552.9 321 606.2 rate per 100,000 Source: NZHIS

Table 73: Leading causes of unintentional and intentional injury by subregion, rates, ages 15-24 years, 1995-1996, males

Cause Subregion unintentional injury MVCs falls striking/struck intentional injury homicide, inj Hawkes Bay 8400.4 2394.2 1651.2 805.0 1836.9 1413.8 Wanganui 7941.5 2110.8 1734.6 564.3 2048.1 1651.0 Manawatu 6649.8 1840.8 1181.2 805.3 1395.9 989.4 Porirua/Kapiti 5740.1 1531.9 1181.2 738.3 1125.9 756.7 Hutt Valley 4966.1 802.0 997.3 987.0 1583.4 1141.3 Wellington 4187.4 862.8 965.7 593.7 839.1 562.0 Wairarapa 7860.1 2428.0 1070.0 1070.0 2139.9 1810.7 Nelson/Marlborough 6278.5 1496.7 989.3 951.3 1103.5 837.1 Central region 6203.9 1554.8 1195.0 795.7 1399.3 1033.5 rate per 100,000 Source: NZHIS

Patterns of Health - Page 129

Table 74: Leading causes of unintentional and intentional injuries by subregion, rates, ages 15-24 years, 1995-1996, females

Cause Subregion unintentional Injury MVCs falls med surg comps intentional injury suicide. self-inf Hawkes Bay 3378.4 1080.7 440.7 356.7 1311.5 818,4 Wanganui 3469.9 783.5 694.0 358.2 1320.8 940.2 Manawatu 2726.0 776.6 442.7 442,7 730.0 566.9 Ponrua/Kapit 2485.1 766.1 317.6 411.1 560.5 411.1 184.0Hutt Valley 1523.5 378.3 235.1 654,4 337,4 Wellington 1660.2 322.0 422.2 243.3 629,7 508.1 Wairarapa 4615.4 1538.5 854.7 683.8 1752.1 1324.8 Nelson/Marlborough 2136.9 590.5 224.9 365.5 660.8 562.4 Central region 2448.3 670,9 405.0 340,8 837.5 596.0 rate per 100,000 Source: NZHIS

Table 75: Leading sites of cancer registration by sex, numbers and rates, ages 15-24 years, 1990-1993

Cause Male Female Site n rate n rate All sites 67 93.5 67 94,8 Melanoma 13 18.1 22 31.1 Leukaemia 9 12.6 10 14.1 Testis 14 19.5 0 - Lymphomas 6 8.4 8 11.3 Brain 7 9.8 3 - Cervix 0 - 8 11.3 rate per 100,0(X) Source: NZHJS Table 76: All site cancer registrations by subregion and sex, numbers and rates, ages 15-24 year, 1990-1993, males

Cause

Male Female

Subregion n rate n rate

Hawkes Bay 9 84.1 11 103.7

Wanganui 6 113.5 6 125.6

Manawatu 10 72.4 13 96.0

Porirua/Kapiti 4

Hun Valley 14 122.7 7 63.3

Wellington 12 89.4 17 117.6

Wairarapa 4 2

Nelson/Marlborough 11 136.3 7 93.8

Central region 67 93.5 67 94.8 rate per 100,000 Source: NZHIS

Page 130- The Public Health of the Central Region Li

25-44 year olds

Mortality Unintentional injuries were the leading cause of death for males with motor vehicle crashes accounting for 61 percent of these deaths (table 77). NonMaori rates exceeded Maori rates for all causes except diseases of the circulatory system.

Cancer accounted for 39 percent of all female deaths. Diseases of the circulatory system and unintentional injury were other leading causes of death. NonMaori rates exceeded Maori rates for cancer deaths but the converse occurred for deaths from circulatory diseases and unintentional injuries.

In all subregions, the leading cause of death for males was unintentional injury with the majority due to motor vehicle crashes (table 79). Suicide was the leading cause of death from intentional injury.

Cancer was the leading cause of death for females throughout the Central region with the highest rates found in Wanganui and lowest in PorirualKapiti (table 80).

Hospitalisations The main reason for hospitalisation of males aged 25-44 years during 1995 and 1996 was injury and poisoning (30% of hospitalisations). Maori rates exceeded nonMaori rates for most causes (table 81).

Pregnancy, childbirth and complications accounted for 56 percent of all hospitalisations for females of this age group (table 82). As for males, Maori rates generally exceeded nonMaori rates.

Maori male rates generally exceeded nonMaori male rates throughout the Central region. Injury and poisoning remained the leading cause of hospitalisation in each subregion (tables 83, 84).

For most subregions and causes female Maori rates exceeded nonMaori rates. The exceptions were Nelson/Marlborough and Wellington where nonMaori rates were higher than the Maori rates (tables 85, 86).

Injuries Falls, motor vehicle crashes and cutting/piercing together accounted for 45 percent of all hospitalisations from unintentional injuries for males in this age group (table 87). Homicide accounted 61 percent of all intentional injuries for males.

Male rates exceeded female rates for all causes except medical and surgical complications and suicide. Suicide and self-inflicted injury accounted for 71 percent of intentional injury hospitalisations for females (table 87).

Rates varied across the regions with the lowest male and female rates for unintentional injuries found in Wellington (tables 88, 89). Rates of hospitalisation from motor vehicle crashes varied markedly across the regions. For males the highest rates were found in the Wairarapa (1,190 per 100,000) while the lowest rate was in Wellington (430 per 100,000). Similar variations were found for females.

Patterns of Health - Page 131

Cancer The most common site of cancer registration for Maori males was the testis (table 90). Testicular cancer was the second leading site of registration for nonMaori males, for whom the rates were highest for melanoma. For females breast cancer was the leading cause of cancer registration for both ethnic groups. Melanoma was also a major cause of registration for nonMaori females (table 91).

Male cancer registration rates were lowest in Hawkes Bay and highest in PorirualKapiti (285 and 387 per 100,000 respectively) (table 92). Female rates were highest in Wairarapa (718 per 100,000) and lowest in Wellington (495 per 100,000) (table 93). Rates for other sites varied within the subregions but small numbers make direct comparisons difficult.

Table 77: Leading causes of death by ethnicity, numbers and rates, ages 25-44 years, 1990-1994, males

Maori NonMaori Cause n rate n rate All causes 102 723.3 885 772.3 Unintentional injury 27 191.4 267 233.0 InjMVCs 16 113.5 164 143.1 Intentional injury 16 113.5 184 160.6 Suicide, self-inf 11 78.0 163 142.2 Discirculatoiy 37 262.4 137 119.6 Ischaemic heart 19 134.7 84 73.3 Cancer 12 85.1 144 125.7 "rate per 100,000 Source: NZHIS

Table 78: Leading causes of death by ethnicity, numbers and rates, ages 25-44 years, 1990-1994, females

Maori NonMaori

Cause n rate n rate

All causes 66 421.1 535 457.3

Cancer 18 114.8 217 185.5

Cancer, breast 3 - 66 56.4

Dis circulatory 15 95.7 92 78.6

Unintentional injury 13 82.9 74 63.3

MYCs 11 70.2 52 44.4

Intentional injury 7 44.7 60 51.3

Suicide 4 - 47 40.2 rate per 100,000 Source: NZHIS

Page 132- The Public Health of the Central Region I

Table 79: Leading causes of death by subregion, rates, ages 25-44 years, 1990-1994, males

Cause

all unintentional intentional suicide. dis ischaemic Subregion causes injury MVCs injury self-inf circulatory heart Hawkes Bay 1011.5 399.4 259.4 166.0 145.2 186.7 103.7 Wanganui 894.2 301.5 176.8 218.3 176.8 145.6 1040 Manawatu 741.5 207.0 130.0 154.1 139.6 134.8 72.2 Porirua/Kapiti 800.1 237.4 167.1 202.2 175.9 175.9 105.5

Hutt Valley 681.0 186.2 98.0 132.3 107.8 142.1 I fP_.9 Wellington 600.4 114.0 57.0 110.2 102.6 98.8 45.6 Wairarapa 792.8 202.8 129.1 147.5 147.5 184.4 129.1 Nelson/Marlborough 780.9 251.7 161.3 180.7 148.4 71.0 38.7 Central region 766.9 228.4 139.9 155.4 135.2 135.2 80.0 rate per 100.000 Source: NZHIS Table 80: Leading causes of death by subregion, rates, ages 25-44 years, 1990-1994, females

Cause Subregion - all causes cancer ca breast dis circulatory unintentional injury MVCs Intentional injury Hawkes Bay 495.3 208.8 38.8 92.3 77.7 68.0 43.7

Wanganui 559.3 264.4 91.5 132.2 101.7 81.4 - Manawatu 458.7 140.4 32.8 93.6 93.6 74.9 56.2 Porirua/Kapiti 523.3 130.8 - 106.3 81.8 57.2 81.8 Hutt Valley 502.1 207.6 67.6 82.1 57.9 29.0 48.3 Wellington 324.7 139.7 49.1 37.8 30.2 18.9 49.1 Wairarapa 490.5 245.2--- - 105.1 - - - Nelson/Marlborough 406.8 165.3 76.3 57.2 57.2 38.1 50.9

Central region 453.0 177.1 52.0 80.7 65.6 47.5 50.5 rate per 100,000 Source: NZHIS Table 81: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 25-44 years, 1995-1996, males

Maori NonMaori

nCause rate n rate

2679All causes 1528.6 15482 1340.9

Injury, poisoning 859 490.1 4503 390.0

Fractures 254 144.9 1396 120.9

Dis digestive 324 184.9 2204 190.9

Mental disorders 219 125.0 900 77.9

Dis respiratory 208 118.7 840 72.8

Dis circulatory 198 113.0 971 84.1

Symptoms, signs 189 107.8 1467 127.1

Dis musculoskeletal 193 110.1 1311 113.5 irate per 10.000 Source: NZHIS

Patterns of Health - Page 133 Table 82: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 25-44 years, 1995-1996, females

Maori NonMaori Cause n rate n rate Allcauses 7263 3801.8 41925 3473.9 Preg childbirth, comps 3870 2025.8 23889 1979.4 Normal delivery, probs 1500 785.2 8341 691.1 Preg comps 1138 595.7 6024 499.1 Complications labour 656 343.4 6133 508.2 Abortive pregnancy 364 190.5 2056 170.4 Disgenitourmary 727 380.5 4414 365.7 Dis female genital 398 208.3 3115 258.1 Injury; poisoning 532 278.5 2176 180.3 Dis digestive 430 225.1 2512 208.1 rate per 10,000 Source: NZHIS Table 83: Leading causes of hospitalisation by subregion, rates, Maori, ages 25-44 years, 1995-1996, males

Cause Subregion all causes injury, poisoning dis digestive mental disorders dis respiratory fractures Hawkes Bay 2062.3 701.2 194.8 199.7 180.2 187.5 Wanganui 2033.9 683.1 272.2 56.5 128.4 226.0 Manawatu 1435.4 407.7 191.8 195.3 109.6 95.9 Porirua/Kapiti 1074.9 368.4 144.9 - 90.6 120.8 Hutt Valley 1188.1 381.4 150.3 99.0 88.0 132.0 Wellington 1195.0 309.6 130.6 140.3 87.1 91.9 Wairarapa 2083.3 761.5 287.4 129.3 172.4 273.0 Nelson/Marlborough 874.2 263.0 163.5 - 56.9 78.2 Central region 1528.6 490.1 184.9 125.0 118.7 144.9 rate per 10,000 Source: NZHIS Table 84: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 25-44 years, 1995-1996, males

Cause Subregion all causes injury, poisoning dis digestive mental disorders dis respiratory fractures Hawkes Bay 1659.3 521.8 222.5 116.4 90.8 149.6 Wanganui 1643.9 489.5 258.4 27.3 98,7 142.8 Manawatu 1435.4 409.6 180.2 137.1 84.1 116.9 Porirua/Kapiti 1257.2 386.9 135.5 42.1 73.9 111.9 Hutt Valley 1229.7 335.4 226.8 70.5 69.9 109.7 Wellington 1031.6 294.8 108.0 82.2 60.9 108.4 Wairarapa 1582.0 496.5 227.9 81.2 67.7 139.9 Nelson/Marlborough 1391.0 379.5 260.8 18.4 52.7 119.9 Central region 1340.9 390.0 190.9 77.9 72.8 120.9 rate per 10,000 Source: NZHIS

Page 134- The Public Health of the Central Region U

Table 85: Leading causes of hospitalisation by subregion, rates, Maori, ages 25-44 years, 1995-1996, females

Cause normal complications injury Subregion all causes delivery probs preg comps labour dis genitourinary poisoning Hawkes Bay 4519.1 974.4 712.3 327.6 378.4 393.2 Wanganui 4540.5 818.5 72.7 466.4 439.0 297.2 Manawatu 3770.5 746.2 608.2 355.0 348.5 253.1 Porirua/Kapiti 3593.3 784.9 626.9 458.7 341.5 239.6 Hutt Valley 3590.3 923.6 569.4 298.6 399.3 218.8 Wellington 2755.1 371.4 404.3 277.4 380.8 268.0 Wairarapa 4129.4 833.3 559.7 348.3 348.3 273.6 Nelson/Marlborough 2392.4 488.7 211.5 204.2 401.2 109.4 Central region 3801.8 785.2 595.7 343.4 380.5 278.0 rare per 10,000 Source: NZHIS

Table 86: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 25-44 years, 1995-1996, females

Cause normal complications injury Subregion all causes delivery probs preg comps labour dis genitourinary poisoning Hawkes Bay 3648.4 777.0 457.7 424.9 344.8 194.9 Wanganui 3920.0 671.6 624.0 470.9 523.6 241.9 Manawatu 3567.5 673.9 557.6 535.1 394.8 201.3 Porirua/Kapiti 3572.2 770.4 533.4 571.5 345.7 170.1 Hutt Valley 3550.6 761.9 528.6 511.4 347.2 168.6 Wellington 3046.0 548.9 526.3 556.5 269.5 160.0 Wairarapa 3864.0 752.3 451.8 547.7 409.2 234.4 Nelson/Marlborough 3433.7 725.5 324.6 439.8 461.3 149.7

-Central region 3473.9 691.1 499.1 508.2 365.7 180.3 rare per 10,000 Source: NZHJS

Patterns of Health - Page 135 Table 87: Leading causes of unintentional and intentional injury by ethnicity and sex, numbers and rates, ages 25-44 years, 1995-1996

Male Female

Maori NonMaori Maori NonMaori

Cause n rate n rate n rate n rate

Unintentional injury 849 4844.2 4501 3898.3 529 2769.1 2434 2016.8

Falls 155 884.4 737 638.3 74 387.4 298 246.9

MVCs 134 764.6 812 703.3 86 450.2 311 257.7

Cutting/piercing 123 701.8 456 394.9 33 172.7 130 107.7

Late effects 91 519.2 506 438.2 43 225.1 202 167.4

Med surg comps 91 519.2 531 459.9 155 811.4 798 661.2

Striking/struck 74 422.2 356 308.3 25 130.9 72 59.7

Adverse effects drugs 22 125.5 104 90.1 17 89.0 176 145.8

Intentional injury 200 1141.2 801 693.7 154 806.1 567 469.8

Homicide, inj 143 815.9 467 404.5 75 392.6 90 74.6

Suicide, self-inf 53 302.4 304 263.3 75 392.6 438 3629 rate per 100,000 Source: NZHIS Table 88: Leading causes of unintentional and intentional injury by subregion, rates, ages 25-44 years, 1995-1996, males

Cause

Subregion unintentional injury MVCs falls med surg comps intentional injury homicide, ml Hawkes Bay 5611.3 1149.6 810.3 714.1 947.0 683.7 Wanganui 5369.0 756.6 860.3 507.9 953.6 621.9 Manawatu 4291.5 928.0 522.9 560.6 767.9 395.7 Porirua/Kapiti 3921.1 587.7 754.4 464.9 745.6 508.8 Hutt Valley 3194.5 447.9 595.6 472.5 718.6 388.9 Wellington 2807.2 430.2 708.8 306.8 603.0 335.0 Wairarapa 5227.2 1189.8 721.7 429.1 1150.8 721.7 Nelson/Marlborough 3804.0 629.2 541.8 320.4 570.9 361.2 Central region 4022.9 711.3 670.7 467.7 752.7 458.7 rate per 100,000 Source: NZHJS

Page 136- The Public Health of the Central Region 0 U Table 89: Leading causes of unintentional and intentional injury by subregion, rates, ages 25-44 years, 1995-1996, females

Cause

Subregion unintentional Injury med surg comps MVCS falls intentional injury suicide, self-it Hawkes Bay 2711.8 782.9 382.0 391.4 504.6 330.1 Wanganui 3182.7 1184.7 321.3 411.6 582.3 371.5 Manawatu 2615.3 904.8 423.1 193.6 598.7 436.6 Porirua/Kapiti 1996.4 683.8 275.1 345.8 353.7 275.1 Hutt Valley 1669.3 629.6 143.1 190.8 591.4 319.5 Wellington 1569.9 445.7 209.3 266.7 509.8 432.2 Wairarapa 2438.1 382.1 491.3 382.1 582.2 382.1 Nelson/Marlborough 1630.0 545.2 204.5 119.3 403.2 329.4 Central region 2119.6 681.7 284.0 266.1 515.8 367.0 rate per 100,000 Source: NZHIS

Table 90: Leading sites of cancer registration by ethnicity, numbers and rates, ages 25-44 years, 1990-1993, males

Maori NonMaori

Site rate n rate

All sites 276.5 381 332.5 I Testis 85.1 51 44.5

Lymphomas 41 35,8 I Trachea, lung 14 12.2 I Leukaemia 18 15.7 I Melanoma 114 99.5 I Large bowel 31 27. I Brain ii 19 16.6 rate per 100,0(X) Source: NZHIS

Patterns of Health - Page 137 Table 91: Leading sites of cancer registration by ethnicity, numbers and rates, ages 25-44 years, 1990-1993, females

Maori NonMaori Site n rate n rate All sites 87 555.0 718 613.7 Breast 26 165.9 227 194.0 Cervix 17 108.5 82 70.1 Ovary 7 44.7 33 28.2 Trachea, lung 6 38.3 16 13.7 Melanoma 2 - 189 161.6 Brain I - 16 13.7 Large bowel 3 - 32 27.4 rate per 100,000 Source: NZHIS

Table 92: Leading sites of cancer registration by subregion, ages 25-44 years, rates, 1990 -1993, males Site Subregion all sites melanoma testis lymphomas large bowel Hawkes Bay 285.3 83.0 36.3 36.3 - Wanganui 332.7 135.2 - - - Manawatu 346.7 115.6 62.6 48.1 28.9 Porirua/Kapiti 386.9 52.8 123.1 44.0 - Hutt Valley 308.6 102.9 39.2 24.5 - Wellington 311.6 79.8 22.8 38.0 - Wairarapa 350.3 92.2 - - 92.2 Nelson/Marlborough 342.0 58.1 64.5 32.3 45.2 Central region 326.4 89.4 49.0 35.0 24.9 rate per 100,000 Source: NZH!S Table 93: Leading sites of cancer registration by subregion, ages 25-44 years, rates, 1990 -1993, females

Site Subregion all sites breast melanoma cervix ovary Hawkes Bay 636.1 194.2 111.7 97.1 24.3 Wanganui 701.6 264.4 111.9 81.4 - Manawatu 664.7 196.6- 168.5 121.7 32.8 Porirua/Kapiti 588.7 171.7 122.6 65.4 40.9 Hutt Valley 632.5 188.3 159.3 72.4 33.8 Wellington 494.5 162.3 132.1 45.3 30.2 Wairarapa 718.2 175.2 227.7 - - Nelson/Marlborough 559.4 203.4 158.9 38.1 31.8 Central region 606.8 190.7 144.0 74.6 30.2 rate per 100,000 Source: NZHIS

Page 138- The Public Health of the Central Region 0 I 45-64 year olds

Mortality Cancer and ischaemic heart disease accounted for 34 percent and 32 percent respectively of male deaths, while 51 percent of female deaths were due to cancer (tables 94, 95).

Cancer death rates for nonMaori were higher than Maori for males and female, but there was a converse pattern for deaths from cerebrovascular disease.

Ischaemic heart disease and cancer were the leading causes of death for males in each subregion (table 96). Porirua/Kapiti had the highest male rates for both causes while Nelson/Marlborough had the lowest.

Cancer consistently accounted for about half of all female deaths in the subregions. Contrary to the pattern in other subregions, in Wanganui lung cancer accounted for more deaths than breast cancer (table 97).

Hospitalisations Diseases of the circulatory system were the leading cause of hospitalisation for males aged 45-64 years for both ethnic groups (table 98). Within this broad disease category other heart disease was the leading cause of hospitalisation for Maori and ischaemic heart disease for nonMaori. Male rates were higher than female rates.

Diseases of the circulatory system were the leading cause of hospitalisation for Maori females compared to diseases of the digestive system for nonMaori females (table 99).

For both sexes, hospitalisation rates for diseases of the respiratory system were more than twice as high for Maori as for nonMaori. Cancer rates were highest for nonMaori. NonMaori hospitalisation rates were higher for females than males, but this was not the experience for Maori.

Diseases of the circulatory system remained the leading cause of hospitalisation for males in all subregions and for Maori female (tables 100, 101, 102, 103). For nonMaori females the leading cause of hospitalisation varied across the region with the most common cause being diseases of the digestive system.

Injuries Thirty one percent of male and 39 percent of female hospitalisations for unintentional injury were due to medical and surgical complications (table 104). For males the next, most common causes were motor vehicle crashes and falls, whereas for females falls and adverse effects of drug use were other leading causes of hospitalisation.

The ranking of causes of hospitalisation varied little across the region except for a number of subregions where male rates of hospitalisation for late effects of injury were more common than motor vehicle crashes (table 105). Male rates generally exceeded female rates, with the exception of intentional injuries. Hospitalisation rates for medical and surgical complications and late effects of injury were higher for females than males in Manawatu and Porirua/Kapiti (table 106).

Patterns of Health - Page 139 Cancer For Maori males lung cancer was the leading cause of cancer registration compared to large bowel cancer among nonMaori males (table 107).

For both ethnic groups breast cancer was the leading cause of cancer registration for females (table 108). Maori female rates were higher than nonMaori rates for cancers of the lung, cervix and uterus.

Across the region male cancer registration rates were highest for large bowel and lung cancer (table 109). The highest large bowel cancer rates were found in the Wairarapa and the highest lung cancer rates in PorirualKapiti.

Breast cancer remained the most common site of female cancer registrations across the subregions (table 110).

Table 94: Leading causes of death by ethnicity, numbers and rates, ages 45-64 years, 1990-1994, males

Maori NonMaori Cause n rate n rate All causes 247 4469.8 3122 4237.6 Dis circulatory 116 2099.2 1333 1809.3 Ischaemic heart 73 1321.0 995 1350.5 Cerebrovascular 12 217.2 144 195.5 Cancer 56 1013.4 1105 1499.9 Ca lung 23 416.2 282 382.8 Ca large bowel 5 90.5 202 274.2 Disrespiratoiy 21 380.0 161 218.5 CORD 16 289.5 132 179.2 rate per 100,000 Source: NZHIS

Page 140— The Public Health of the Central Region 0 I

Table 95: Leading causes of death by ethnicity, numbers and rates, ages 45-64 years, 1990-1994, females

Maori NonMaori Cause n rate n rate All causes 188 3265.6 2040 2791.1 Cancer 57 990.1 1085 1484.5 Ca breast 6 104.2 267 365,3 Ca large bowel 3 - 176 240,8 Ca trachea, lung 22 382.1 153 209.3 Dis circulatory 83 1441.7 519 710.1 Ischaemic heart 38 660.1 296 405.0 Cerebrovascular 20 347.4 116 158.7 Dis respiratory 14 243.2 118 161.4 CORD 12 208.4 97 132.7 rate per 100,000 Source: NZHIS

Table 96: Leading causes of death by subregion, rates, ages 45-64 years, 1990-1994, males Cause dis ca trachea, dis Subregion all causes circulatory ischaemic heart cancer lung respiratory unintentional injury Hawkes Bay 4600.1 1980.3 1410.1 1541.1 416.1 200.3 169.5 Wanganui 4945.0 2267.1 1544.3 1511.4 525.7 312.1 295.7 Manawatu 3956.8 1679.1 1360.4 1375.9 342.0 241.0 202.1 Porirua/Kapiti 5201.0 2319.2 1660.5 1784.0 466.6 343.1 137.2 Hutt Valley 4272.4 1941.3 1485.0 1418.6 323.5 224.0 141.0 Wellington 3906.4 1513.8 1107.7 1484.3 413.5 214.1 132.9 Wairarapa 4556.6 1871.4 1383.2 1546.0 406.8 217.0 325.5 Nelson/Marlborough 3470.9 1506.2 1075.9 1244.3 290.0 159.0 102.9 Central region 4253.8 1829.8 1348.7 1466.1 385.2 229.8 169.2 rate per 100,000 Source: NZHIS

Patterns of Health - Page 141 Table 97: Leading causes of death by subregion, rates, ages 45-64 years, 1990-1994, females Cause

Subregion all causes cancer ca breast Ca trachea, lung ca large bowel circulatory ischaemic heart Hawkes Bay 3198.4 1447.6 348.6 265.3 181.9 1068.7 568.4 Wanganui 3470.5 1436.6 209.8 290.6 129.1 920.1 468.1 Manawatu 2898.2 1537.5 445.9 207.6 276.8 714.9 407.4 PorirualKapiti 3203.3 1554.8 348.5 335.1 147.4 871.2 482.5 Hutt Valley 2716.6 1493.3 337.5 194.0 278.4 700.2 371.2 Wellington 2140.0 1194.1 364.4 116.3 193.8 566.0 271.4 Wairarapa 2860.2 1550.4 213.8 187.1 401.0 775.2 561.3 Nelson/Marlborough 2572.2 1495.7 333.4 238.2 257.2 581.1 390.6 Central region 2825.8 1448.4 346.2 222.0 227.0 763.5 423.6 rare per 100,000 Source: NZHJS

Table 98: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 45-64 years, 1995-1996, males

Maori NonMaorl Cause n rate n rate Allcauses 2104 2863.8 19330 2361.7 Dis circulatory 513 698.2 4781 584.1 Injury, poisoning 243 330.7 2263 276.5 Other heart 227 309.0 903 110.3 Ischaemic heart 152 206.9 2594 316.9 Dis digestive 240 326.7 2647 323.4 Disrespiratoiy 189 257.2 1051 128.4 Symptoms, signs 183 249.1 2060 251.7 Cancer 144 196.0 1651 201.7 rate per 10,000 Source: NZHIS

Page 142 - The Public Health of the Central Region I Table 99: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 45-64 years, 1995-1996, females

Maori NonMaorl Cause n rate n rate All causes 2392 3147.8 18649 2274.9 Dis circulatory 434 571.1 2305 281.2 Other heart 158 207.9 498 60.7 Ischaemic heart 131 172.4 904 110.3 Dis respiratory 311 409.3 1222 149.1 Dis female genital 166 218.4 1607 196.0 Other heart dis 158 207.9 498 60.7 Dis genitourinary 301 396.1 2393 291.9 Dis digestive 238 313.2 2735 333.6 Symptoms, signs 238 313.2 2051 250.2 Injury, poisoning 194 255.3 1578 192.5 Cancer 135 177.7 2122 258.8 rate per 10,000 Source: NZHIS

Table 100: Leading causes of hospitalisation by subregion, rates, Maori, ages 45-64 years, 1995-1996, males

Cause Subregion all causes dis circulatory injury, poisoning dis digestive other heart dis respiratory Hawkes Bay 3516.0 796.5 446.5 416.0 405.9 309.5 Wanganui 4405.7 801.0 516.8 555.6 361.8 413.4 Manawatu 2411.3 727.0 292.6 141.8 257.1 230.5 Porirua/Kapiti 2367.3 503.4 258.5 231.3 163.3 163.3 Hutt Valley 2462.1 407.2 284.1 407.2 161.0 208.3 Wellington 2171.5 622.4 290.5 179.8 276.6 193.6 Wairarapa 3055.6 1194.4 - 472.2 472.2 361.1 Nelson/Marlborough 1616.7 733.3 150.0 150.0 400.0 150.0 Central region 2863.8 698.2 330.7 326.7 309.0 257.2 rate per 10,000 Source: NZHIS

Patterns of Health - Page 143 Table 101: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 45-64 years, 1995-1996, males

Cause Subregion all causes dis circulatory injury poisoning dis digestive other heart dis respiratory Hawkes Bay 2539.8 561.8 328.5 324.6 81.1 165.4 Wanganui 2803.2 521.3 368.8 409.6 97.5 140.1 Manawatu 2416.0 625.5 281.0 303.5 127.7 133.1 PorirualKapiti 2078.1 559.1 197.8 247.2 139.5 163.6 Hutt Valley 2296.9 661.8 257.7 356.6 103.9 108.8 Wellington 1897.0 484.4 255.4 205.9 114.5 115.2 Wairarapa 2823.5 635.3 337.3 389.5 143.8 146.4 Nelson/Marlborough 2561.8 632.3 249.8 436.5 100.7 86.0 Central region 2361.7 584.1 276.5 323.4 110.3 128.4 rate per 10,000 Source: NZHJS

Table 102: Leading causes of hospitalisation by subregion, rates, Maori, ages 45-64 years, 1995-1996, females

Cause Subregion all causes dis circulatory dis respiratory dis genitourinary dis digestive symptoms, signs Hawkes Bay 3477,5 632.3 311.5 469.5 423.1 371.9 Wanganui 4370.6 804.2 804.2 512.8 314.7 396.3 Manawatu 2747.5 519.8 387.8 437.3 189.8 272.3 Porirua/Kapiti 3092.5 481.6 570.3 228.1 278.8 354.9 Hutt Valley 2711.0 506.3 295.4 400.8 327.0 200.4 Wellington 2646.6 500.7 472.1 257.5 143.1 343.3 Wairarapa 3333,3 413.2 330.6 440.8 440.8 - Nelson/Marlborough 2228.0. 518.1 172.7 224.5 310.9 293.6 Central region 3147.8 571.1 409.3 396.1 313.2 313.2 rate per 10,000 Source: NZHIS Table 103: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 45-64 years, 1995-1996, females

Cause Subregion all causes dis circulatory dis respiratory dis genitourinary dis digestive symptoms, signs Hawkes Bay 2358.6 275.8 160.5 263.4 374.0 264.1 Wanganui 2844.1 340.6 233,4 373.4 487.6 271.4 Manawatu 2455.6 321.3 153.5 329.6 364.4 294.9 PorirualKapiti 2077.8 288.4 179.2 245.5 192.7 198.8 Hutt Valley 2227.1 292.1 134.2 256.9 387.0 275.7 Wellington 1766.4 200.9 127.5 202.3 180.9 213.0 Wairarapa 2867.7 368.3 215.7 397.3 402.5 271.0 Nelson/Marlborough 2301.6 264.2 89.8 380.8 380.8 221.4 Central region 2274.9 281.2 149.1 291.9 333.6 250.2 rate per 10,000 Source: NZHIS

Page 144- The Public Health of the Central Region I Table 104: Leading causes of unintentional and intentional injuries by ethnicity and sex, rates, ages 45-64 years, 1995-1996

Male Female Maori NonMaori Maori NonMaori Cause n rate n rate n rate n rate

3073 348Unintentional injury 4736.6 3754.5 292 3842.6 2228 2717.8

Med surg comps 111 1510.8 953 116 133 1750.2 842 1027.1

MVCs 52 707.8 285 348.2 31 407.9 164 200.1

Falls 46 626.1 562 686.6 35 460.6 488 595.3

Adverse effects drugs 33 449.2 177 216.3 31 407.9 241 294.0

Late effects 27 367.5 243 296.9 7 92.1 104 126.9

Cutting/piercing 18 245.0 182 222.4 111 44.8 68 82.9

Intentional injury 16 217.8 119 145.4 29 381.6 132 161.0

Homicide, inj 9 122.5 60 73.3 7 92.1 13 15.9

Suicide, self-inf 6 81.7 52 63.5 22 289.5 108 131.7 rate per 100,000 Source: NZHIS

Table 105: Leading causes of unintentional and intentional injuries by subregion, rates, ages 45-64 years, 1995-1996, males

Cause Subregion unintentional injury med surg comps falls MVC5 late effects intentional Injury Hawkes Bay 4673.0 1230.8 770.9 622.2 365.2 142.0 Wanganui 5550.4 1715.0 826.3 452.1 483.3 202.7 Manawatu 4065.2 1231.7 555.3 469.9 356.0 106.8 Porirua/Kapiti 2934.4 869.9 498.7 208.8 162.4 139.2 Hutt Valley 3132.3 1174.6 647.5 271.1 112.9 143.1 Wellington 3308.8 1136.1 810.6 312.3 146.2 172.7 Wairarapa 4229.4 1099.2 860,2 382.3 454.0 334.5 Nelson/Marlborough 3583.1 1178.8 593.3 257.6 507.4 117.1 Central region 3835.4 1192.9 681.6 377.8 302.7 151.4 rare per 100,000 Source: NZHIS

Patterns of Health - Page 145 Table 106: Leading causes of unintentional and intentional injuries by subregion, rates, ages 45-64 years, 1995-1996, females

Cause Subregion unintentional injury med surg comps falls adverse effects drugs MVCS intentional injury Hawkes Bay 3129.8 1207.9 600.6 327.0 246.9 126.8 Wanganui 3643.5 1490.5 542.0 481.8 316.2 180.7 Manawatu 3081.9 1322.8 450.2 387.8 200.8 284.0 Porirua/Kapiti 3088.3 1242.0 637.8 402.8 246.2 123.1 Hutt Valley 2300.7 865.6 584.7 197.4 189.8 159.5 Wellington 2367.9 868.4 603.8 142.5 264.6 190.0 Wairarapa 3122.0 1032.7 840.5 312.2 240.2 240.2 Nelson/Marlborough 2447.8 863.9 592.0 312.0 96.0 152.0 Central region 2813.2 1088.4 583.9 303.6 217.7 179.7 rate per 100,000 Source: NZHJS

Table 107: Leading sites of cancer registrations by ethnicity, numbers and rates, ages 45-64 years, 1990-1993, males

Maori NonMaori Site n rate n rate All sites 100 1809.6 1567 2126.9 Trachea, lung 36 651.5 260 352.9 Large bowel 11 199.1 328 445.2 Stomach 9 162.9 55 74.7 Lymphomas 5 90.5 74 100.4 Bladder 4 - 86 116.7 Prostate 2 - 117 158.8 Melanoma 1 - 152 206.3 "rate per 100,000 Source: NZHJS

Table 108: Leading sites of cancer registrations by ethnicity, numbers and rates, ages 45-64 years, 1990-1993, females

Maori NonMaori Site n rate n rate

All sites 146 2536.0 1923 2631.0

Breast 40 694.8 631 863.3

Trachea, lung 36 625.3 128 175.1

Cervix 12 208.4 63 86.2

Uterus 8 139.0 86 117.7

Large bowel 7 121.6 282 385.8

Ovary 3 98 134.1

Melanoma 193 264.1 rate per 100,000 Source: NZHJS

Page 146 - The Public Health of the Central Region 0 I Table 109: Leading sites of cancer registration by subregions, rates, ages 45-64 years, 1990-1993, males Site Subregion all sites large bowel trachea, lung melanoma prostate bladder Hawkes Bay 2265.4 462.3 369,9 200.3 161.8 200.3 Wanganui 2267.1 427.1 443.6 164.3 131.4 164.3 Manawatu 2254.4 466.4 388.7 225.4 209.9 116.6 Porirua/Kapiti 2319.2 439.1 494.0 164.7 164.7 109.8 Hutt Valley 1924.7 282.1 331.8 273.8 165.9 66.4 Wellington 1949.5 369.2 369.2 184.6 66.5 66.5 Wairarapa 2576.6 650.9 434.0 189.9 217.0 - Nelson/Marlborough 1730.8 495.8 271.3 102.9 131.0 93.6 Central region 2105.1 428.1 373.8 193.2 150.3 113.7 rate per 100,000 Source: NZHIS

Table 110: Leading sites of cancer registration by sub regions, rates, ages 45-64 years, 1990-1993, females

Site Subregion all sites breast large bowel melanoma trachea, lung ovary Hawkes Bay 2516.3 864.0 333.5 144.0 174.3 113.7 Wanganui 2679.6 774.8 484.3 290.6 274.4 129.1 Manawatu 2706.0 853.3 369.0 238.3 253.7 130.7 Porirua/Kapiti 2895.1 884.6 201.0 227.9 348.5 147.4 Hutt Valley 2674.4 843.7 438.7 354.3 185.6 109.7 Wellington 2403.7 876.2 302.4 302.4 139.6 108.6 Wairarapa 2967.1 828.7 588.1 267.3 213.8 240.6 Nelson/Marlborough 2524.5 838.3 371.5 171.5 162.0 133.4 Central region 2624.1 851.0 366.5 246.0 208.0 128.1 rate per 100,000 Source: NZHIS

Patterns of Health - Page 147 65-74 year olds

Mortality Diseases of the circulatory system accounted for 48 percent of the 4,709 male deaths and 43 percent of the 3,195 female deaths among 65-74 year olds in the Central region (tables 111, 112).

Male mortality rates were higher than female mortality rates and the difference between Maori and nonMaon rates varied. For males, Maori rates were higher than nonMaori for ischaemic heart disease, but lower for cerebrovascular disease. Cancer rates for males and females were highest for nonMaori.

The major causes of death in this age group were similar for males and females and across the region (tables 113, 114). For males, ischaemic heart disease rates were higher than those for cancer, whereas females had a converse experience.

Hospitalisations Generally, Maori rates exceeded nonMaori rates and male rates were higher than female rates (table 115, 116). The main exception was hospitalisations for cancer and ischaemic heart disease where the nonMaori rates exceeded Maori rates.

Among females, the Maori rates for other heart disease and diseases of the respiratory system were three times those for nonMaori.

Male cancer hospitalisation rates varied more than twofold across the region with the lowest rate in Wellington (543 per 10,000) and the highest rate in Wanganui (1,338 per 10,000). Similarly, the highest female cancer rates were in Wanganui (664 per 10,000) and the lowest in Wellington (356 per 10,000) (tables 117, 118).

Injuries Late effects of injury accounted for 42 percent of male Maori hospitalisations for unintentional injuries, but only 3 percent of nonMaori hospitalisations (table 119).

While there were no reported suicides and self-inflicted injuries for Maori in this age group, this category accounted for the majority of hospitalisations for intentional injury among nonMaori males and females.

Except for falls the male rates exceeded female rates in most regions for unintentional injuries (tables 120, 121).

Cancer For Maori males the most common site of cancer registrations was the lung compared to the large bowel and prostate for nonMaori (table 122). Lung cancer rates for Maori were twice the nonMaori rate for males and 2.5 times the nonMaori rate for females (table 123). In contrast, large bowel registrations for nonMaon were 1.5 times the Maori rate for males.

Manawatu had the highest registration rates for males and females in the Central region. The lowest male rates were in Nelson/Marlborough and the lowest female rates in Wellington (tables 124, 125).

Page 148— The Public Health of the Central Region I Table 111: Leading causes of death by ethnicity, numbers and rates, ages 65-74 years, 1990-1994, males

Maori NonMaori Cause n rate n rate All causes 148 17745.8 4561 17949.6 Dis circulatory 76 9112.7 2206 8681.6 lschaemic heart 54 6474.8 1515 5962.2 Cerebrovascular 9 1079.1 362 1424.6 Cancer 34 4076.7 1408 5541.1 Ca lung 18 2158.3 374 1471.9 Dis respiratory 9 1079.1 447 1759.1 CORD 6 719.4 349 1373.5 Endocnne,nutr,metabol 14 1678.7 95 373.9 "rate per 100,000 Source: NZHIS

Table 112: Leading causes of death by ethnicity, numbers and rates, ages 65-74 years, 1990-1994, females

Maori NonMaori Cause n rate n rate All causes 111 10914.5 3084 10229.9 Dis circulatory 54 5309.7 1315 4362.0 Ischaemic heart 31 3048.2 802 2660.3 Cerebrovascular 14 1376.6 300 995.1 Cancer 24 2359.9 1064 3529.4 Ca lung 11 1081.6 199 660.1 Dis respiratory 13 1278.3 286 948.7 CORD 10 983.3 219 726.4 rate per 100,000 Source: NZHIS

Table 113: Leading causes of death by subregion, rates, ages 65-74 years, 1990-1994, males Cause Subregion all causes dis circulatory ischaemic heart cerebrovascular cancer ca trachea, lung dis respiratory 9259.3Hawkes Bay 18947.6 6346.0 1400.2 5352.3 1422.8 1829.3 Wanganui 19734.4 10027.5 6913.9 1739.9 6135.5 1923.1 1923.1 Manawatu 18686.2 9121.2 6480.2 1575.7 5725.7 1664.4 1797.6 Porirua/Kapiti 18805.3 8591.4 5567.8 1917.4 5826.0 1659.3 2212.4 Hutt Valley 18264.8 8847.0 6107.3 1227.2 5879.0 1626.7 1912.1 Wellington 16089.0 7551.4 5381.8 1155.3 5240.9 1042.5 1408.8 Wairarapa 18257.6 8787.9 6212.1 1136.4 5681.8 1439.4 1515.2 Nelson/Marlborough 15760.7 7818.3 5137.8 1216.2 4666.2 1340.3 1365.1 Central region 17951.4 8699.3 5981.2 1414.3 5497.1 1494.4 1738.3 rate per 100,000 Source: NZH!S

Patterns of Health - Page 149 Table 114: Leading causes of death by subregion, rates, ages 65-74 years, 1990-1994, females Cause

Subregion all causes dis circulatory ischaemic heart cerebrovascular cancer dis respiratory Hawkes Bay 10443.1 4761.9 2702.7 1268.6 3456.5 809.0 Wanganui 11222.2 4703.7 3074.1 1037.0 3592.6 1222.2 Manawatu 11358.0 4881.3 2868.0 1158.6 3950.6 873.7 Porirua/Kapiti 9927.7 4209.9 2827.5 596.9 3518.7 942.5 Hutt Valley 10969.9 4637,5 2919.0 1106.4 3648.8 1365.3 Wellington 8833.9 3462.9 2049.5 753.8 3392.2 918.7 Wairarapa 11263.9 5042.6 3143.4 1047.8 3601.8 1113.3 Nelson/Marlborough 8723.4 3757.4 2263.2 922.9 2834.5 703.1 Central region 10254.2 4393.7 2673.5 1007.8 3491.9 959.6 - rate per 100,000 Source: NZHIS Table 115: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 65-74 years, 1995-1996, males

Maori NonMaori

Cause n rate n rate

All causes 760 6301.8 17128 6135.8

Dis circulatory 185 1534.0 4515 1617.4

Other heart 69 572,1 1019 365.0

Ischaernic heart 43 356.6 2003 717.5

Dis respiratory 109 903.8 1439 515.5

Dis digestive 73 605.3 2115 757.7

Symptoms, signs 62 514.1 1463 524.1

Injury, poisoning 64 530.7 1225 438.8

Cancer 58 480.9 2202 788.8 rate per 10,000 Source: NZHIS

Table 116: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 65-74 years, 1995-1996, females

Maori NonMaori Cause n rate n rate All causes 874 6238.4 14031 4512.7 Dis circulatory 190 1356.2 2982 959.1 Ischaemic heart 39 278.4 1211 389.5 Other heart 101 720.9 736 236.7 Dis respiratory 165 1177.7 1183 380.5 Dis digestive 85 606.7 1786 574.4 Symptoms, signs 71 506.8 1159 372.8 Dis nervous 70 499.6 1016 326.8 Cancer 60 428.3 1562 502.4 Injury, poisoning 59 421.1 1231 395.9 rate per 10,000 Source: NZHIS

Page 150- The Public Health of the Central Region I Table 117: Leading causes of hospitalisation by subregion, rates, ages 65-74 years, 1995-1996, males Cause

Subregion all causes dis circulatory cancer dis digestive dis respiratory ischaemic heart Hawkes Bay 6620.0 1689.0 710.5 765.3 562.3 734.9 Wanganui 6777.5 1293.1 1338.3 981.1 591.1 504.9 Manawatu 6632.8 1704.5 878.1 752.7 679.0 772.6 Porirua/Kapiti 5169.0 1538.0 604.7 502.3 511.6 623.3 Hutt Valley 6388.2 1744.2 680.3 906.2 617.3 743.4 Wellington 5432.4 1554.0 542.5 555.6 456.0 626.3 Wairarapa 6297.8 1804.2 838.4 845.1 570.1 643.9 Nelson/Marlborough 5761.7 1534.8 811.7 793.5 288.8 804.9 Central region 6142.6 1614.0 776.1 751.3 531.6 702.6 rare per 10,000 Source: NZJIJS

Table 118: Leading causes of hospitalisation by subregion, ages 65-74 years, 1995-1996, females Cause Subregion all causes dis circulatory dis digestive cancer dis respiratory injury, poisoning Hawkes Bay 4288.8 1027.0 599.4 433.0 465.2 517.1 Wanganui 4474.8 853.4 652.8 663.7 543.4 488.7 Manawatu 4707.9 1063.2 656.0 632.0 480.9 387.0 Porirua/Kapiti 3701.2 893.5 373.4 395.6 370.7 348.5 Hutt Valley 4389.1 985.2 621.2 430.0 450.5 398.2 Wellington 3780.7 812.9 394.4 355.9 327.1 377.6 Wairarapa 5077.9 1217.0 713.4 641.5 515.6 419.7 Nelson/Marlborough 4421.3 1000.2 632.8 547.1 253.1 263.3 Central region 4318.2 976.2 575.8 499.2 414.9 397.0 rare per 10,000 Source: NZHIS

Table 119: Leading causes of unintentional and intentional injuries by ethnicity and sex, numbers and rates, ages 65-74 years, 1995-1996

Male Female Maori NonMaori Maori NonMaori n rate n rate n rate n rate Unintentional injury 142 11774.5 2186 7830.9 101 7209.1 2055 6609.4 Late effects 60 4975.1 74 265.1 6 428.3 65 209.1 Med surg comps 33 2736.3 1162 4162.6 48 3426.1 775 2492.6 Falls 26 2155.9 411 1472.3 20 1427.6 729 2344.7 Adverse effects drugs 9 746.3 190 680.6 12 856.5 227 730.1 MVCs 4 - 90 322.4 6 428.3 77 247.7 Cutting/piercing 3 - 45 161.2 1 - 27 86. Intentional injury 1 - 35 125.4 0 - 22 70.8 rate per 100 000 Source: NZHIS

Patterns of Health - Page 151

Table 120: Leading causes of unintentional and intentional injuries by subregion, rates, ages 65-74 years, 1995-1996, males

Cause unintentional med surg falls adverse late intentional Subregion injury comps effects drugs effects injury Hawkes Bay 10008.1 4019.5 1806.7 832.3 1806.7 182.7 Wanganui 80460 3858.8 1724.1 903.1 246.3 - Manawatu 8821.2 4759.1 1632.8 836.3 278.8 119.5 Porirua/Kapiti 7255.8 3876.0 1395.3 713.2 - 217.1 Hutt Valley 6908.3 3913.8 1418.4 315.2 - 131.3 Wellington 8307.1 5005.2 1493.7 655.1 131.0 - Wairarapa 6774.0 3890.0 1609.7 536.6 - - Nelson/Marlborough 6389.3 3206.0 1000.5 591.2 318,3 - Central region 7994.2 4103.6 1500.6 683.4 460.1 123.6 rate per 100,000 Source: NZH!S

Table 121: Leading causes of unintentional and intentional injuries by subregion, rates, ages 65-74 years, 1995-1996, females

Cause unintentional med surg falls adverse late Intentional Subregion injury comps effects drugs effects Injury Hawkes Bay 7586.3 2683.8 2809.1 697.8 375.7 - Wanganui 8315.1 3355.2 2917.6 729.4 364.7 - Manawatu 7628.5 3206.2 2340.2 995.0 165.8 Porirua/Kapiti 5781.5 1770.4 2019.4 774.6 387.3 - Hutt Valley 6097.8 2366.3 2593.9 523.3 204.8 113.8 Wellington 6180.9 2356.9 2212.6 673.4 264.6 - Wairarapa 6954.4 2817.7 2697.8 599.5 359.7 - Nelson/Marlborough 4899.0 1918.8 1245.2 755.3 - - Central region 6635.3 2532.9 2305.1 735.5 255.4 67.7 rate per 100,000 Source: NZHIS

Table 122: Leading sites of cancer registration by ethnicity, numbers and rates, ages 65-74 years, 1990-1993, males

Maori NonMaori Sites n rate n rate

All sites 66 7913.7 1843 7253.0

Trachea, lung 21 2518.0 309 1216.1

Prostate 9 1079.1 367 1444.3

Large bowel 7 839.3 315 1239.7

Bladder 5 599.5 95 373.9

Melanoma 123 484.1

Stomach 3 67 263.7 rate per 100,000 Source: NZHIS

Page 152 - The Public Health of the Central Region I

Table 123: Leading sites of cancer registration by ethnicity, numbers and rates, ages 65-74 years, 1990-1993, females

Maori NonMaori Site n rate n rate All Sites 56 5506.4 1504 4988.9 Trachea, lung 15 1474.9 179 593.8 Breast 14 1376.6 343 1137.8 Large bowel 4 - 316 1048.2 Uterus 2 - 65 215.6 Ovary 2 - 57 189.1 Melanoma 0 - 97 321.8 rate per 100,000 Source: NZH!S

Table 124: Leading sites of cancer registration by subregion, rates, ages 65-74 years, 1990-1993, males

Site Subregion all sites trachea, lung large bowel prostate melanoma bladder Hawkes Bay 7362.2 1355.0 1242.1 1287.3 316.2 587.2 Wanganui 7554.9 1236.3 1648.4 961.5 412.1 457.9 Manawatu 8588.5 1597.9 1176.2 2041.7 754.5 510.4 Porirua/Kapiti 6895.3 1179.9 1143.1 1806.8 553.1 368.7 Hutt Valley 6877.9 1512.6 884.7 1170.1 570.8 171.2 Wellington 6593.4 789.0 1098.9 1098.9 450.8 169.1 Wairarapa 8181.8 1287.9 1969.7 1666.7 454.5 - Nelson/Marlborough 6478.0 1017.6 1265.8 1365.1 248.2 372.3 Central region 7277.4 1258.0 1227.5 1433.4 472.7 381.2 rate per 100.000 Source: NZHIS

Table 125: Leading sites of cancer registration by subregion, rates, ages 65-74 years, 1990-1993, females

Site Subregion all sites breast large bowel trachea, lung melanoma uterus Hawkes Bay 4743.5 1029.6 919.3 772.2 312.6 202.2 Wanganui 5629,6 1333.3 1000.0 851.9 333.3 259.3 Manawatu 6096.9 1405.5 1443.5 683.8 436.8 227.9 Porirua/Kapiti 5278.0 1162.4 596.9 596.9 345.6 345.6 Hutt Valley 4566.9 988.7 1341.8 423,7 329.6 117.7 Wellington 4311.0 918.7 848.1 541.8 212.0 164.9 Wairarapa 5239.0 1113.3 1178.8 720.4 392.9 - Nelson/Marlborough 4482.5 1230.5 813.0 483.4 175.8 307.6 Central region 5006.7 1145.8 1027.0 622.6 311.3 215.0 rate per 100,000 Source: NZHIS

Patterns of Health - Page 153 75 years and older

Mortality The most common cause of death for males and females aged 75 years and over in the Central region was ischaemic heart disease followed by cerebrovascular disease for females and cancer for males (tables 126, 127). NonMaori rates exceeded Maori rates for all causes.

With the exception of cerebrovascular disease, male rates generally exceeded female rates.

Chronic obstructive respiratory disease was a major cause of death for males throughout the region, whereas for women pneumonia was more common for females (tables 128, 129).

Hospitalisations The major cause of hospitalisation for Maori males in the Central region during 1995 and 1996 was diseases of the circulatory system, specifically other heart disease (table 130). For nonMaori males ischaemic heart disease rates were the highest among diseases of the circulatory system.

Diseases of the respiratory system were also a major cause ofhospitalisation for males and females (table 131).

The highest hospitalisation rates for persons aged 75 years and older were found in Wairarapa, with the lowest male rates in Porirua/Kapiti and female rates in Nelson/Marlborough (tables 132, 133).

Injuries Falls accounted for 54 percent of the 6,948 hospitalisations for unintentional injuries among persons aged 75 years and older (table 134).

Female rates exceeded male rates for all causes except medical and surgical complications and motor vehicle crashes. NonMaori rates exceeded Maori rates.

Hospitalisation rates for falls were lowest in Nelson/Marlborough and highest in Hawkes Bay for males and the Huff for females (tables 135, 136).

Cancer From 1990 to 1993, 58 percent of male registrations were for cancers of the prostate, large bowel and lung (table 137). For females large bowel cancer and breast cancer were the most common sites followed by lung cancer (together accounting for 47% of registrations) (table 138).

For males in the Central region large bowel cancer and lung cancer alternated as the second most common sites of cancer registration with rates varying among the regions (table 139). For females, the large bowel and breast were the most common sites of cancer registration (table 140).

Page 154 - The Public Health of the Central Region I Table 126: Leading causes of death by ethnicity, numbers and rates, ages 75 years and older, 1990-1994, males

Maori NonMaori

Cause n rate n rate

All causes 73 29674.8 7630 53975.7

Dis circulatory 33 13414.6 3735 26421.9

Ischaemic heart 20 8130.1 2127 15046.7

Cerebrovascular 7 2845.5 841 5949.3

Cancer 17 6910.6 11683 11905.8

Dis respiratory 9 3658.5 1188 8404.1

CORD 6 2439.0 642 4541.6

Pneumoma, influenza 472 3339.0 rate per 100,000 Source: NZIIIS

Table 127: Leading causes of death by ethnicity, numbers and rates, ages 75 years and older, 1990-1994, females

Maori NonMaori

Cause n rate n rate

All causes 82 22043.0 9782 39803.1

Dis circulatory 46 12365.6 5364 21826.2

Ischaemic heart 25 6720.4 2552 10384.1

Cerebrovascular 16 4301.1 1721 7002.8

Other heart 3 - 632 2571.6

Cancer 16 4301.1 1523 6197.1

Respiratory 8 2150.5 1293 5261.2 Pneumonia, influenza - 771 3137.2

CORD 6 1612.9 416 1692.7 rate per 100000 Source: NZHIS

Patterns of Health - Page 155 Table 128: Leading causes of death by subregion, rates, ages 75 years and older, 1990-1994, males

Cause dis ischaemic dis Subregion all causes circulatory heart cerebrovascular cancer respiratory CORD Hawkes Bay 53873.2 27190.9 16118.9 5594.7 12519.6 7120.5 4147.1 Wanganui 53998.4 25811.6 13697.5 6650.8 12193.2 8155.2 4275.5 Manawatu 56308.4 27453.3 15576.3 5724.3 11954.8 9151.1 4400,3 Porirua/Kapiti 53663.8 24569.0 13074.7 5387.9 13002.9 8764.4 5172.4 Hutt Valley 52202.3 23762.9 14083.7 5709.6 11201.7 9298.5 4730.8 Wellington 51570.4 26139.8 14336.4 6788.2 11803.4 8206.7 4812.6 Wairarapa 59144.5 29056.0 15634.2 7227.1 12094.4 8554.6 4719.8 Nelson/Marlborough 50902.2 26115.9 15764.5 5270.7 10303.9 7787.3 4226.0 Central region 53582.4 26210.4 14934.6 5898.7 11825.3 8326.4 4507.5 rate per 100,000 Source: NZHIS

Table 129: Leading causes of death by subregion, rates, ages 75 years and older, 1990-1994, females Cause dis ischaemic dis pneumonia. Subregion all causes circulatory heart cerebrovascular cancer respiratory influ Hawkes Bay 40451.0 23161.9 11158.1 7399.6 5778.7 4486.7 2325.6 Wanganui 40485.8 23751.7 11291.0 6657.7 5578.0 4228.5 2339.2. Manawatu 39576.3 21771.5 10367.4 6851.5 6107.7 5318.9 3380.7 Porirua/Kapiti 38139.7 20026.7 8322.2 6764.6 6675.6 5340.5 3026.3 Hutt Valley 40305.4 20945.0 10976.7 5992.5 7087.3 6136.6 3716.5 Wellington 38759.7 20716.4 9195.4 7645.0 6308.5 6308.5 3742.3 Wairarapa 43733.3 24000.0 10933.3 7555.6 5955.6 5600.0 3200.0 Nelson/Marlborough 37463.6 20593,4 10354.9 6951.7 5788.2 4304.8 2879.6 Central region 39552.5 21692.9 10333.2 6965.0 6171.1 5216.7 3099.6 rate per 100,000 Source: NZH!S

Page 156- The Public Health of the Central Region 0- I

Table 130: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 75 years and older, 1995-1996, males

Maori NonMaorl Cause n rate ii rate All causes 280 8805.0 16004 10001.2 Dis circulatory 80 2515.7 4072 2544.7 Other heart 39 1226.4 1250 781.2 Cerebrovascular 17 534.6 855 534.3 Ischaexnic heart 11 345.9 1302 813.6 Dis respiratory 60 1886.8 1737 1085.5 Dis digestive 22 691.8 1742 1088.6 Dis nervous 20 628.9 1061 663.0 Cancer 19 597.5 1931 1206.7 Injury, poisoning 18 566.0 1201 750.5 Pneumonia, influ 28 880.5 626 391.2 rate per 100,000 Source: NZHJS

Table 131: Leading causes of hospitalisation by ethnicity, numbers and rates, ages 75 years and older, 1995-1996, females

Maori NonMaori

Cause n rate n rate

All causes 491 8480.1 20400 7443.1

Dis circulatory 112 1934.4 5056 1844.7

Other heart 48 829.0 1690 616.6

Cerebrovascular 29 500.9 1149 419.2

Ischaexmc heart 19 328.2 1410 514.4

Dis respiratory 106 1830.7 1666 607.9

Dis digestive 50 863.6 2057 750.5

Symptoms, signs 45 777.2 1474 537.8

Injury, poisoning 38 656.3 2923 1066.5

Fractures 18 310.9 1724 629.0

CORD 32 552.7 410 149.6

Dis nervous 26 449.1 1707 622.8 rate per 100,000 Source: NZHJS

Patterns of Health - Page 157 Table 132: Leading causes of hospitalisation by subregion, rates, ages 75 years and older, 1995-1996, males

Cause Subregion all causes dis circulatory cancer dis respiratory dis digestive ischaemic heart Hawkes Bay 11112.3 2634.6 1379.7 1183.6 1226.4 787.9 Wanganui 11367.9 2455.0 1540.7 1511.9 1519.1 683.9 Manawatu 10932.3 2753.8 1241.9 1313.9 1180.7 806.3 Porirua/Kapiti 8390.4 2363.0 1044.5 936.1 667.8 753.4 Hutt Valley 9436.3 2470.6 1024.5 1004.9 1078.4 838.2 Wellington 9074.3 2470.0 834.5 1026.4 714.6 604.3 Wairarapa 12030.0 3114.2 1626,3 1591.7 1176.5 692.0 Nelson/Marlborough 8529.2 2319.5 1140.6 649.0 125.2 848.7 Central region 9977.9 2544.1 1194.9 1101.1 1080.9 765.9 rate per 10,000 Source: NZHIS

Table 133: Leading causes of hospitalisation by subregion, ages 75 years and older, rates, 1995-1996, females

Cause Subregion all causes dis circulatory Injury, poisoning dis digestive dis respiratory fractures Hawkes Bay 7478.9 1902.1 1089,9 808.1 705.3 627.2 Wanganui 7412.9 1666.7 1019.9 974.3 808.5 580,4 Manawatu 7931.9 2165.5 1001.6 819.1 821.2 545,4 Porirua/Kapiti 7255.1 1658.0 1128.4 633.4 571.1 657.7 Hutt Valley 7286,4 1813.5 1131,8 846,1 582,1 719.5 Wellington 6986.0 1728.7 1245,7 530.5 570,1 741,6 Wairarapa 8160.7 2530.0 1021.0 961.0 548.0 630,6 Nelson/Marlborough 6230.6 1549.6 830.3 613.5 391.7 507.5 Central region 7289.1 1846.6 1058.0 752.8 633.2 622.4 rate per 10,000 Source: NZHIS

Page 158 - The Public Health of the Central Region 0 I Table 134: Leading causes of unintentional and intentional injuries by ethnicity and sex, numbers and rates, ages 75 years and older, 1995-1996

Male Female Maori NonMaori Maori NonMaori Cause n rate n rate n rate n rate Unintentional injury 33 10377.4 2252 14073.2 68 11744.4 4595 16765.2 Falls 15 4717.0 873 5455.6 36 6217.6 2805 10234.2 Medsurgcomps 10 3144.7 854 5274.3 15 2590.7 843 3075.7 Adverse effects drugs 3 - 226 1412.3 8 1381.7 396 1444.8 MVCs 1 - 85 531.2 2 - 119 434.2 Intentional injury - - 14 87.5 - - 27 98.5 Suicide, self-inf - 8 50.0 - - 15 54.7 rate per 100,000 Source: NZJIIS

Table 135: Leading causes of unintentional and intentional injuries by subregion, rates, ages 75 years and older, 1995-1996, males

Cause Subregion unintentional injury falls med surg comps adverse effects drugs MVCs intentional injury 606.1Hawkes Bay 16292.3 7486.6 5026.7 1639.9 178.3 Wanganui 15334.8 4967.6 7055.4 1079.9 432.0 - Manawatu 17746.6 5507.6 7343.4 1835.9 576.0 - Porirua/Kapiti 12328.8 4737.4 5137.0 1369.9 342.5 - Hutt Valley 12647.1 6225.5 3872.5 637.3 1078.4 - Wellington 14244.6 6043.2 5419.7 1486.8 431.7 - Wairarapa 10265.3 4729.0 3344.9 692.0 692.0 - Nelson/Marlborough 10061.4 3033.8 3840.2 1651.

Central region 14001.2 5441.2 5232.8 1403.2 527.0 85.8 rate per 100,000 Source: NZHIS

Patterns of Health - Page 159

Table 136: Leading causes of unintentional and intentional injuries by subregion, rates, ages 75 years and older, 1995-1996, females

Cause Subregion unintentional injury falls med surg comps adverse effects drugs MVCs Intentional Injury Hawkes Bay 17170.5 10713,6 2940.6 1624.5 534.6 143.9 Wanganui 18242.1 10572.1 3441.1 1824.2 373.1 - Manawatu 17498.0 9448.5 4136.3 1764.0 263.6 - Porirua/Kapiti 17168.6 9449.6 3703.7 1626.9 657.7 - Hutt Valley 17219.1 11937.5 2425.2 1050.9 269.5 - Wellington 18237.0 11480.6 3035.1 1398.8 686.2 84.7 Wairarapa 16591.6 10810.8 1876.9 1126.1 750.8 - Nelson/Marlborough 11776.3 7489.5 2241.9 985.5 197.1 - Central region 16661.3 10151.1 3065.7 1443.5 432.3 96.5 rate per 100,000 Source: NZHIS

Table 137: Leading sites of cancer registration by ethnicity, ages 75 years and older, numbers and rates, 1990-1993, males

Maori NonMaorl

Site n rate n rate

All sites 29 11788.6 1971 13943,1

Prostate 9 3658.5 525

Large bowel 5 2032.5 323 2284.9

Trachea, lung 4 291 2058.6

Stomach 2 79 558.9

Bladder 1 136 962.1

Melanoma 90 636.7 rate per 100,000 Source: NZHJS

Table 138: Leading sites of cancer registration by ethnicity, ages 75 years and older, numbers and rates, 1990-1993, females

Maori NonMaori

Site n rate n rate

All sites 22 5914.0 1754 7137.0

Large bowel 5 1344.1 426 1733.4

Trachea, lung 4 115 467.9

Breast 3 286 163.7

Leukaemia 69 280,8

Stomach 60 244.1 a

Melanoma 97 394,7 rate per 100,000 Source: NZHJS ci El El

Page 160- The Public Health of the Central Region U Table 139: Leading sites of cancer registration by subregion, rates, ages 75 years and older, 1990-1993, males

Site

Subregion all sites prostate large bowel trachea, lung bladder melanoma Hawkes Bay 15336.5 4303.6 2543.0 2543.0 978.1 508.6 Wanganui 12826.6 3087.9 1583.5 2296.1 712.6 791.8 Manawatu 15264.8 4517.1 2648.0 2180.7 1207.2 545.2 PorirualKapiti 14152.3 3592.0 1796.0 1867.8 502.9 1149.4 Hutt Valley 12071.8 2555.7 1576.9 2175.1 978.8 598.2 Wellington 13779.1 3596.8 2279.6 1722.4 1165.1 506.6 Wafrarapa 15486.7 4424.8 3244.8 1917.4 147.5 1032.4 Nelson/Marlborough 12250.7 3371.3 2564.1 1519.5 1092.1 474.8 Central region 13912.1 3714.5 2281.6 2052.0 953.0 633.0 rate per 100,000 Source: NZHIS

Table 140: Leading sites of cancer registration by subregion, rates, ages 75 years and older, 1990-1993, females

Site

Subregion all sites large bowel breast trachea, lung melanoma leukaemia

399.3Hawkes Bay 6788.8 1620.9 1198.0 352.4 164.4

Wanganui 7512.4 1394.5 764.7 674.8 584.8 269.9

Manawatu 7685.4 1960.8 1239.6 383.1 540.9 338.1

Porirua/Kapiti 7343.1 1958.2 934.6 578.5 712.1

Hutt Valley 7000,9 1671.0 921.9 691.4 288.1 374.5

Wellington 7056.9 1603.8 1122.7 374.2 267.3 294.0 Wairarapa 7555.6 2044.4 1777.8 533.3 Nelson/Marlborough 6457.2 1716.1 1483.4 436.3 145.4 261.8 Central region 7121.4 1728.2 1158.8 477.2 388.9 284.7 rate per 100,000 Source: NZHIS

Patterns of Health - Page 161 I

Special Health Issues

This section presents data from a variety of sources on specific health issues.

Special Health Issues - Page 163 The National Cervical Screening Programme (NCSP) was launched nationally in 1990 and is delivered by a range of providers including general practitioners, nurse and lay smeartakers, health educators and laboratories. The National Cervical Screening Register (NCSR) is the key management tool of the NCSP, and records and provides both information to assist individual women and their smeartakers with personal health management, and information for monitoring population coverage, quality assurance and evaluation. The NCSR forms a communication link between a woman, her general practitioner or other smeartaker, and the laboratory and treatment services, and enables tracking of women moving from one part of the country to another (Ministry of Health, 1996). The NCSR is currently implemented as a central register accessed remotely from 14 regional locations.

Up to May 1998, 88.1 percent of eligible women in the Central region were enrolled on the NCSR (table 141). The highest enrolment rates are in Wellington (89.5%) and Nelson/Marlborough (89.1%), and the lowest rate is in Hawkes Bay (8 1.5 %).

With the exception of Hawkes Bay, at least 75 percent of women in the Central region have had at least one smear result on the NCSR in the previous three years (table 141).

Reference Ministry of Health 1996. National Cervical Screening Programme, Policy. Wellington: Ministry of Health.

Page 164- The Public Health of the Central Region

Table 141: Enrolments on the National Cervical Screening Register

Enrolments Eligible Women Coverage

Area of cervical to December for year to May n 3 year 5 year screening programme 1996 1997 1998 n n % Hawkes Bay 28,919 1,681 31,365 38,466 81.5 27,257 70.9 30,586 79,5 Manawatu/Wanganui 51,746 1,767 53,977 60,687 88.9 45,738 75,4 52,183 86.0 Wellington 95,033 7,240 105,266 117,668 89.5 90,393 76.8 103,535 88.0 Nelson/Marlborough 27,244 491 28,318 31,789 89.1 24,005 75.5 27,345 86.0 Central Region 202,942 11,179 218,926 248,610 88.1 187,393 75.4 213,649 85.9 New Zealand 797,363 62,058 920,528 1,005,231 87.9 732,673 72.9 854,584 85.0 Source: National Cervical Screening Register 1998

Notes. enrolments do not include women who have requested their smears not go to the register, or requested to be removed from the register, have gone overseas, died, or for whom the register has been notified that they have had a total hysterectomy and do not needfurther screening. eligible women are the number of women who were aged 20-69 years inclusive of 5 March 1996, less an adjustment for the proportion of women in each age group who have had a hysterectomy. coverage is the number and pecentage of women aged 20-69 who are currently enrolled, and have at least one smear result on the register in the previous 3 and 5 years respectively, taken as at 21 May 1998.

(b

-u

(V

U The Kenepuru Science Centre, Institute of Environmental Science and Research (ESR), operates a surveillance system of sexually transmitted diseases using data collected by STD clinics. However, these data will underestimate the incidence of disease in the population because many people seek medical treatment for STDs from general practitioners, family planning clinics, and student health clinics (ESR, 1998).

Tables 142-147 show the numbers and rates of syphilis, gonorrhoea, chiamydia, trichomoniasis, herpes-i I attack, and warts- I attack diagnosed among new clinic patients in the Central region.

Reference ESR 1998. STD Surveillance Data New Zealand Sexual Health Clinics, Annual Report January-December 1997. Wellington: ESR

Table 142: Syphilis by area/clinic, numbers and rates, 1996-1997

Syphilis

1996 1997

new clinic patients cases new clinic patients cases

Area/clinic n n rate n n rate

Napier 557 0 - 530 2 3.8

Hastings 325 0 - 288 0

Wanganui 274 0 - 359 0

Palmerston North/Levin 2074 0 - 1949 0.5

Wellington 3792 9 2.4 3426 4 1.2

Hutt 353 1 2.8 397 0

Porirua 318 1 3.1 404 0

Nelson 396 0 - 387 0

Blenheim 195 0 - 194 0

Central region 8284 11 1.3 7934 7 0.9

New Zealand 31489 23 0.7 32105 27 0.8 new clinic patients are patients who have not visited a clinic in the past three months rate per 1000 new clinic patients Source: ESR 1998

Page 166— The Public Health of the Central Region I

Table 143: Gonorrhoea by area/clinic, numbers and rates, 1996-1997

Gonorrhoea

1996 1997 new clinic patients cases new clinic patients cases Area/clinic n n rate n n rate Napier 557 3 5.4 530 12 22.6 Hastings 325 7 21.5 288 10 34.7 Wanganui 274 1 3.6 359 4 11.1 PalmerstonNorth/Levin 2074 1 0.5 1949 2 1.0 Wellington 3792 18 - 4.7 3426 17 5.0 Hutt 353 1 2.8 397 1 2.5 Porirua 318 1 3.1 404 4 9.9 Nelson 396 1 2.5 387 2 5.2 Blenheim 195 0 - 194 0 - Central region 8284 33 4.0 7934 52 6.6 New Zealand 31489 274 8.7 32105 292 9.1 "new clinic patients are patients who have not visited a clinic in the past three months rate per 100 new clinic patients Source: ESR 1998

Table 144: Chlamydia by area/clinic, numbers and rates, 1996-1997

Chiamydia 1996 1997

new clinic patients cases new clinic patients cases

Area/clinic n n rate n n rate

530Napier 557 49 88.0 43 81.1

Hastings 325 33 101.5 288 40 138.9

Wanganui 274 31 113.1 359 31 86.4

PalmerstonNorth/Levin 2074 127 61.2 1949 173 88.8

Wellington 3792 144 38.0 3426 177 51.7

Hutt 353 15 42.5 397 20 50.4

Porinia 318 16 50.3 404 32 79.2

Nelson 396 12 30.3 387 31 80.1

Blenheim 195 5 25.6 194 2 10.3

Central region 8284 432 52.1 7934 549 69.2

New Zealand 31489 1665 52.9 32105 1994 62.1 new clinic patients are patients who have not visited a clinic in the past three months rate per 100 new clinic patients Source: ESR 1998

Special Health Issues - Page 167

Table 145: Trichomoniasis by area/clinic, numbers and rates, 1996-1997

Trichomon iasis

1996 1997 new clinic patients cases new clinic patients cases Area/clinic n n rate n n rate Napier 557 0 - 530 1 1.9 Hastings 325 2 6.2 288 0 - Wanganui 274 0 - 359 2 5.6 Palmerston North/Levin 2074 9 4.3 1949 2 1.0 Wellington 3792 4 1.1 3426 3 0.9 Hutt 353 1 2.8 397 4 10.1 Poruua 318 0 - 404 1 2.5 Nelson 396 0 - 387 0 - Blenheim 195 0 - 194 0 - Central region 8284 16 1.9 7934 13 1.6 New Zealand 31489 121 3.8 32105 129 4.0 new clinic patients are patients who have not visited a clinic in the past three months rate per 100 new clinic patients Source: ESR 1998

Table 146: Herpes - 1st attack by area/clinic, numbers and rates, 1996-1997

Herpes - 1st attack 1996 1997 new clinic patients cases new clinic patients cases Area/clinic n n rate n n rate Napier 557 29 52.1 530 29 54.7 Hastings 325 10 30.8 288 16 55.6 0 Wanganui 274 3 10.9 359 13 36.2 Palmerston North/Levin 2074 69 33.3 1949 45 23.1 Wellington 3792 123 32.4 3426 85 24.8 Hun 353 14 39.7 397 18 45.3 Porirua 318 8 25.2 404 13 32.2 Nelson 396 11 27.8 387 3 7.8 Blenheim 195 8 41.0 194 3 15.5 Central region 8284 275 33.2 7934 225 28.4 New Zealand 31489 802 25.5 32105 725 22.6 new clinic patients are patients who have not visited a clinic in the past three months rate per 100 new clinic patients II Source: ESR 1998

11 II 11

Page 168- The Public Health of the Central Region Li Table 147: Warts - 1st attack by area/clinic, numbers and rates, 1996-1997

Warts - 1st attack 1996 1997

new clinic patients cases new clinic patients cases

Area/clinic n n rate n n rate

530Napier 557 97 174.1 78 147.2

Hastings 325 38 116.9 288 48 166.7

Wanganui 274 46 167.9 359 47 130.9

Palmerston North/Levin 2074 185 89.2 1949 177 90.8

Wellington 3792 375 98.9 3426 332 96.9

Hutt 353 70 198.3 397 80 201.5

Porirua 318 43 135.2 404 40 99.0

Nelson 396 53 133.8 387 84 217.1

Blenheim 195 29 148.7 194 36 185.6

Central region 8284 936 113.0 7934 922 116.2

New Zealand 31489 3660 116.2 32105 3711 115.6 new clinic patients are patients who have not visited a clinic in the past three months rate per 100 new clinic patients Source: ESR 1998

Special Health Issues - Page 169 MOTOR VEHICLE CRASHES Previous sections have shown that motor vehicle crashes (MVCs) are major contributors to the mortality and morbidity from unintentional injuries in the Central region.

The Land Transport Safety Authority (LTSA) collects data on various aspects of MVCs which complements the data from the national health statistical collections. Data for 1995-1996 combined show that the highest rates of MVCs in the Central region occur in Rangitikei District (55.2 per 10,000 population), Tararua District (45.3/10,000), Ruapehu District (43.0/10,000) and Central Hawkes Bay District (42.0/10,000) (table 148). The accident rates in the Wairarapa (27.2/10,000), Wellington (29.1/10,000), and Nelson/Marlborough (29.3/10,000) subregions are below the national average (31.0/10,000).

The casualty rate in the Rangitikei District (93.3/10,000) was more than twice as high as the overall New Zealand rate (44.5/10,000). There were also high rates in the Tararua District (74.6/10,000), Central Hawkes Bay District (63.5/10,000) and Wairoa District (60.7/10,000).

The fatality rates in the districts of Central Hawkes Bay District and Rangitikei were respectively, 5.9 and 5.2 per 100,000 population compared to the New Zealand rate of 1.5 per 100,000. Since 1993, the accident and causality rates in the districts of Wairoa, Central Hawkes Bay and South Wairarapa have increased by at least 33 percent, but declined by about 18 percent in the Nelson/Marlborough subregion, 17 percent in Napier City, and approximately 10 percent in the Wellington subregion.

The Wellington subregion (42.9/100,000), especially Wellington City (57.8/100,000 population), Nelson City (35.7/100,000) and Palmerston North City (32.2/100,000) had the highest rates of pedestrian accidents in the Central region (table 149).

In Palmerston North City, the rate of accidents involving motorcyclists was 64.6/100,000 compared to the national rate of 37.5/100,000. There were also above average rates in the Hastings District (46.9/100,000), Napier City (44.3/100,000), Wanganui District (46.1/100,000), Manawatu District (42.6/100,000), and Nelson City (53.0/100,000). There is a similar pattern in the rates of pedal cyclist accidents with the rate in Nelson City (54.2/100,000) more than double the New Zealand average (21.3/100,000).

includes all constituent areas of Ruapehu District

Page 170— The Public Health of the Central Region I Table 148: Accidents and casualties by area, numbers and rates, 1995-1996

Accidents Injuries Fatalities Accidents Casualties Area Injury Fatal rate rate Wairoa District 69 7 115 7 37.8 60.7 Hastings District 453 19 679 27 35.7 53.4 Napier City 272 7 379 7 26.3 36.4 Central Hawkes Bay District 94 13 147 15 42.0 63.5 Chatham Island District 4 0 6 0 26.7 40.0 Hawkes Bay subregion 892 46 1326 56 319 48.4 RuapehuDistrict 136 12 211 12 43.0 64.8 Wanganui District 203 18 291 20 24.2 34.1 Rangitikei District 166 14 287 17 55.2 93.3 Wanganui subregion 505 44 789 49 34.7 53.0 Manawatu District 199 13 298 15 37.6 55.5 Palmerston North City 471 8 672 8 32.2 45.7 Tararua District 161 14 274 14 45.3 74.6 Horowhenua District 197 20 320 22 36.0 56.8 Manawatu subregion 1028 55 1564 59 35.6 53.4 Masterton District 115 6 189 6 26.1 42.1 Carterton District 38 3 69 3 29.3 51.4 South Wairarapa District 48 4 73 4 28.4 42.1 Wairarapa subregion 201 13 331 13 27.2 43.8 Kapiti Coast District 222 10 345 10 30.0 45.9 Porirua City 234 8 347 8 25.5 37.4 Upper Hurt City 175 1 238 1 23.8 32.4 Hutt City 580 7 783 10 30.7 41.5 Wellington City 928 15 1231 17 30.3 40.1 Wellington subregion 2139 41 2944 46 29.1 40.0 Tasman District 234 7 396 7 31.4 52.5 Nelson City 239 2 310 2 29.7 38.4 Marlborough District 195 11 308 12 26.8 41.6 Nelson/Marlborough subregion 668 20 1014 21 29.3 44.1 New Zealand 21825 958 31666 1095 31.0 44.5 includes all constituent areas of Ruapehu District includes injury and fatal accidents "includes injuries and fatalities rate per 10,000 population Source: LTSA 1995a, 1996

Special Health Issues - Page 171

Table 149: Pedestrian, motorcycle and pedal cycle accidents by area, numbers and rates, 1995-1996

Pedestrians Motorcyclists Pedal cyclists Area n rate n rate n rate Wairoa District 3 14.9 2 10.0 2 10.0 Hastings District 19 14.4 62 46.9 48 36.3 Napier City 22 20.7 47 44.3 29 27.3 Central Hawkes Bay District 3 11.8 8 31.4 2 7.8 Chatham Island District 0 - 1 66.7 0 - Hawkes Bay subregion 47 16.5 120 42.0 81 28.4 Ruapehu District 3 8.7 6 17.4 0 0.0 Wanganui District 8 8.8 42 46.1 34 37.3 Rangitikei District 3 9.2 10 30.7 1 3.1 Wanganui subregion 14 8.8 58 36.7 35 22.1 Manawatu District 7 12.4 24 42.6 10 17.7 Palmerston North City 48 32.3 96 64.6 70 47.1 Tararua District 2 5.2 13 33.7 8 20.7 Horowhenua District 17 28.2 21 34.9 10 16.6 Manawatu subregion 74 24.4 154 50.7 98 32.2 Kapiti Coast District 24 31.0 28 36.2 5 6.5 Porirua City 29 30.6 19 20.0 16 16.9 Upper Hutt City 21 28.5 29 39.3 14 19.0 Hutt City 67 35.1 57 29.9 42 22.0 Wellington City 180 57.8 112 36.0 110 35.3 Wellington subregion 321 42.9 245 32.7 187 25.0 Masterton District 6 13.0 16 34.6 14 30.2 Carterton District 3 21.4 3 21.4 0 - South Wairarapa District 1 5.5 7 38.3 1 5.5 Wairarapa subregion 10 12.7 26 33.1 15 19.1 Tasman District 6 7.8 31 40.4 11 14.3 Nelson City 29 35.7 43 53.0 44 54.2 Marlborough District 12 15.6 28 36.4 21 27.3 Nelson/Marlborough subregion 47 20.0 102 43.4 76 32.4 New Zealand 2022 27.5 2762 37.5 1567 21.3

includes all constituent areas of Ruapehu District rate per 100,000 population Source: LTSA 1995a, 1996

Page 172 -The Public Health of the Central Region I

Risks and social costs

LTSA have developed a number of alternative measures to determine the impact of motor vehicle crashes on both society and individuals (LTSA 1 995b). These include: • social costs, which are the costs to society in terms of loss of life, of suffering, and of damage to property

risk which describes the average social cost from road crashes per kilometre of travel

• exposure which describes the degree to which individuals are exposed to risk

• per-capita social cost which describes the total amount of risk to which individuals are exposed

The social cost of all road crashes, excluding crashes resulting only in property damage, in the area approximating the Central region is about $792 million per annum (table 150). Although the social cost of crashes in an area will reflect the size of the population, the highest costs of fatal crashes in the Central region are in Hastings District ($36 million per year), Tasman District ($29 million per year) and Manawatu District ($25 million per year). Wellington City has the highest social costs of serious ($37 million per year) and minor crashes ($22 million per year).

Using the measure of risk (social cost per unit of traffic volume) shows that the social cost of crashes in the districts of Tasman, Hastings, Horowhenua and Central Hawkes Bay is between 14- 16 cents per vehicle-kilometre compared to the national average of 9.8 cents (table 151). The costs in the constituent areas of the Wellington subegion are below the New Zealand average.

Consistent with the overall New Zealand pattern, the average per-capita social cost of crashes in the country areas of the Central region ($1,759 per person per year) is more than twice. as high as the cost in either towns ($751) or cities ($905) (table 151). The total cost in Central Hawkes Bay District ($1,435), Ruapehu District ($1,362), Tasman District ($1,353), and South Wairarapa District ($1,311) are well above the national average ($840).

In the Central region, the average social costs of crashes per road kilometre per year in Porirua City ($140,000), Wellington City ($106,000), Lower Huff City ($105,000), Nelson City ($104,000), Palmerston North City ($98,000) are three times the national average ($33,000) (table 151). Below average costs occur primarily in the more rural areas.

The caveat in the intrepretation of these data is that a dangerous road carrying a large volume of traffic will have a very high social cost per road kilometre whereas a safe road with little traffic will have a low social cost per road kilometre. Therefore, country roads which on average are more risky than roads in towns and cities, have a lower average social cost per road kilometre because they carry less traffic (LTSA, 1996).

In the districts of Hastings, Central Hawkes Bay, South Wairarapa, and Tasman, alcohol alone accounts for more than three cents of social cost per vehicle-kilometre, or more than 20 percent of total risk (table 152). The respective national averages were 1.7 cents and 17 percent. In Rangitikei District, speed accounted for more than four cents of social cost per vehicle-kilometre, or 37 percent of total risk. Other areas where speed-related crashes had a high social cost were the Ruapehu District (26% of total risk) and Carterton District (25% of total risk). The social costs of priority-related crashes (eg, failure to give way or stop) in Napier City (2.8 cents) and Nelson City (2.8 cents) were twice the national average (1.3 cents) (table 153). In Carterton District, crashes due to overtaking accounted for two cents of social costs (16 percent of total risk), the highest in the Central region. The Central region generally has above average social costs for position-related crashes (eg, failure to keep left, sudden braking or swerving), with the highest costs in the districts of Wairoa, Marlborough, and Tasman.

Special Health Issues — Page 173 The cities of Napier, Porirua, and Nelson have the highest risk of pedestrian-related crashes in the Central region (table 154). Masterton District has the highest social costs (1.2 cents of social cost per vehicle-kilometre) for cyclist-related crashes.

The highest risk from road factors (eg, roads works, slippery surfaces or obstructions) as causes of crashes occur in the districts of Carterton, Horowhenua, Tararua, and Hastings (table 154). The social cost from crashes involving vehicle-related factors (eg, worn tyres, faulty lights and brakes) was highest in the Manawatu District (2.2 cents compared to the national average of 0.6 cents of social cost per vehicle-kilometre).

References LTSA 1993. Motor Accidents in New Zealand, 1993. Wellington: Land Transport Safety Authority.

LTSA 1 995a. Motor Accidents in New Zealand, 1995. Wellington: Land Transport Safety Authority

LTSA 1 995b. Safety Directions. Wellington: Land Transport Safety Authority. LTSA 1996. MotorAccidents in New Zealand, 1996. Wellington: Land Transport Safety Authority.

Page 174— The Public Health of the Central Region Table 150: Social cost of crashes by crash severity, settlement type ($million/yr) and area

Fatal Serious Minor Total Area Country Town City Total Country Town City Total Country Town City Total Country Town City Total Wairoa District 6 6 4 1 5 1 2 12 1 13 Hastings District 36 36 34 34 13 13 83 83 Napier City 14 14 14 14 7 7 34 34 Central Hawkes Bay District 13 2 15 6 1 7 2 2 21 3 24 Ruapehu District 15 2 17 8 2 9 3 4 26 4 30 Wanganui District 17 17 15 15 4 4 36 36 Rangitikei District 17 2 18 12 1 13 4 4 32 3 35 Manawatu District 23 2 25 20 2 22 5 5 48 4 52 Palmerston North City 15 15 21 21 10 10 46 46 Tararua District 12 1 12 11 2 13 3 1 4 26 3 29 1-Iorowhenua District 18 4 22 11 3 14 3 1 5 32 8 40 Kapiti Coast District 10 10 16 16 5 5 31 31 Porirua City 15 15 14 14 6 6 35 35 Upper Hutt City 4 4 12 12 4 4 20 20 Lower Hutt City 15 15 23 23 15 15 53 53 Wellington City 16 16 37 37 - 22 22 74 74 Masterton District 3 2 5 4 2 6 1 1 2 7 6 13 Carterton District 2 2 4 1 5 1 1 6 1 7 South Wairarapa District 0 7 2 9 2 1 3 1 1 10 2 12 Tasman District 28 1 29 19 3 22 7 1 7 54 4 59

0 Nelson City 8 8 15 15 5 5 28 28 Marlborough District 12 3 16 13 4 17 4 2 6 30 9 38 Central region 156 21 150 326 114 23 201 337 35 6 91 134 304 48 440 792 New Zealand 772 96 463 1331 508 100 575 1183 162 40 288 489 1442 235 1326 3004

-U all constituent areas ofRuapehu District

(D Source: LTSA 1995b

U -u to Table 151: Selected road safety ratios by area CD -I

C., risk (cents/vkt) per capita social cost ($/person/yr) social cost per road km ($000/kmlyr) CD Area Country Town City Total Country Town City Total Country Town City Total Wairoa District 12.6 8.5 12.2 1642 665 1176 12 10 11 Hastings District 14.7 14.7 1295 1295 46 46 Napier City 10.0 10.0 882 882 89 89

0 Central Hawkes Bay District 15.4 9.1 14.3 1996 715 1435 17 36 18

S.- RuapehuDistrict CD 13.2 14.8 13.3 1711 1163 1362 17 31 18 Wanganui District 13.3 13.3 1174 1174 37 37 .4 Rangitikei District 12.8 10.8 12.6 1663 843 1234 25 32 26 Manawatu District 12.7 6.5 11.8 1655 509 1017 33 30 33 toCD 0 Palmerston North City 10.7 10,7 943 943 98 98 Tararua District 11.8 9.7 11,5 1529 757 1135 13 28 14 ilorowhenua District 15.2 11.8 14.3 1970 929 1089 67 52 64 Kapiti Coast District 8,8 8.8 779 779 80 80 Porirua City 9.7 9.7 857 857 140 140 Upper Hutt City 9.0 9.0 798 798 82 82 Lower Hutt City 7.9 7.9 700 700 105 105 Wellington City 5.9 5.9 524 524 106 106 Masterton District 8.3 7.5 7.9 1073 592 653 10 42 15 Carterton District 13.4 7.0 12.0 1738 549 1020 15 32 16 South Wairarapa District 11.7 15.4 12.3 1523 1206 1311 16 38 18 Tasman District 19.5 4,7 15.7 2541 366 1353 31 30 31 Nelson City 12.5 12.5 1107 1107 104 104 Marlborough District 16.0 9.3 13.7 2074 726 1049 19 48 22 New Zealand 12.4 8.1 8.3 9,8 1608 635 732 840 21 35 8733 "vkt= vehicle-km travelled includes all constituent areas of Ruapehu District Source: LTSA 1995b

I c c c c c c c c c c c c c I Table 152: Risk (cents/veh-km) by cause of crash (alcohol and speed) and area

Area Alcohol Alcohol and speed Speed Wairoa District 2.6 2.5 1.3 Hastings District 3.3 2.4 1.9 Napier City 2.2 1.0 1.3 Central Hawkes Bay District 3.3 1.7 2.8 Ruapehu District 1.7 2.1 3.4 Wanganui District 2.5 3.0 2.0 Rangitikei District 1.2 1.1 4.7 Manawatu District 2.4 1.7 1.9 Palmerston North City 1.0 1.5 1.6 Tararua District 2.7 2.0 2.1 Horowhenua District 2.7 3.0 2.4 Kapiti Coast District 1.7 0.7 0.9 Porirua City 2.2 0.5 1.0 Upper Hutt City 1.0 0.3 1.5 Lower Hutt City 0.8 1.0 1.4 Wellington City 0.5 0.7 0.8 Masterton District 0.9 1.5 0.9 Carterton District 1.2 2.0 3.0 South Wairarapa District 3.4 1.7 2.8 Tasman District 3.4 3.0 2.1 Nelson City 1.0 0.9 2.0 Marlborough District 1.9 2.3 1.8 New Zealand 1.7 1.3 1.5 includes all constituent areas ofRuapehu District Source: LTSA 1995b

Special Health Issues -. Page 177 Table 153: Risk (cents/veh-km) by cause of crash (other driver factors) and area

Area Priority Overtaking Positlon Wairoa District 0.5 0.1 4.5 Hastings District 2.0 0.3 3.5 Napier City 2.6 0.2 1.2 Central Hawkes Bay District 1.0 1,4 3.3 Ruapehu District 1.0 0.1 3.7 Wanganui District 1.7 0.2 3.2 Rangitikei District 0.9 0.4 3.4 Manawatu District 1.8 0.3 2.9 Palmerston North City 1.8 0.2 2.8 Tararua District 0.5 0.1 2.3 Horowhenua District 1.6 0.2 3.1 Kapiti Coast District 0.9 0.4 3.1 Porirua City 1.2 0.3 3.1 Upper Hutt City 2.1 0.1 3.3 Lower Hutt City 1.5 0.2 2.0 Wellington City 0.8 0.1 1.8 Masterton District 0.9 0.0 2.9 Carterton District 0.8 2.0 1.8 South Wairarapa District 0.5 0.5 3.0 Tasman District 2.5 0.2 4.0 Nelson City 2.8 0.6 3.0 Marlborough District 1.8 0.1 4.2 New Zealand 1.3 0.2 2.4 priority mainly consists offailure to give way or stop where not combined with alcohol or excessive speed position includes failure to keep left, following too close, suddenly braking or swerving, inattention, inexperience and tiredness includes all constituent areas of Ruapehu District Source: LISA 1995b

Page 178- The Public Health of the Central Region I Table 154: Risk (cents/veh-km) by other causes of crash and area

Area Pedestrian Involved Cyclist involved Road factor involved Vehicle factor involved Wairoa District 1.1 0.1 1.0 0.2 Hastings District 0.8 0.7 2.1 1.1 Napier City 1.4 0.6 0.8 1.2 Central Hawkes Bay District 0.1 1.8 0.6 RuapehuDistrict 1.0 0.6 1.5 1.4 Wanganui District 0.2 0.6 1.2 1.6 Rangitikei District 0.6 0.0 1.5 1.6 Manawatu District 0.2 0.4 1.7 2.2 Palmerston North City 0.9 0.7 0.5 1.3 Tararua District 0,6 0.1 2.2 1.2 Horowhenua District 0.8 0.2 2.4 1.0 Kapiti Coast District 0.8 0.2 0.8 0.3 Porirua City 1.3 0.1 0.8 0.6 Upper Hutt City 1.0 0.1 0.5 0.9 Lower Hutt City 0.6 0.3 0.6 0.5 Wellington City 1.1 0.3 0.3 0.3 Masterton District 0,1 1.2 0.6 0.4 Carterton District 0.8 0.3 2.8 1.7 South Wairarapa District 0.3 0.2 0.2 Tasman District 0.5 0.2 1.5 1.6 Nelson City 1.2 0,9 1.5 1.0 Marlborough District 1.1 0.3 1.6 0.9 New Zealand 0.8 0.3 1.0 0.6 includes all constituent areas ofRuapehu District Source: LTSA 1995b

Special Health Issues - Page 179 INJURY CLAIMS DATA

The Accident Rehabilitation and Compensation Insurance Corporation (ACC) publishes annual data on the numbers and costs of claims for injuries by the locality in which the injury is reported to have occurred.

Between 1994-1997, about one in four of all new entitlement claims in New Zealand was made from the Central region at a cost of$ 184 million (table 155). The number of claims had declined by 6.5 percent during this period, but the cost increased by 4.8 percent. Within the Central region, 36.8 percent of the claims were from the Wellington area and 31.4 percent from the combined ManawatulWanganui regions. There was a 13.9 percent increase in the number of new claims and a 25.3 percent increase in costs in Nelson/Marlborough, but marked declines in both claims (22.5%) and costs (17.3%) in Hawkes Bay. The number of claims in ManawatulWanganui decreased by 11.3% with minimal change in the cost, whereas the converse occurred in Wellington (0.8% decrease in claims and 14.4% increase in cost).

In 1996-1997, 18,551 new work related entitlement claims were made in the Central region at a total cost of $35 million (table 156). In all areas the number of claims and costs declined between these two years, with the greatest national decreases in claims occurring in Hawkes Bay (27.6%) and Wellington (25.6%). In the Central region in 1994-1997, there were 6,822 new motor vehicle-related injury accidents on a public road at a total cost of $19 million (table 157). However, over this period the number of claims declined by at least 33% in Hawkes Bay and Manawatu/Wanganui with concomitant falls in the cost (39.9% and 26.2% respectively). Although the cost increased in Nelson/ Marlborough (7.1%) there was minimal change in the number of claims.

During 1994-1997 there were 37,559 new claims for non-work injuries to earners at a cost of $64 million (table 158). The number of claims had increased by 13.0 percent in Nelson/Marlborough and 3.2 percent in Wellington, with respective increases of 10.6 percent and 12.0 percent in the costs. The converse occurred in Hawkes Bay and ManawatufWanganui where the number of claims decreased by about 14 percent and the costs by approximately 5 percent. The cost of the 19,720 new sport and recreation claims in Central region during 1994-1997 was $24 million (table 159). In the Manawatu/Wanganui area, the number of new claims fell by 25.9 percent with a 32.0 percent decline in the costs. In contrast, there was a 13.8 percent increase in the number of claims in Nelson/Marlborough while the costs soared by 30.6 percent. The costs also rose in Wellington (18.1%), but there was no change in the number of claims.

References ACC 1995. Injury Statistics 1994 and 1995. Wellington: Accident Rehabilitation and Compensation Corporation.

ACC 1996. Injury Statistics 1996. Wellington: Accident Rehabilitation and Compensation Corporation.

ACC 1997. Injury Statistics 1997. Wellington: Accident Rehabilitation and Compensation Corporation

Page 180- The Public Health of the Central Region I Table 155: All entitlement claims and cost by area, 1994-1996

Total new claims Total new cost ($000) Area 1994 1995 1996 1997 1994 1995 1996 1997 HawkesBay 6029 6241 5662 4672 7915 9089 7905 6547 Manawatu/Wanganui 9910 10598 10846 8786 12979 15548 14982 12813 Wellington 10935 12339 13048 10844 15447 18696 19608 17666 Nelson/Marlborough 3994 4580 4941 4550 5111 6770 6516 6405 Central region 30868 33758 34497 28852 41452 50103 49011 43431 New Zealand 120893 135094 138611 127081 165299 200710 201244 193082 excludes Chatham Islands District includes all constituent areas of Ruapehu District includes Chatham Islands District, at sea, overseas, in the air and other islands Source: ACC 1995, 1996, 1997

Table 156: Work related entitlement claims and cost by area, 1994-1996

Total new claims Total new cost ($000) Area 1996 1997 1996 1997 HawkesBay 1597 1157 2783 2524 Manawatu/Wanganui 3252 2660 5548 4687 Wellington 3850 2866 7613 6532 Nelson/Marlborough 1671 1498 3014 2629 Central region 10370 8181 18958 16372 New Zealand 41741 36894 77302 71956 excludes Chatham Islands District "includes all constituent areas of Ruapehu District includes Chatham Islands District, at sea, overseas, in the air and other islands Source: ACC1995, 1996, 1997

Table 157: Motor vehicle account entitlement claims and cost by area, 1994-1997

Total new claims Total new cost ($000)

Area 1994 1995 1996 1997 1994 1995 1996 1997

1080HawkesBay 365 348 345 240 1047 1150 649

ManawatuAVanganui 669 609 638 447 1847 1708 1928 1364

Wellington 535 633 544 450 1338 1882 1524 1184

Nelson/Marlborough 244 284 237 234 496 880 693 531

Central region 1813 1874 1764 1371 4761 5517 5295 3728

New Zealand 6968 7617 7322 6388 17855 21835 22240 20475 excludes Chatham Islands District "includes all constituent areas of Ruapehu District includes Chatham Islands District, at sea, overseas, in the air and other islands Source: ACC 1995, 1996, 1997

Special Health Issues - Page 181

Table 158: Earners account entitlement claims and cost by area, 1994-1997

Total new claims Total new cost ($000) Area 1994 1995 1996 1997 1994 1995 1996 1997 HawkesBay 1521 1569 1575 1310 2644 2861 2612 2516 Manawatu/Wanganui 2920 3039 3050 2503 4640 5285 5106 4401 Wellington 3444 3793 4129 3555 5867 6244 7279 6573 Nelson/Marlborough 1173 1290 1363 1325 1980 2198 2079 2189 Central region 9058 9691 10117 8693 15131 16588 17076 15679 New Zealand 36129 38850 41869 39304 58174 66217 70735 71194 excludes Char/win Islands District includes all constituent areas of Ruapehu District includes Chatham Islands District, at sea, overseas, in the air and other islands Source: ACC 1995, 1996, 1997

Table 159: Sport and recreation entitlement claims and cost by area, 1994-1997

Total new claims Total new cost ($000)

Area 1994 1995 1996 1997 1994 1995 1996 1997

871Hawkes Bay 753 799 809 674 879 892 865

Manawatu/Wanganui 1802 1874 1869 1336 2282 2724 2320 1551

Wellington 1773 1693 2030 1782 1889 1953 2375 2231

Nelson/Marlborough 593 597 661 675 654 834 827 854

Central region 4921 4963 5369 4467 5696 6390 6414 5501

New Zealand 20643 21320 21940 20371 23515 26227 26578 25654 excludes Chatham Islands District includes all constituent areas of Ruapehu District includes Chatham Islands District, at sea, overseas, in the air and other islands Source: ACC 1995, 1996, 1997

Page 182— The Public Health of the Central Region LI

The National Audiology Centre (NAC) collates annual data on audiometry and tympanometry screening carried out by Vision Hearing Testers and Public Health Nurses on three year olds and new school entrant aged children.

During Julyl 996-June 1997, the hearing failure rate of new school entrants in the Central region (9.2%) exceeded the national rate (8.4%). The rate for Pacific Island children (23.1%) was more than three times higher than the rate for Other (7.4%), while the rate for Maori was 13.1 percent (table 160). Within the Central region, the highest rate of failures among new school entrants was in the area covered by Hutt Valley Health, and the lowest in the Good Health Wanganui area.

Despite showing variability, there is evidence that the failure rates among new school entrants have been declining in all areas since 1991/92 (table 161).

Among three year olds in the Central region, the failure rate is highest in Wairarapa Health (7.5%), while the rates in all other areas are below the New Zealand average (7.1%) (table 162).

References NAC 1996. New Zealand Hearing Screening Statistics July 1995-June 1996. Auckland: National Audiology Centre.

NAC 1998. New Zealand Hearing Screening Statistics July 1996-June 1997. Auckland: National Audiology Centre.

Special Health Issues— Page 183

Table 160: New school entrant failure rates by health district, July 1995-June 1997

July 1995-June 1996 July 1996-June 1997 % of new entrants % of new entrants Health district Maori Pacific Is Other Total Maori Pacific Is Other Total Hawkes Bay 6.6 5.4 5.7 12.6 5.1 7.4 Wanganui 15.0 5.2 7.7 3.3 2.6 2.8 Manawatu 9.3 4.3 5.0 5.5 21.3 5.3 5.6 Wellington 8.3 12.2 3.9 5.5 22 23.5 11.3 14.1 Wairarapa 29.4 25.0 10.7 14.2 14.7 13.3 6.6 8.2 Nelson 19.6 5.3 5.8 14.8 4.6 5.1 Blenheim 16.3 6.9 8.6 Central region 10.3 12.3 5.2 6.1 13.1 23.1 7.4 9.2 New Zealand 13.5 15.7 6.7 8.5 13.0 16.1 6.4 8.4 excludes Blenheim Source: NAG 1996, 1998

Table 161: Three year old failure rates by health district, July 1995-June 1997

July 1995-June 1996 July 1996-June 1997 % of three year old failures % of three year old failures

Health district Maori Pacific Is Other Total Maori Pacific Is Other Total

Hawkes Bay 6.8 3.7 4.6 13.1 3.8 5,9

Wanganui 22.7 8.4 12.0 5.5 2.2 2.6

Manawatu 17.6 2.5 3.7 11.7 2.3 3.3

Wellington 8,8 6.6 3.8 4.6 6.8 20.0 1.9 3.8

Wairarapa 42.6 14.3 8.4 14.1 18.4 5.3 7.5

Nelson 29.4 4,3 5.0 20 5.1 5,7

Blenheim 11.9 3.1 4.2

New Zealand 14.6 15.6 5.9 7.6 16.8 17.1 4.8 7.1 Blenheim Note: small numbers, for example, in the Nelson area only 34 Maori children were test and 10 (29.4%) failed tympanometry screening Source: NAG 1996, 1998

Table 161b: New school entrants failure rates by health district, July 1991 -June 1997

% of new school entrants Health District 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97 8.3Hawkes Bay 4.1 12.8 6.4 5.7 7.4 Wanganui 7.2 9.3 14.3 8.2 7.7 2.8 Manawatu 7.4 8.1 7.6 6.2 7.3 5.6

Wellington 10.3 10.2 8.5 6.7 5,5 14,1 Wairarapa 7.2 6.1 4.4 8,6 14.2 8.2 Nelson 8.6 6.2 7.7 6.8 5.8 6.1 New Zealand 10.5 9.7 8.8 8.3 8.5 8.4 excludes Blenheim Source: NAG 1996, 1998.

Page 184- The Public Health of the Central Region I

The Children Young Persons and Their Families Service (CYPFS) collects data on the numbers and types of abuse. In 1997, more than 30 percent of the notifications to the Wairoa (35.5%) and Dannevirke (34.5%) District CYPFS Units were for behaviour/relationship problems (table 162). Between 10-15 percent of the notifications to the Dannevirke (16.9%), Hastings (15.9%), Porirua (1 2.4%),Waipukurau (12.2%), Palmerston North (11.9%), and Napier (10.5%) District Units were for neglect.

In the Ponrua District, 17.6 percent of the notifications were concerned with physical abuse.

Table 162: Types of abuse by Children Young Persons and Their Families Service (CYPFS) Unit and ethnicity, notifications, 1997

Ethnicity CYPFS Unit Type of abuse Maori Non Maori Unknown Total Wairoa District Abuse not found 15 17 2 34 Behaviour/relationship problems 28 21 1 50 Emotional abuse 25 4 0 29 Neglect 2 1 0 3 Physical abuse 1 1 0 2 Sexual abuse 3 0 0 3 Unknown 9 11 0 20 Total 83 55 3 141 Hastings District Abuse not found 66 78 16 160 Behaviour/relationship problems 29 25 5 59 Emotional abuse 5 10 0 15 Neglect 38 24 7 69 Physical abuse 16 18 2 36 Self harm/suicidal 0 1 0 1 Sexual abuse 5 9 2 16 Unknown 33 37 8 78 Total 192 202 40 434 Napier District Abuse not found 44 137 23 204 Behaviour/relationship problems 19 70 5 94 Emotional abuse 3 18 3 24 Neglect 19 33 10 62 Physical abuse 17 22 5 44 Self harm/suicidal 0 1 0 1 Sexual abuse 18 27 4 49 Unknown 24 72 18 114 Total 144 380 68 592

Special Health Issues— Page 185 Table 162: Types of abuse by Children Young Persons and Their Families Service (CYPFS) Unit and ethnicity, notifications, 1997 continued... Ethnicity CYPFS Unit Type of abuse Maori Non Maori Unknown Total Waipukurau District Abuse not found 5 18 1 24 Behaviour/relationship problems 16 15 1 32 Emotional abuse 0 3 0 3 Neglect 5 4 6 15 Physical abuse 3 0 2 5 Self harm/suicidal 0 1 0 1 Sexual abuse 3 1 2 6 Unknown 15 13 9 37 Total 47 55 21 123 Wanganui District Abuse not found 47 75 9 131 Behaviour/relationship problems 18 40 5 63 Emotional abuse 9 10 0 19 Neglect 22 33 0 55 Physical abuse 20 25 2 47 Self harm/suicidal 0 1 0 1 Sexual abuse 5 29 11 45 Unknown 67 99 35 201 Total 188 312 62 562 Feilding District Abuse not found 0 19 6 25 Behaviour/relationship problems 3 13 5 21 Emotional abuse 1 8 1 10 Neglect 1 9 2 12 Physical abuse 5 6 2 13 Self harm/suicidal 0 2 1 3 Sexual abuse 0 4 2 6 Unknown 11 35 12 58 Total 21 96 31 148 Palmerston North District Abuse not found 26 99 30 155 Behaviour/relationship problems 20 66 23 109 Emotional abuse 1 19 8 28 Neglect 20 43 7 70 Physical abuse 7 26 9 42 Self harm/suicidal 3 1 4 Sexual abuse 4 12 8 24 - Unknown 29 88 40 157 Total 107 356 126 589

Page 186— The Public Health of the Central Region U

Table 162: Types of abuse by Children Young Persons and Their Families Service (CYPFS) Unit and ethnicity, notifications, 1997 continued... Ethnicity CYPFS Unit Type of abuse Maori NonMaorl Unknown Total Dannevirke Abuse not found 9 21 18 48 Behaviour/relationship problems 10 25 16 51 Emotional abuse 0 1 1 2 Neglect 13 2 10 25 Physical abuse 4 2 3 9 Self harm/suicidal 0 1 0 1 Sexual abuse 2 4 1 7 Unknown 2 3 0 5 Total 40 59 49 148 Horowhenua District Abuse not found 26 66 18 110 Behaviour/relationship problems 13 51 2 66 Emotional abuse 1 12 0 13 Neglect 11 23 0 34 Physical abuse 6 15 0 21 Self harm/suicidal 1 2 0 3 Sexual abuse 5 17 1 23 Unknown 13 53 12 78 Total 76 239 33 348 Paraparaumu District Abuse not found 11 54 4 69 Behaviour/relationship problems 5 29 1 35 Emotional abuse 0 12 1 13 Neglect 1 14 0 15 Physical abuse 5 12 0 Self harm/suicidal 1 1 1 3 Sexual abuse 2 12 3 17 Unknown 10 65 12 87 Total 35 199 22 256 Porirua District Abuse not found 20 51 5 76 Behaviour/relationship problems 24 32 0 56 Emotional abuse 6 7 0 13 Neglect 16 34 4 54 Physical abuse 19 57 1 77 Self harm/suicidal 0 2 0 2 Sexual abuse 4 28 5 37 Unknown 34 74 14 122 Total 123 285 29 437

Special Health Issues - Page 187 Table 162: Types of abuse by Children Young Persons and Their Families Service (CYPFS) Unit and ethnicity, notifications, 1997 continued... Ethnicity CYPFS Unit Type of abuse Maori NonMaori Unknown Total Lower Huff District Abuse not found 13 55 12 80 Behaviour/relationship problems 16 61 9 86 Emotional abuse 5 13 2 20 Neglect 14 13 13 40 Physical abuse 18 20 7 45 Self harm/suicidal 1 5 0 6 Sexual abuse 15 27 13 55 Unknown 74 194 109 377 Total 156 388 165 709 Upper Huff District Behaviour/relationship problems 0 1 0 1 Total 0 1 0 Wellington District Abuse not found 21 68 13 102 Behaviour/relationship problems 26 37 4 67 Emotional abuse 3 3 1 7 Neglect Il 23 2 36 Physical abuse 16 31 2 49 Self harm/suicidal 0 2 0 2 Sexual abuse 2 16 4 22 Unknown 19 71 17 107 Total 98 251 43 392 Masterton District Abuse not found 18 68 24 110 Behaviour/relationship problems 17 35 6 58 Emotional abuse 11 34 2 47 Neglect 15 20 5 40 Physical abuse 8 31 1 40 Self harm/suicidal 0 3 0 3 Sexual abuse 5 24 6 35 Unknown 21 68 25 114 Total 95 283 69 447

Page 188— The Public Health of the Central Region fl I

Table 162: Types of abuse by Children Young Persons and Their Families Service (CYPFS) Unit and ethnicity, notifications, 1997 continued...

Ethnicity CYPFS Unit lype of abuse Maori NonMaori Unknown Total Nelson District Abuse not found 28 122 54 204 Behaviour/relationship problems 27 99 25 151 Emotional abuse 10 33 4 47 Neglect 14 48 8 70 Physical abuse 2 24 5 31 Self harm/suicidal 0 3 0 3 Sexual abuse 2 25 4 31 Unknown 38 190 87 315 Total 121 544 187 852 Blenheim District Abuse not found 11 51 8 70 Behaviour/relationship problems 9 45 3 57 Emotional abuse 3 14 1 18 Neglect 5 20 1 26 Physical abuse 3 13 0 16 Self harm/suicidal 0 2 0 2 Sexual abuse 1 12 1 14 Unknown 20 107 41 168 Total 52 264 55 371 Source: CYPFS 1998

Special Health Issues - Page 189 In the Central region during 1992 and 1993 there were 2,008 mental health first admissions for persons aged 15 years and older (there were 13 admission in persons under 15 years of age) (table 163). Of these admissions, 53 percent were male and 72 percent were for people aged between 15 and 44 years of age.

Throughout the region the male age-standardised rates were greater than the female rates (table 163). Male and female rates were highest in Wanganui, while Manawatu had the lowest male rate and Wairarapa the lowest female rate.

Among 15 to 24 year olds, there were high male rates of first admissions in Wairarapa, Wanganui and Hawkes Bay (table 164). The leading conditions for admission were alcohol dependence or abuse, drug dependence or abuse and schizophrenic disorders.

Female rates in the 15-24 year age group were highest in Wanganui, Manawatu, and Hawkes Bay with stress and adjustment and affective psychoses the leading causes of admission (table 165).

Throughout the Central region, males aged 25 to 44 years of age were most commonly admitted for alcohol dependence or abuse (table 166). Wanganui was the exception with affective psychoses the leading cause of admission.

Overall, the leading cause of admission for females aged 25 to 44 years was affective psychoses and stress and adjustment and reaction (table 167). Interpreting the pattern of rates at the regional level is difficult because of the small number of cases involved.

In the 45-64 year age group the leading cause of admission for males was alcohol dependence or abuse (table 168), while for females it was affective psychoses (table 169).

For those aged over 65 years the most common cause of admission for males (table 170) and females (table 171) was senile and presenile organic psychoses.

Page 190- The Public Health of the Central Region I

Table 163: All conditions for mental health by subregion and gender, 15 years and over, 1992-1993

Male Female Subregion n rate n rate Hawkes Bay 141 284.7 151 280.0 Wanganui 107 436.5 102 413.2 Manawatu 168 302.3 153 267.6 Porirua/Kapiti 92 328.7 77 245.4 Hutt 167 331.7 137 266.9 Wellington 208 353.2 167 272.4 Wairarapa 50 367.6 26 183.1 Nelson/Marlborough 133 338.3 127 306.2 Central region 1068 333.2 940 278.1 jj per 100,00 standardised to NZ population Source: NZHJS Table 164: Leading conditions for mental health by subregion, numbers and rates, aged 15-24 years, 1992-1993 males

Cause Subregion all conditions alcohol dependence drug dependence schizophrenic disorders n rate n rate n rate n rate 54 6Hawkes Bay 504.3 56.0 8 74.7 6 56.0 Wanganui 27 510.8 4 - 4 - 2 - Manawatu 58 420.2 18 130.4 6 43.5 4 - Porirua/Kapiti 22 354.8 6 96.8 0 - 7 112.9 Hutt Valley 57 499.7 8 70.1 9 78.9 9 78.9 Wellington 58 432.0 9 67.0 13 96.8 13 96.8 Wairarapa 19 690.7 6 218.1 3 - Nelson/Marlborough 36 445.9 6 74.3 4 - 5 61.9 Central region 331 462.0 58 80.9 50 69.8 49 68.4 rate per 100,000 Source: NZHIS Table 165: Leading conditions for mental health, by subregion, numbers and rates, aged 15-24 years, 1992-1993 females Cause all conditions stress and adjustment affective psychoses Subregion n rate n rate n rate Hawkes Bay 32 301.7 11 103.7 2 - Wanganui 26 544.4 1 - 6 125.6 Manawatu 47 347.1 10 73.8 8 59.1 Porirua/Kapiti 9 144.9 0 - 5 80.5 Hutt Valley 30 271.3 7 63.3 4 - Wellington 25 172.9 5 34.6 0 - Wairarapa 7 270.7 1 - 2 - Nelson/Marlborough 11 147.4 2 - 2 - Central region 187 264.5 37 52.3 29 41.0 rate per 100,000 Source: NZHIS

Special Health Issues - Page 191 Table 166: Leading conditions for mental health, aged 25-44 years, 1992-1993 males

Cause all alcohol affective schizophrenic stress and drug dependence Subregion conditions dependence psychoses disorders adjustment or abuse Hawkes Bay 280.1 88.2 25.9 - 51.9 36.3 Wanganui 592.6 93.6 135.2 - 104.0 - Manawatu 390.0 105.9 57.8 57.8 48.1 48.1 PorirualKapiti 298.0 87.9 44.0 61.5 - 44.0 Hutt Valley 387.0 98.0 49.0 39.2 34.3 58.8 Wellington 372.4 136.8 53.2 68.4 22.8 26.6 Wairarapa ------Nelson/Marlborough 355.0 103.3 - - 58.1 - Central region 370.7 104.9 50.5 42.7 41.2 38.1 rate per 100000 Source: NZHJS

Table 167: Leading conditions for mental health, by subregion and rates, aged 25-44 years, 1992-1993 females

Cause all alcohol affective schizophrenic stress and drug dependence Subregion conditions dependence psychoses disorders adjustment or abuse Hawkes Bay 344.7 38.8 53.4 72.8 48.6 24.3 Wanganui 508.4 152.5 71.2 50.8 81.4 61.0 Manawatu 365.1 93.6 98.3 46.8 28.1 37.4 Porirua/Kapiti 294.3 81.8 - 57.2 - - Hutt Valley 304.2 67.6 29.0 43.5 38.6 38.6 Wellington 283.1 45.3 30.2 49.1 49.1 - Wairarapa 157.6 - - - - - Nelson/Marlborough 470.4 69.9 82.6 44.5 69.9 - Central region 340.7 69.3 53.5 49.7 44.5 30.9 rate per 100,000 Source: NZHJS

Page 192 - The Public Health of the Central Region I-i

Table 168: Leading condition for mental health, by subregion, numbers and rates, aged 45-64 years, 1992-1993 males

Cause all conditions alcohol dependence or abuse Subregion n rate n rate Hawkes Bay 21 161.8 5 38.5 Wanganui 15 246.4 6 98.6 Manawatu 20 155.5 7 54.4 Porirua/Kapiti 12 164.7 4 - Hutt Valley 21 174.2 4 - Wellington 30 221.5 14 103.4 Wairarapa 10 271.2 1 - Nelson/Marlborough 23 215.2 2 - Central region 153 193.2 43 54.3 rate per 100,000 Source: NZHIS

Table 169: Leading condition for mental health, by subregion, numbers and rates, aged 45-64 years, 1992-1993 females

Cause all conditions affective psychoses rate rate Subregion n Li

Hawkes Bay 17 128.8 45.5

Wanganui 18 290.6 129.1

Manawatu 18 138.4 E 76.9

Porirua/Kapiti 21 281.5 134.0

Hutt Valley 27 227.8 50.6

Wellington 30 232.6 E 69.8

Wairarapa 7 187.1 E

Nelson/Marlborough 26 247.1 I 95.3

Central region 164 208.0 76.1 rate per 100,000 Source: NZHIS

I

Special Health Issues - Page 193 Table 170: Leading condition for mental health, by subregion, numbers and rates, ages 65 years and older, 1992-1993 males

Cause all conditions affective psychoses

Subregion n rate n rate

Hawkes Bay 12 171.8 2

Wanganui 8 232.1 3

Manawatu 9 127.2 2

Porirua/Kapiti 24 584.8 13 316.8

Hutt Valley 10 187.2 4

Wellington 22 398.3 11 199.2

Wairarapa 3 0

Nelson/Marlborough 19 309.7 9 146.7

Central region 107 263.5 44 108.4 ,.ate per 100,000 Source: NZHJS

Table 171: Leading condition for mental health, by subregion, numbers and rates, ages 65 years and older, 1992-1993 females

Cause all conditions affective psychoses Subregion n rate n rate Hawkes Bay 31 319.7 7 72.2 Wanganui 8 162.5 2 - Manawatu 10 103.1 2 - Porirua/Kapiti 11 202.6 5 92.1 Hutt Valley 17 220.2 3 - Wellington 37 463.3 15 187.8 Wairarapa 3 - 0 - Nelson/Marlborough 18 225.3 7 87.6 Central region 135 240.7 41 73.1 rate per 100,000 Source: NZHJS

Page 194- The Public Health of the Central Region I

Appendix Tables

This appendix has additional tables.

Appendix Tables - Page 195 Table Al: Leading causes of hospitalisation by subregion, numbers, ages 1-4 years, 1995-1996, males

Cause Subregion all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 2016 622 346 299 247 213 Wanganui 944 293 162 148 116 127 Manawatu 1383 360 233 257 165 217 Porirua/Kapiti 1119 282 183 155 121 109 Hutt Valley 1360 350 227 193 148 134 Wellington 1292 357 177 156 148 114 Wairarapa 434 148 48 63 40 48 Nelson/Marlborough 975 232 119 163 94 101 Central region 9523 2644 1495 1434 1079 1063 Source: NZHIS

Table A2: Leading causes of hospitalisation by subregion, numbers, ages 1-4 years, 1995-1996, females

Cause infectious, Subregion all causes dis respiratory dis nervous injury, poisoning otitis media parasitic Hawkes Bay 1518 445 229 211 157 147 Wanganui 657 186 121 120 94 74 Manawatu 975 235 203 171 158 90 Porirua/Kapiti 718 161 94 108 62 122 Hutt Valley 946 241 132 175 94 83 Wellington 928 230 137 139 94 93 Wairarapa 322 89 63 49 35 22 Nelson/Marlborough 726 118 114 84 65 60 Central region 6790 1705 1093 1057 759 691 Source: NZHIS

Table A3: Leading causes of hospitalisation by subregion, numbers, Maori, ages 1-4 years, 1995-1996, males

Cause all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 700 258 123 73 131 54 Wanganui 329 121 43 41 52 37 Manawatu 310 98 50 63 55 55 PorirualKapiti 244 52 44 43 23 21 Hutt Valley 298 74 57 58 43 47 Wellington 170 55 25 27 24 24 Wairarapa 122 56 8 16 20 15 Nelson/Marlborough 83 30 8 13 14 13 Central region 2256 744 358 334 362 266 Source: NZHIS

Page 196— The Public Health of the Central Region I

Table A4: Leading causes of hospitalisation by subregion, rates, Maori, ages 1-4 years, 1995-1996, males

Cause Subregion all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 3915.0 1443.0 687.9 408.3 732.7 302.0 Wanganui 4046.7 1488.3 5289 504.3 639.6 455.1 Manawatu 2583.3 816.7 416.7 525.0 458.3 458.3 PorirualKapiti 2968.4 632.6 535.3 523.1 279.8 255.5 Hutt Valley 2947.6 731.9 563.8 573.7 425.3 464.9 Wellington 3256.7 1053.6 478.9 517.2 459.8 459.8 Wairarapa 3567.3 1637.4 233.9 467.8 584.8 438.6 Nelson/Marlborough 1554.3 561.8 149.8 243.4 262.2 243.4 Central region 3208.2 1058.0 509.1 475.0 514.8 378.3 rate per 10,000 Source: NZHJS

Table A5: Selected leading causes of hospitalisation by subregion, numbers, non Maori, ages 1-4 years, 1995-1996, males

Cause Subregion all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 1316 364 223 226 116 159 Wanganui 615 172 119 107 64 90 Manawatu 1073 262 183 194 110 162 PorirualKapiti 875 230 139 112 98 88 Hutt Valley 1062 276 170 135 105 87 Wellington 1122 302 152 129 124 90 Wairarapa 312 92 40 47 20 33 Nelson/Marlborough 892 202 111 150 80 88 Central region 7267 1900 1137 1100 717 797 Source: NZHJS

Table A6: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 1-4 years, 1995-1996, males

Cause Subregion all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 4391.1 1214.5 744.1 754.1 387.1 530.5 Wanganui 4100.0 1146.7 793.3 713.3 426.7 600.0 Manawatu 3067.5 749.0 523.2 554.6 314.5 463.1 PorirualKapiti 4113.8 1081.3 653.5 526.6 460.7 413.7 Hutt Valley 3067.6 797.2 491.0 389.9 303.3 251.3 Wellington 2947.2 793.3 399.3 338.8 325.7 236.4 Wairarapa 3611.1 1064.8 463.0 544.0 231.5 381.9 Nelson/Marlborough 3059.0 692.7 380.7 514.4 274.3 301.8 Central region 3432.5 897.5 537.1 519.6 338.7 376.5 rate per 10,000 Source: NZHIS

Appendix Tables - Page 197 Table A7: Leading causes of hospitalisation by subregion, rates, Maori, ages 1-4 years, 1995-1996, females

Cause Subregion all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 541 200 75 59 97 42 Wanganui 230 70 47 35 18 27 Manawatu 216 59 44 43 31 40 PorirualKapiti 152 35 25 18 19 16 Hutt Valley 197 57 40 27 23 23 Wellington 81 24 11 24 11 21 Wairarapa 58 22 5 8 5 8 Nelson/Marlborough 44 8 9 5 1 4 Central region 1519 475 256 219 205 181 rate per 10,000 Source: NZHIS

Table A8: Leading causes of hospitalisation by subregion, rates, Maori, ages 1-4 years, 1995-1996, females

Cause Subregion all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 3249.2 1201.2 450.5 354.4 582.6 252.3 Wanganui 2839.5 864.2 580.2 432.1 222.2 333.3 Manawatu 1786.6 488.0 363.9 355.7 256.4 330.9 Porirua/Kapiti 1919.2 441.9 315.7 227.3 239.9 202.0 Hutt Valley 2045.7 591.9 415.4 280.4 238.8 238.8 Wellington 1656.4 490.8 224.9 490.8 224.9 429.4 Wairarapa 1790.1 679.0 154.3 246.9 154.3 246.9 Nelson/Marlborough 888.9 161.6 181.8 101.0 - - Central region 2251.4 704.0 379.4 324.6 303.8 268.3 rate per 10,000 Source: NZHJS

Table A9: Selected leading causes of hospitalisation by subregion, numbers, nonMaori, ages 1-4 years, 1995-1996, females

Cause Subregion all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 977 245 136 170 86 115 Wanganui 427 116 73 86 42 67 Manawatu 759 176 127 160 65 118 PorirualKapiti 566 126 83 76 44 46 Hutt Valley 749 184 135 105 54 71 Wellington 847 206 128 113 66 73 Wairarapa 264 67 44 55 17 27 Nelson/Marlborough 682 110 75 109 43 61 Central region 5271 1230 801 874 417 578 Source: NZHJS

Page 198- The Public Health of the Central Region I Table AlO: Selected leading causes of hospitalisation by subregion, rates, nonMaori, ages 1-4 years, 1995-1996, females

Cause Subregion all causes dis respiratory injury, poisoning dis nervous asthma otitis media Hawkes Bay 3468.2 869.7 482.8 603.5 305.3 408.2 Wanganui 3170.0 861.2 541.9 638.5 311.8 497.4 Manawatu 2277.2 528.1 381.0 480.0 195.0 354.0 Porirua/Kapiti 2790.9 621.3 409.3 374.8 217.0 226.8 Hutt Valley 2313.9 568.4 417.1 324.4 166.8 219.3 Wellington 2350.8 571.7 355.3 313.6 183.2 202.6 Wairarapa 2933.3 744.4 488.9 611.1 188.9 300.0 Nelson/Marlborough 2503.7 403.8 275.3 400.1 157.9 223.9 Central region 2637.0 615.3 400.7 437.2 208.6 289.2 rate per 10,000 Source: NZHJS

Table All: Leading causes of unintentional and intentional injuries by subregion, numbers ages 1-4 years, 1995-1996, males

Cause unintentional poisoning Subregion injury falls by drugs, etc hot caustic submersion etc Hawkes Bay 377 110 29 46 40 Wanganui 173 53 25 19 11 Manawatu 248 72 25 21 13 Porirua/Kapiti 190 61 28 17 5 Hutt Valley 240 75 22 20 10 Wellington 197 80 19 14 12 Wairarapa 57 17 10 4 1 Nelson/Marlborough 132 21 14 9 21 Central region 1614 489 172 150 113 Source: NZHIS

ELM

Appendix Tables - Page 199 Table Al2: Leading causes of unintentional and intentional injury by subregion, numbers, ages 1-4 years, 1995-1996, females

Cause unintentional poisoning poisoning Subregion injury falls by drugs, etc. submersion by solids etc Hawkes Bay 225 72 26 18 19 Wanganui 126 43 23 13 3 Manawatu 183 64 32 9 17 Porirua/Kapiti 114 42 17 8 8 Hutt Valley 180 60 17 9 4 Wellington 155 60 28 5 6 Wairarapa 52 22 6 4 6 Nelson/Marlborough 94 33 11 11 7 Central region 1129 396 160 77 70 Source: NZHIS

Table A13: Leading causes of hospitalisation by subregion, numbers, Maori, ages 5-14 years, 1995-1996, males

Cause Area all causes injury, poisoning dis respiratory dis nervous fractures otitis media Hawkes Bay 571 179 117 73 66 41 Wanganui 283 97 49 42 44 25 Manawatu 259 92 32 46 38 33 Porirua/Kapiti 193 39 27 29 14 20 Hutt Valley 204 63 23 39 38 26 Wellington 103 33 17 24 15 20 Wairarapa 86 23 21 10 7 6 Nelson/Marlborough 86 26 16 16 8 10 Central region 1785 552 302 279 230 181 Source: NZHIS

Page 200- The Public Health of the Central Region 1

Table A14: Leading causes of hospitalisation by subregion, numbers, nonMaori ages 5-14 years, 1995-1996, male

Cause Subregion all causes injury, poisoning dis respiratory dis nervous fractures otitis media Hawkes Bay 1523 380 297 190 161 90 Wanganui 658 207 99 72 103 57 Manawatu 1355 412 254 151 180 106 Porirua/Kapiti 885 221 120 112 109 65 Hutt Valley 1143 339 155 108 153 57 Wellington 1040 298 144 95 124 60 Wairarapa 404 97 87 50 46 40 Nelson/Marlborough 1036 207 140 163 83 113 Central region 8044 2161 1296 941 959 588 Source: NZHJS

Table A15: Leading causes of hospitalisation by subregion, numbers, ages 5-14 years, 1995-1996, male

Cause Subregion all causes injury, poisoning dis respiratory dis nervous dis digestive fractures Hawkes Bay 2094 559 414 263 187 227 Wanganui 941 304 148 114 101 147 Manawatu 1614 504 286 197 131 218 Porirua/Kapiti 1078 260 147 141 119 123 Hutt Valley 1347 402 178 147 150 191 Wellington 1143 331 161 119 125 139 Wairarapa 490 120 108 60 37 53 Nelson/Marlborough 1122 233 156 179 242 91 Central region 9829 2713 1598 1220 1092 1189 Source: NZHJS

Table A16: Leading causes of hospitalisation by subregion, rates, ages 5-14 years, 1995-1996, males

Cause Subregion all causes injury, poisoning dis respiratory dis nervous dis digestive fractures Hawkes Bay 1728.6 461.4 341.8 217.1 154.4 187.4 Wanganui 1622.7 524.2 255.2 196.6 174.2 253.5 Manawatu 1366.2 426.6 242.1 166.8 110.9 184.5 Porirua/Kapiti 1464.3 353.2 199.7 191.5 161.6 167.1 Hutt Valley 1272.3 379.7 168.1 138.8 141.7 180.4 Wellington 1181.0 342.0 166.4 123.0 129.2 143.6 Wairarapa 1483.5 363.3 327.0 181.7 112.0 160.5 Nelson/Marlborough 1258.8 261.4 175.0 200.8 271.5 102.1 Central region 1412.8 390.0 229.7 175.4 157.0 170.9 rate per 10,000 Source: NZH!S

Appendix Tables - Page 201 Table A17: Leading cause of hospitalisation by subregion, numbers, Maori, ages 5-14 years, 1995-1996, females

Cause Subregion all causes injury, poisoning dis respiratory dis nervous dis digestive fractures Hawkes Bay 490 128 93 59 55 53 Wanganui 213 57 25 35 29 23 Manawatu 160 38 25 30 22 21 Porirua/Kapiti 141 29 16 32 19 15 Hutt Valley 196 44 44 34 28 21 Wellington 70 15 16 13 5 5 Wairarapa 72 18 16 11 6 8 Nelson/Marlborough 41 10 9 6 9 4 Central region 1383 339 244 220 173 150 Source: NZHIS

Table A18: Selected leading causes of hospitalisation by subregion, numbers, nonMaori, ages 5-14 years, 1995-1996, females

Cause Subregion all causes injury, poisoning dis respiratory dis nervous dis digestive fractures Hawkes Bay 1265 238 254 173 131 126 Wanganui 532 130 107 75 48 60 Manawatu 1019 254 232 133 81 136 Porirua/Kapiti 583 147 106 82 77 65 Hutt Valley 756 150 153 97 89 76 Wellington 867 174 132 111 99 78 Wairarapa 320 62 59 48 27 31 Nelson/Marlborough 807 140 132 131 192 60 Central region 6149 1295 1175 850 744 632 Source: NZHIS

Table A19: Leading causes of hospitalisation by subregion, numbers, ages 5-14 years, 1995-1996, females

Cause Subregion all causes injury, poisoning dis respiratory dis nervous dis digestive fractures Hawkes Bay 1755 366 347 232 186 179 Wanganui 745 187 132 110 77 83 Manawatu 1179 292 257 163 103 157 Porirua/Kapiti 724 176 122 114 96 80 Hutt Valley 952 194 197 131 117 97 Wellington 937 189 148 124 104 83 Wairarapa 392 80 75 59 33 39 Nelson/Marlborough 848 150 141 137 201 64 Central region 7532 1634 1419 1070 917 782 Source: NZHJS

Page 202 - The Public Health of the Central Region I

Table A20: Leading causes of hospitalisation by subregion, rates, ages 5-14 years, 1995-1996, females

Cause Subregion all causes injury, poisoning dis respiratory dis nervous dis digestive fractures Hawkes Bay 1519.5 316.9 300.4 200.9 161.0 155.0 Wanganui 1334.4 334.9 236.4 197.0 137.9 148.7 Manawatu 1049.1 259.8 228.7 145.0 91.7 139.7 Porirua/Kapiti 1066.0 259.1 179.6 167.8 141.3 117.8 Hutt Valley 958.1 195.2 198.3 131.8 117.8 97.6 Wellington 1023.4 206.4 161.6 135.4 113.6 90.7 Wairarapa 1238.5 252.8 237.0 186.4 104.3 123.2 Nelson/Marlborough 994.6 175.9 165.4 160.7 235.7 75.1 Central region 1142.1 247.8 215.2 162.3 139.1 118.6

Source: NZHIS

Table A21: Leading causes of unintentional and intentional injuries by subregion, numbers, ages 5-14 years, 1995-1996, males

Cause Subregion unintentional injury falls striking/struck MVCs other road intentional injury Hawkes Bay 599 241 51 59 70 14 Wanganui 312 142 33 23 32 13 Manawatu 534 233 64 56 33 10 Porirua/Kapiti 295 141 21 21 22 7 Hutt Valley 415 181 44 27 27 13 Wellington 342 185 34 22 21 12 Wairarapa 127 47 12 15 9 5 Nelson/Marlborough 246 72 45 29 20 8 Central region 2870 1242 304 252 234 82 Source: NZHIS

Table A22: Leading causes of unintentional and intentional injuries by subregion, numbers, ages 5-14 years, 1995-1996, females

Cause Subregion unintentional injury falls other road MVCs med surg comps intentional injury flawkes Bay 368 171 34 28 23 23 Wanganui 194 72 34 13 11 9 Manawatu 308 145 38 24 22 12 Porirua/Kapiti 168 90 20 19 8 15 Hutt Valley 194 101 10 9 13 11 Wellington 198 97 15 22 10 10 Wairarapa 86 44 12 8 2 5 Nelson/Marlborough 58 68 24 13 9 4 Central region 1674 788 187 136 98 89 Source: NZHIS

IAppendix Tables - Page 203 Table A23: Leading causes of death by subregion, numbers, ages 15-24 years, 1990-1994, males

Cause

Subregion all causes unintentional injury MVCs intentional injury suicide Hawkes Bay 105 64 53 19 18 Wanganui 45 26 21 12 8 Manawatu 94 53 42 30 25 Porirua/Kapiti 49 24 20 15 13 Hutt Valley 82 39 28 35 33 Wellington 81 41 27 32 31 Wairarapa 31 18 12 10 9 Nelson/Marlborough 49 27 21 12 10 Central region 536 292 224 165 147 Source: NZH!S

Table A24: Leading causes of death by subregion, numbers, ages 15-24 years, 1990-1994, females

Cause Subregion all causes unintentional injury MVCs intentional injury suicide Hawkes Bay 37 23 18 5 3 Wanganui 16 9 8 3 3 Manawatu 40 20 17 4 2 Porirua/Kapiti 26 13 10 2 2 Hutt Valley 23 9 8 4 3 Wellington 24 12 11 9 8 Wairarapa 10 3 2 2 1 Nelson/Marlborough 21 111 8 3 1 Central region 197 100 82 32 23 Source: NZHIS

Table A25: Leading causes of hospitalisation by subregion, numbers, Maori, ages 15-24 years, 1995-1996, males

Cause

Subregion all causes injury, poisoning dis digestive dls respiratory fractures intracranial injury Hawkes Bay 539 274 31 40 69 66 Wanganui 203 112 14 13 23 22 Manawatu 235 112 24 25 36 20 Porirua/Kapiti 113 48 14 7 12 10 Hutt Valley 201 99 36 10 31 13 Wellington 107 48 12 8 18 18 Wairarapa 82 40 9 7 4 12 Nelson/Marlborough 76 41 4 9 8 17 Central region 1556 774 144 119 201 178 Source: NZHIS

Page 204 - The Public Health of the Central Region I

Table A26: Selected leading causes of hospitalisation by subregion, numbers, nonMaori, ages 15-24 years, 1995-1996, males

Cause

Subregion all causes injury, poisoning dis digestive dis respiratory fractures intracranial injury Hawkes Bay 1276 629 129 72 191 153 Wanganui 622 312 59 56 109 60 Manawatu 1678 830 167 153 255 222 Porirua/Kapiti 615 292 71 46 91 67 Hutt Valley 1095 483 145 86 170 88 Wellington 1240 532 117 108 166 117 Wairarapa 348 175 40 24 47 48 Nelson/Marlborough 1043 488 112 50 181 101 Central region 7917 3741 840 595 1210 856 Source: NZHIS

Table A27: Leading causes of hospitalisation by subregion, numbers, ages 15-24 years, 1995-1996, males

Cause Subregion all causes injury, poisoning dis digestive dis respiratory fractures intracranial injury Hawkes Bay 1815 903 160 112 260 219 Wanganui 825 424 73 69 132 82 Manawatu 1913 942 191 178 291 242 Porirua/Kapiti 728 340 85 53 103 77 Hutt Valley 1296 582 181 96 201 101 Wellington 1347 580 129 116 184 135 Wairarapa 430 215 49 31 51 60 Nelson/Marlborough 1119 529 116 59 189 118 Central region 9473 4515 984 714 1411 1034 Source: NZHIS

Table A28: Leading causes of hospitalisation by subregion, rates, ages 15-24 years, 1995-1996, males

Cause

Subregion all causes injury, poisoning dis digestive dis respiratory fractures intracranial injury Hawkes Bay 1873.1 931.9 165.1 115.6 268.3 226.0 Wanganui 1724.1 886.1 152.6 144.2 275.9 171.4 Manawatu 1467.2 722.5 146.5 136.5 223.2 185.6 Porirua/Kapiti 1343.7 627.5 156.9 97.8 190.1 142.1 Hutt Valley 1332.5 598.4 186.1 98.7 206.7 103.8 Wellington 1066.3 459.1 102.1 91.8 145.7 106.9 Wairarapa 1769.5 884.8 201.6 127.6 209.9 246.9 Nelson/Marlborough 1419.3 671.0 147.1 74.8 239.7 149.7 Central region 1444.0 688.2 150.0 108.8 215.1 157.6 rate per 10,000 Source: NZHIS

Appendix Tables - Page 205 Table A29: Leading causes of hospitalisation by subregion, numbers, Maori, ages 15-24 years, 1995-1996, females Cause normal delivery, preg complications abortive injury. Subregion all causes probs comps labour pregnancy poisoning Hawkes Bay 1818 477 377 268 122 117 Wanganui 818 165 217 149 29 49 Manawatu 864 215 172 142 48 62 Porirua/Kapiti 599 160 154 126 33 26 Hutt Valley 769 220 128 115 71 26 Wellington 400 74 85 57 56 28 Wairarapa 345 84 75 54 36 29 Nelson/Marlborough 270 64 42 41 43 17 Central region 5883 1459 1250 952 438 354

Table A30: Selected leading causes of hospitalisation by subregion, numbers, nonMaori, ages 15-24 years, 1995-1996, females

Cause normal delivery, preg complications abortive injury, Subregion all causes probs comps labour pregnancy poisoning Hawkes Bay 2986 472 515 299 192 265 Wanganui 1417 321 214 194 43 126 Manawatu 3259 612 488 395 142 302 Porirua/Kapiti 1645 303 309 270 102 111 Hutt Valley 2431 380 396 250 222 167 Wellington 2598 358 254 244 259 262 Wairarapa 782 108 144 85 88 96 Nelson/Marlborough 2121 222 324 198 372 149 Central region 17239 2776 2644 1935 1420 1478

Table A31: Leading causes of hospitalisation by subregion, numbers, ages 15-24 years, 1995-1996, females

Cause normal delivery, preg complications abortive Injury, Subregion all causes probs comps labour pregnancy poisoning Hawkes Bay 4804 992 849, 567 314 382 Wanganui 2235 379 538 343 72 175 Manawatu 4123 703 784 537 190 364 Porirua/Kapiti 2244 469 457 396 135 137 Hutt Valley 3200 616 508 365 293 193 Wellington 2998 328 443 301 315 290 Wairarapa 1127 228 183 139 124 125 Nelson/Marlborough 2391 388 264 239 415 166 Central region 23122 4103 4026 2887 1858 1832

Page 206 - The Public Health of the Central Region I

Table A32: Leading causes of hospitalisation by subregion, rates, ages 15-24 years, 1995-1996, females Cause normal delivery, preg complications abortive injury, Subregion all causes probs comps labour pregnancy poisoning Hawkes Bay 5040.4 1040.8 890.8 594.9 329.5 400.8 Wanganui 5003.4 848.4 1204.4 767.9 161.2 391.8 Manawatu 3202.1 546.0 608.9 417.1 147.6 282.7 Porirua/Kapiti 4192.8 876.3 853.9 739.9 252.2 256.0 Mutt Valley 3272.0 629.9 519.4 373.2 299.6 197.3 Wellington 2145.4 234.7 317.0 215.4 225.4 207.5 Wairarapa 4816.2 974.4 782.1 594.0 529.9 534.2 Nelson/Marlborough 3361.5 545.5 371.2 336.0 583.4 233.4 Central region 3533.7 627.1 615.3 441.2 284.0 280.0 rate per 10,000 Source: NZHIS

Table A33: Leading causes of unintentional and intentional injuries by subregion, ages 15-24 years, 1995-1996, males

Cause Subregion unintentional injury MVCs falls striking/struck intentional injury homicide, mi Hawkes Bay 814 232 160 78 178 137 Wanganui 380 101 83 27 98 79 Manawatu 867 240 154 105 182 129 Porirua/Kapiti 311 83 64 40 61 41 Mutt Valley 483 78 97 96 154 111 Wellington 529 109 122 75 106 71 Wairarapa 191 59 26 26 52 44 Nelson/Marlborough 495 118 78 75 87 66 Central region 4070 1020 784 522 918 678 Source: NZHIS

Table A34: Leading causes of unintentional and intentional injuries by subregion, numbers, ages 15-24 years, 1995-1996, females

Cause Subregion unintentional injury MVCs falls med surg comps intentional injury suicide, self-inf Hawkes Bay 322 103 42 34 125 78 Wanganui 155 35 31 16 59 42 Manawatu 351 100 57 57 94 73 Porirua/Kapiti 133 41 17 22 30 22 Mutt Valley 149 37 23 18 64 33 Wellington 232 45 59 34 88 71 Wairarapa 108 36 20 16 41 31 Nelson/Marlborough 152 42 16 26 47 40 Central region 1602 439 265 223 548 390 Source: NZHIS

Appendix Tables - Page 207

Table A35: Leading conditions for mental health, by subregion, numbers, ages 25-44 years, 1992-1993, males

Condition All Alcohol Affective Schizophrenic Stress and Drug dependence Subregion conditions dependence psychoses disorders adjustment or abuse Hawkes Bay 54 17 5 3 10 7 Wanganui 57 9 13 4 10 1 Manawatu 81 22 12 12 10 10 Porinia/Kapiti 34 10 5 7 1 5 Hutt Valley 79 20 10 8 7 12 Wellington 98 36 14 18 6 7 Wairarapa 18 4 2 1 0 3 Nelson/Marlborough 55 16 4 2 9 4 Central region 477 135 65 55 53 49 Source: NZHIS

Table A36: Leading condition for mental health, by subregion, numbers, ages 25-44 years, 1992-1993, females

Conditions all affective stress and alcohol neurotic schizophrenic and Subregion conditions psychoses adjustment dependence disorders other disorders Hawkes Bay 71 8 11 15 10 5 Wanganui 50 15 7 5 8 6 Manawatu 78 20 21 10 6 8 PorirualKapiti 36 10 4 7 3 4 Hutt Valley 63 14 6 9 8 8 Wellington 75 12 8 13 13 4 Wairarapa 9 2 1 0 0 2 Nelson/Marlborough 74 11 13 7 11 4 Central region 452 92 71 66 59 41 Source: NZJIIS

Page 208 - The Public Health of the Central Region p Table A37: Leading causes of death, by subregion, numbers, ages 25-44 years, 1990-1994, males

Cause

Subregion all causes unintentional injury MVCs intentional injury suicide dis circulatory ischaemic heart Hawkes Bay 195 77 50 32 28 36 20 Wanganui 86 29 17 21 17 14 10 Manawatu 154 43 27 32 29 28 15 Porirua/Kapiti 91 27 19 23 20 20 12 Hutt Valley 139 38 20 27 22 29 21 Wellington 158 30 15 29 27 26 12 Wairarapa 43 11 7 8 8 10 7 Nelson/Marlborough 121 39 25 28 23 11 6 Central region 987 294 180 200 174 174 103 rate per 100,000 Source: NZHJS

Table A38: Leading causes of death by subregion, numbers, ages 25-44 years, 1990-1994, females

Cause

Subregion all causes cancer ca breast dis circulatory unintentional injury MVCs intentional injury Hawkes Bay 102 43 8 19 16 14 9 Wanganui 55 26 9 13 10 8 2 Manawatu 98 30 7 20 20 16 12 Porirua/Kapiti 64 16 4 13 10 7 10 Hutt Valley 104 43 14 17 12 6 10 Wellington 86 37 13 10 8 5 13 Wairarapa 28 14 2 6 2 1 3 Nelson/Marlborough 64 26 12 9 9 6 8 Central region 601 235 69 107 87 63 67 Source: NZHIS

Table A39: Leading causes of hospitalisation by subregion, numbers, Maori, ages 25-44 years, 1995-1996, males

Cause

Subregion all causes Injury, poisoning dis digestive mental disorders dls respiratory fractures Hawkes Bay 847 288 80 82 74 77 Wanganui 396 133 53 11 25 44 Manawatu 419 119 56 57 32 28 Porirua/Kapiti 178 61 24 3 15 20 Hutt Valley 324 104 41 27 24 36 Wellington 247 64 27 29 18 19 Wairarapa 145 53 20 9 12 19 Nelson/Marlborough 123 37 23 1 8 11 Central region 2679 859 324 219 208 254 Source: NZHIS

Appendix Tables - Page 209 Table A40: Selected leading causes of hospitalisation by subregion, numbers, nonMaori, ages 25-44 years, 1995-1996, males

Cause Subregion all causes injury, poisoning dis digestive mental disorders dis respiratory fractures Hawkes Bay 2595 816 348 182 142 234 Wanganui 1266 377 199 21 76 110 Manawatu 2628 750 330 251 154 214 Porirua/Kapiti 1225 377 132 41 72 109 Hutt Valley 2163 590 399 124 123 193 Wellington 2712 775 284 216 160 285 Wairarapa 701 220 101 36 30 62 Nelson/Marlborough 2192 598 411 29 83 189 Central region 15482 4503 2204 900 840 1396 Source: NZHJS Table A41: Leading causes of hospitalisation by subregion, numbers, ages 25-44 years, 1995-1996, males

Cause Subregion all causes Injury, poisoning dis digestive symptoms, signs dis musculoskeletal fractures Hawkes Bay 3442 1104 428 311 221 311 Wanganui 1662 510 252 112 217 154 Manawatu 3047 869 386 270 237 242 Porirua/Kapiti 1403 438 15 100 153 129 Hutt Valley 2487 694 440 278 150 229 Wellington 2959 839 311 256 239 304 Wairarapa 846 273 121 78 65 81 Nelson/Marlborough 2315 635 434 251 222 200 Central Region 18161 5362 2528 1656 1504 1650 Source: NZHJS Table A42: Leading causes of hospitalisation by subregion, rates, ages 25-44 years, 1995-1996, males Cause Subregion all causes Injury, poisoning dls digestive symptoms, signs dis musculoskeletal fractures Hawkes Bay 1743.1 559.1 216.8 157.5 111.9 157.5 Wanganui 1722.6 528.6 261.2 116.1 224.9 159.6 Manawatu 1435.4 409.4 181.8 127.2 111.6 114.0 Porirua/Kapiti 1230.7 384.2 136.8 87.7 134.2 113.2 Hutt Valley 1224.2 341.6 216.6 136.8 73.8 112.7 Wellington 1043.5 295.9 109.7 90.3 84.3 107.2 Wairarapa 1650.1 532.5 236.0 152.1 126.8 158.0 Nelson/Marlborough 1348.6 369.9 252.8 146.2 129.3 116.5 Central Region 1365.6 403.2 190.1 124.5 113.1 124.1 rate per 10.000 Source: NZHIS

Page 210- The Public Health of the Central Reg/on p Table A43: Leading causes of hospitalisation by subregion, numbers, Maori, ages 25-44 years, 1995-1996, females

Cause all normal delivery. preg complications dis injury, Subregion causes probs comps labour genitourinary poisoning Hawkes Bay 2138 461 337 155 179 186 Wanganui 993 179 169 102 96 65 Manawatu 1147 227 185 108 106 77 Porirua/Kapiti 705 154 123 90 67 47 Hutt Valley 1034 266 164 86 115 63 Wellington 586 79 86 59 81 57 Wairarapa 332 67 45 28 28 22 Nelson/Marlborough 328 67 29 28 55 15 Central region 7263 1500 1138 656 727 532 Source: NZHIS

Table A44: Selected leading causes of hospitalisation by subregion, numbers, nonMaori, ages 25-44 years, 1995-1996, females

Cause all normal delivery, preg complications dis injury, Subregion causes probs comps labour genitourinary poisoning Hawkes Bay 6010 1280 754 700 568 321 Wanganui 3047 522 485 366 407 188 Manawatu 6840 1292 1069 1026 757 386 Porirua/Kapiti 3844 829 574 615 372 183 Hutt Valley 6422 1378 956 925 628 305 Wellington 8374 1509 1447 1530 741 440 Wairarapa 1813 353 212 257 192 110 Nelson/Marlborough 5575 1178 527 714 749 243 Central region 41925 8341 6024 6133 4414 2176 Source: NZHIS

Table A45: Leading causes of hospitalisation by subregion, numbers, ages 25-44 years, 1995-1996, females

Cause all normal delivery, preg complications dis dis Subregion causes probs comps labour genitourinary digestive Hawkes Bay 8148 1741 1091 855 747 605 Wanganui 4040 701 654 468 503 305 Manawatu 7987 1519 1254 1134 863 478 Porirua/Kapiti 4549 983 697 705 439 213 Hutt Valley 7456 1644 1120 1011 743 465 Wellington 8960 1588 1533 1589 822 358 Wairarapa 2145 420 257 285 220 110 Nelson/Marlborough 5903 1245 556 742 804 408 Central region 49188 9841 7162 6789 5141 2942 Source: NZHIS

Appendix Tables - Page 211 Table A46: Leading causes of hospitalisation by subregion, rates, ages 25-44 years, 1995-1996, females Cause all normal delivery, preg complications dis dis Subregion causes probs comps labour genitourinary digestive I-lawkes Bay 3842.7 821.1 514.5 403.2 352.3 285.3 Wanganui 4056.2 703.8 656.6 469.9 505.0 306.2 Manawatu 3595.3 683.8 564.5 510.5 388.5 215.2 PorirualKapiti 3575.4 722.6 547.8 554.1 345.0 167.4 Hutt Valley 3556.1 784.1 534.2 482.2 354.4 221.8 Wellington 3025.1 536.1 517.6 536.5 277.5 120.9 Wairarapa 3902.8 764.2 467.6 518.6 400.3 200.1 Nelson/Marlborough 3352.6 707.1 315.8 421.4 456.6 231.7 Central region 3518.7 704.0 512.3 485.7 367.8 210.5 rate per 10,000 Source: NZHIS

Table A47: Leading causes of unintentional and intentional injuries by subregion, numbers, ages 25-44 years, 1995-1996, males

Cause

Subregion unintentional injury MVCs falls med surg comps intentional injury homicide, inj Hawkes Bay 1108 227 160 141 187 135 Wanganui 518 73 83 49 92 60 Manawatu 911 197 111 119 163 84 Porirua/Kapiti 447 67 86 53 85 58 Hutt Valley 649 91 121 96 146 79 Wellington 796 122 201 87 171 95 Wairarapa 268 61 37 22 59 37 Nelson/Marlborough 653 108 93 55 98 62 Central region 5350 946 892 622 1001 610 Source: NZHJS

Table A48: Leading causes of unintentional and intentional injuries by subregion, numbers, ages 25-44 years, 1995-1996, females

Cause

Subregion unintentional injury med surg comps MVCs falls Intentional Injury suicide, self-inf Hawkes Bay 575 166 81 83 107 70 Wanganui 317 118 32 41 58 37 Manawatu 581 201 94 43 133 97 Porirua/Kapiti 254 87 35 44 45 35 Hutt Valley 350 132 30 40 124 67 Wellington 465 132 62 79 151 128 Wairarapa 134 21 27 21 32 21 Nelson/Marlborough 287 96 36 21 71 58 Central region 2963 953 397 372 721 513 Source: NZHIS

Page 212 - The Public Health of the Central Region Table A49: Leading sites of cancer registration by subregion, ages 25-44 years, numbers, 1990-1993, males

Site

Subregion all sites melanoma testis lymphomas large bowel Hawkes Bay 55 16 7 7 3 Wanganui 32 13 3 2 3 Manawatu 72 24 13 10 6 Porirua/Kapiti 44 6 14 5 2 Hutt Valley 63 21 8 5 3 Wellington 82 21 6 10 3 Wairarapa 19 5 2 1 5 Nelson/Marlborough 53 9 10 5 7 Central region 420 115 63 45 32 Source: NZHJS

Table A50: Leading sites of cancer registration by subregion, numbers, ages 25-44 years, numbers, 1990-1993, females

Site

Subregion all sites breast melanoma cervix ovary

Hawkes Bay 131 40 23 20 5

Wanganui 69 26 11 8 2

Manawatu 142 42 36 26 7

Ponrua/Kapiti 72 21 15 8 5

Hutt Valley 131 39 33 15 7

Wellington 131 43 35 12 8

Wairarapa 41 10 13 4

Nelson/Marlborough 88 32 25 6 5

Central region 805 253 191 99 40 Source: NZHJS

Table A51: Leading causes of death, numbers, ages 45-64 years, 1990-1994, males

Cause

Subregion all causes dis circulatory ischaemic heart cancer ca trachea, lung dis respiratory unintentional Injury Hawkes Bay 597 257 183 200 54 26 22 Wanganui 301 138 94 92 32 19 18 Manawatu 509 216 175 177 44 31 26 Porirua/Kapiti 379 169 121 130 34 25 10 Hutt Valley 515 234 179 171 39 27 17 Wellington 529 205 150 201 56 29 18 Wairarapa 168 69 51 57 15 8 12 Nelson/Marlborough 371 161 115 133 31 17 11 Central region 3369 1449 1068 1161 305 182 134 Source: NZHIS

Appendix Tables - Page 213 L Table A52: Leading causes of death, numbers, ages 45-64 years, 1990-1994, females 0 Cause

Subregion all causes cancer ca breast ca trachea, lung ca large bowel dis circulatory lschaemic heart

Hawkes Bay 422 191 46 35 24 141 75

Wanganui 215 89 13 18 8 57 29

Manawatu 377 200 58 27 36 93 53

Porirua/Kapiti 239 116 26 25 11 65 36

Hutt Valley 322 177 40 23 33 83 44

Wellington 276 154 47 15 25 73 35

Wairarapa 107 58 8 7 15 29 21

Nelson/Marlborough 270 157 35 25 27 61 41

Central region 2228 1142 273 175 179 602 334 Source: NZHIS

Table A53: Leading causes of hospitalisation by subregion, numbers, Maori, ages 45-64 years, 1995-1996, males

Cause Subregion all causes dis circulatory injury, poisoning dis digestive other heart dis respiratory Hawkes Bay 693 157 88 82 80 61 Wanganui 341 62 40 43 28 32 Manawatu 272 82 33 16 29 26 Porirua/Kapiti 174 37 19 17 12 12 Hutt Valley 260 43 30 43 17 22 Wellington 157 45 21 13 20 14 Wairarapa 110 43 3 17 17 13 Nelson/Marlborough 97 44 9 9 24 9 Central region 2104 513 243 240 227 189 Source: NZHJS

Table A54: Selected leading causes of hospitalisation by subregion, numbers, nonMaori, ages 45-64 years, 1995-1996, males

Cause Subregion all causes dis circulatory injury, poisoning dis digestive other heart dis respiratory Hawkes Bay 3255 720 421 416 104 212 Wanganui 1581 294 208 231 55 79 Manawatu 3121 808 363 392 165 172 PorirualKapiti 1639 441 156 195 110 129 Hutt Valley 2808 809 315 436 127 133 Wellington 2718 694 366 295 164 165 Wairarapa 1080 243 129 149 55 56 Nelson/Marlborough 3128 772 305 533 123 105 Central region 19330 4781 2263 2647 903 1051

Source: NZHIS

Page 214 - The Public Health of the Central Region 01 Table A55: Leading causes of hospitalisation by subregion, numbers, ages 45-64 years, 1995-1996, males

Cause Subregion all causes dis circulatory dis digestive injury, poisoning symptoms, signs ischaemic heart Hawkes Bay 3948 877 498 509 417 465 Wanganui 1922 356 274 248 194 163 Manawatu 3393 890 408 396 368 469 Porirua/Kapiti 1813 478 212 175 195 218 Hutt Valley 3068 852 479 345 345 473 Wellington 2875 739 308 387 293 378 Wairarapa 1190 286 166 132 107 134 Nelson/Marlborough 3225 816 542 314 324 446 Central region 21434 5294 2887 2506 2243 2746 Source: NZHIS

Table A56: Leading causes of hospitalisation by subregion, rates, ages 45-64 years, 1995-1996, males

Cause Subregion all causes dis circulatory dis digestive injury, poisoning symptoms, signs ischaemic heart Hawkes Bay 2669.9 593.1 336.8 344.2 282.0 314.5 Wanganui 2996.6 555.0 427.2 386.7 302.5 254.1 Manawatu 2415.6 633.6 290.5 281.9 262.0 333.9 Porirua/Kapiti 2102.8 554.4 245.9 203.0 226.2 252.8 Hutt Valley 2310.1 641.5 360.7 259.8 259.8 356.1 Wellington 1910.2 491.0 204.6 257.1 194.7 251.1 Wairarapa 2843.5 683.4 396.7 315.4 255.7 320.2 Nelson/Marlborough 2517.6 637.0 423.1 245.1 252.9 348.2 Central region 2403.0 593.5 323.7 281.0 251.5 307.9 rate per 10.000 Source: NZHJS

Table A57: Leading causes of hospitalisation by subregion, numbers, Maori, ages 45-64 years, 1995-1996, females

Cause Subregion all causes dis circulatory dis respiratory dis genitourinary dis digestive symptoms, signs Hawkes Bay 748 136 67 101 91 80 Wanganui 375 69 •69 44 27 34 Manawatu 333 63 47 53 23 33 Porirua/Kapiti 244 38 45 18 22 28 Hutt Valley 257 48 28 38 31 19 Wellington 185 35 33 18 10 24 Wairarapa 121 15 12 16 16 3 Nelson/Marlborough 129 30 10 13 18 17 Central region 2392 434 311 301 238 238 Source: NZHIS

Appendix Tables- Page 215 Table A58: Selected leading causes of hospitalisation by subregion, numbers, nonMaori, ages 45-64 years, 1995-1996, females

Cause Subregion all causes dis circulatory dis respiratory dis genitourinary dls digestive symptoms, signs Hawkes Bay 3027 354 206 338 480 339 Wanganui 1645 197 135 216 282 157 Manawatu 3248 425 203 436 482 390 Porirua/Kapiti 1693 235 146 200 157 162 Hutt Valley 2722 357 164 314 473 337 Wellington 2480 282 179 284 254 299 Wairarapa 1090 140 82 151 153 103 Nelson/Marlborough 2744 315 107 454 454 264 Central region 18649 2305 1222 2393 2735 2051 Source: NZHIS

Table A59: Leading causes of hospitalisation by subregion, numbers, ages 45-64 years, 1995-1996, females

Cause Subregion all causes dis digestive dis circulatory dis genitourinary symptoms, signs cancer Hawkes Bay 3775 571 490 439 419 355 Wanganui 2020 309 266 260 191 191 Manawatu 3581 505 488 489 423 399 PorirualKapiti 1937 179 273 218 190 217 Hutt Valley 2979 504 405 352 356 237 Wellington 2665 264 317 302 323 343 Wairarapa 1211 169 155 167 106 137 Nelson/Marlborough 2873 472 345 467 281 378 Central region 21041 2973 2739 2694 2289 2257 Source: NZHIS

Table A60: Leading causes of hospitalisation by subregion, rates, ages 45-64 years, 1995-1996, females Cause Subregion all causes dis digestive dis circulatory dis genitourinary symptoms, signs cancer Flawkes Bay 2519.2 381.0 327.0 293.0 279.6 236.9 Wanganui 3041.3 465.2 400.5 391.4 287.6 287.6 Manawatu 2480.1 349.7 338.0 338.7 293.0 276.3 Porirua/Kapiti 2167.4 200.3 305.5 243.9 212.6 242.8 Hutt Valley 2262.0 382.7 307.5 267.3 270.3 180.0 Wellington 1808.1 179.1 215.1 204.9 219.1 232.7 Wairarapa 2908.3 405.9 372.2 401.1 254.6 329.0 Nelson/Marlborough 2298.2 377.6 276.0 373.6 224.8 302.4 Central region 2348.9 331.9 305.8 300.7 255.5 252.0 Source: NZHIS

Page 216- The Public Health of the Central Region p Table A61: Leading causes of unintentional and intentional injuries by subregion, numbers, ages 45-64 years, 1995-1996, males

Cause

Subregion unintentional injury med surg comps falls MVCS late effects intentional injury Hawkes Bay 691 182 114 92 54 21 Wanganui 356 110 53 29 31 13 Manawatu 571 173 78 66 50 15 Porirua/Kapiti 253 75 43 18 14 12 Hutt Valley 416 156 86 36 15 19 Wellington 498 171 122 47 22 26 Wairarapa 177 46 36 16 19 14 Nelson/Marlborough 459 151 76 33 65 15 Central region 3421 1064 608 337 270 135 Source: NZHJS

Table A62: Leading causes of unintentional and intentional injuries by subregion, numbers, ages 45-64 years, 1995-1996, females

Cause

Subregion unintentional injury med surg comps falls adverse effects drugs MVCs intentional injury Hawkes Bay 469 181 90 49 37 19 Wanganui 242 99 36 32 21 12 Manawatu 445 191 65 56 29 41 Porirua/Kapiti 276 111 57 36 22 11 Hutt Valley 303 114 77 26 25 21 Wellington 349 128 89 21 39 28 Wairarapa 130 43 35 13 10 10 Nelson/Marlborough 306 108 74 39 12 19 Central Region 2520 975 523 272 195 161 Source: NZHIS

Table: A63: Leading sites of cancer registration by subregion, numbers, ages 45-64 years, 1990-1993, males

Site

Subregion All sites large bowel trachea, lung melanoma prostate bladder Hawkes Bay 294 60 48 26 21 26 Wanganui 138 26 27 10 8 10 Manawatu 290 60 50 29 27 15 Ponnia/Kapiti 169 32 36 12 12 8 Hutt Valley 232 34 40 33 20 8 Wellington 264 50 50 25 9 9 Wairarapa 95 24 16 7 8 4 Nelson/Marlborough 185 53 29 11 14 10 Central region 1667 339 296 153 119 90 Source: NZHIS

Appendix Tables - Page 217 Table A64: Leading sites of cancer registration by subregion, numbers, ages 45-64 years, 1990-1993, females

Site Subregion All sites breast large bowel melanoma trachea, lung ovary Hawkes Bay 332 114 44 19 23 15 Wanganui 166 48 30 18 17 8 Manawatu 352 111 48 31 33 17 Porirua/Kapiti 216 66 15 17 26 11 Hutt Valley 317 100 52 42 22 13 Wellington 310 113 39 39 18 14 Wairarapa 111 31 22 10 8 9 Nelson/Marlborough 265 88 39 18 17 14 Central region 2069 671 289 194 164 101 Source: NZHIS Table A65: Leading causes of death by subregion, numbers, ages 65-74 years, 1990-1994, males

Cause Subregion all causes dis circulatory ischaemic heart cerebrovascular cancer ca lung dis respiratory Hawkes Bay 839 410 281 62 237 63 81 Wanganui 431 219 151 38 134 42 42 Manawatu 842 411 292 71 258 75 81 Porirua/Kapiti 510 233 151 52 158 45 60 Hutt Valley 640 310 214 43 206 57 67 Wellington 571 268 191 41 186 37 50 Wairarapa 241 116 82 15 75 19 20 Nelson/Marlborough 635 315 207 49 188 54 55 Central region 4709 2282 1569 371 1442 392 456 Source: NZHIS

Table A66: Leading causes of death by subregion, numbers, ages 65-74 years, 1990-1994, females

Cause Subregion all causes dis circulatory ischaemic heart cerebrovascular cancer dis respiratory Hawkes Bay 568 259 147 69 188 44 Wanganui 303 127 83 28 97 33 Manawatu 598 257 151 61 208 46 Porirua/Kapiti 316 134 90 19 112 30 Hutt Valley 466 197 124 47 155 58 Wellington 375 147 87 32 144 39 Wairarapa 172 77 48 16 55 17 Nelson/Marlborough 397 171 103 42 129 32 Central region 3195 1369 833 314 1088 299 Source: NZHIS

Page 218— The Public Health of the Central Region p Table A67: Leading causes of hospitalisation by subregion, numbers, ages 65-74 years, 1995-1996, males

Cause Subregion all causes dis circulatory cancer dis digestive dis respiratory ischaemic heart Hawkes Bay 3261 832 350 377 277 362 Wanganui 1651 315 326 239 144 123 Manawatu 3331 856 441 378 341 388 Porirua/Kapiti 1667 496 195 162 165 201 Hutt Valley 2432 664 259 345 235 283 Wellington 2073 593 207 212 174 239 Wairarapa 939 269 125 126 85 96 Nelson/Marlborough 2534 675 357 349 127 354 Central region 17888 4700 2260 2188 1548 2046 Source: NZHIS

Table A68: Leading causes of hospitalisation by subregion, numbers, ages 65-74 years, 1995-1996, females

Cause Subregion all causes dis circulatory dis digestive cancer dis respiratory injury, poisoning Hawkes Bay 2397 574 335 242 260 289 Wanganui 1227 234 179 182 149 134 Manawatu 2555 577 356 343 261 210 Porirua/Kapiti 1338 323 135 143 134 126 Hutt Valley 1929 433 273 189 198 175 Wellington 1572 338 164 148 136 157 Wairarapa 847 203 119 107 86 70 Nelson/Marlborough 2166 490 310 268 124 129 Central region 14031 3172 1871 1622 1348 1290 Source: NZHIS

Appendix Tables - Page 219 Table A69: Leading causes of unintentional and intentional injuries by subregion, rates, ages 65-74 years, 1995-1996, males

Cause unintentional med surg adverse effects late intentional Subregion injury comps falls drugs effects injury Hawkes Bay 493 198 89 41 89 9 Wanganui 196 94 42 22 6 3 Manawatu 443 239 82 42 14 6 Porirua/Kapiti 234 125 45 23 4 7 Hutt Valley 263 149 54 12 1 5 Wellington 317 191 57 25 5 4 Wairarapa 101 58 24 8 1 - Nelson/Marlborough 281 141 44 26 14 2 Central region 2328 1195 437 199 134 36 rare per 10,000 Source: NZHIS

Table A70: Leading causes of unintentional and intentional injuries by subregion, rates, ages 65-74 years, 1995-1996, females

Cause unintentional adverse Intentional Subregion injury med surg comps falls effects drugs MVC5 injury Hawkes Bay 424 150 157 39 21 2 Wanganui 228 92 80 20 10 3 Manawatu 414 174 127 54 9 4 Porirua/Kapiti 209 64 73 28 14 3 Hutt Valley 268 104 114 23 9 5 Wellington 257 98 92 28 11 2 Wairarapa 116 47 45 10 6 2 Nelson/Marlborough 240 94 61 37 3 1 Central region 2156 823 749 239 83 22 rare per 100,000 Source: NZHIS

Page 220 - The Public Health of the Central Region U Table A71: Leading sites of cancer registration by subregion, rates, ages 65-74 years, 1990-1993, males

Site

Subregion all sites trachea, lung large bowel prostate melanoma bladder Hawkes Bay 326 60 55 57 14 26 Wanganui 165 27 36 21 9 10 Manawatu 387 72 53 92 34 23 Porirua/Kapiti 187 32 31 49 15 10 Hutt Valley 241 53 31 41 20 6 Wellington 234 28 39 39 16 6 Wairarapa 108 17 26 22 6 4 Nelson/Marlborough 261 41 51 55 10 15 Central region 1909 330 322 376 124 100 rate per 100,000 Source: NZHIS

Table A72: Leading sites of cancer registration by subregion, rates, ages 65-74 years, 1990-1993, females

Site

Subregion all sites breast large bowel trachea, lung melanoma uterus Hawkes Bay 258 56 50 42 17 11 Wanganui 152 36 27 23 9 7 Manawatu 321 74 76 36 23 12 PorirualKapiti 168 37 19 19 11 11 Hutt Valley 194 42 57 18 14 5 Wellington 183 39 36 23 9 7 Wairarapa 80 17 18 11 6 0 Nelson/Marlborough 204 56 37 22 8 14 Central region 1560 357 320 194 97 67 rate per 100,000 Source: NZHIS Table A73: Leading causes of death by subregion, numbers, ages 75 years and older, 1990-1994, males

Cause

Subregion all causes dis circulatory ischaemic heart cerebrovascular cancer dis respiratory CORD Hawkes Bay 1377 695 412 143 320 182 106 Wanganui 682 326 173 84 154 103 54 Manawatu 1446 705 400 147 307 235 113 Porirua/Kapiti 747 342 182 75 181 122 72 Hutt Valley 960 437 259 105 206 171 87 Wellington 1018 516 283 134 233 162 95 Wairarapa 401 197 106 49 82 58 32 Nelson/Marlborough 1072 550 332 111 217 164 89 Central region 7703 3768 2147 848 1700 1197 648 Source: NZHJS

Appendix Tables - Page 221 L Table A74: Leading causes of death by subregion, numbers, ages 75 years and older, fl 1990-1994, females

Cause

Subregion all causes dis circulatory ischaemic heart cerebrovascular cancer dis respiratory pneumonia, influ Hawkes Bay 1722 986 475 315 246 191 99 Wanganui 900 528 251 148 124 94 52 Manawatu 1756 966 460 304 271 236 150 Porirua/Kapiti 857 450 187 152 150 120 68 Hutt Valley 1399 727 381 208 246 213 129 Wellington 1450 775 344 286 236 236 140 Wairarapa 492 270 123 85 67 63 36 Nelson/Marlborough 1288 708 356 239 199 148 99 Central region 9864 5410 2577 1737 1539 1301 773 Source: NZHIS

Table A75: Leading causes of hospitalisation by subregion, numbers, ages 75 years and older, 1995-1996, males

Cause

Subregion all causes dis circulatory cancer dis respiratory dls digestive ischaemic heart Hawkes Bay 3117 739 387 332 344 221 Wanganui 1579 341 214 210 211 95 Manawatu 3037 765 345 365 328 224 Porirua/Kapiti 1470 414 183 164 117 132 Hutt Valley 1925 504 209 205 220 171 Wellington 1892 515 174 214 149 126 Wairarapa 1043 270 141 138 102 60 Nelson/Marlborough 2221 604 297 169 293 221 Central region 16284 4152 1950 1797 1764 1250 Source: NZHIS

Page 222 - The Public Health of the Central Region U Table A76: Leading causes of hospitalisation by subregion, numbers, ages 75 years and older, 1995-1996, females

Cause

Subregion all causes dis circulatory injury, poisoning dis digestive dis respiratory fractures Hawkes Bay 3637 925 530 393 343 305 Wanganui 1788 402 246 235 195 140 Manawatu 3912 1068 494 404 405 269 Porirua/Kapiti 2096 479 326 183 165 190 Hun Valley 2704 673 420 314 216 267 Wellington 2647 655 472 201 216 281 Wairarapa 1087 337 136 128 73 84 Nelson/Marlborough 2529 629 337 249 159 206 Central region 20400 5168 2961 2107 1772 1742 Source: NZHIS

Table A77: Leading causes of unintentional and intentional injuries by subregion, numbers, ages 75 years and older, 1995-1996, males

Cause

Subregion unintentional injury falls med surg comps adverse effects drugs MVCs Intentional injury Hawkes Bay 457 210 141 46 17 5 Wanganui 213 69 98 15 6 1 Manawatu 493 153 204 51 16 1 Porirua/Kapiti 216 83 90 24 6 1 Hutt Valley 258 127 79 13 22 3 Wellington 297 126 113 31 9 1 Wairarapa 89 41 29 6 6 1 Nelson/Marlborough 262 79 100 43 4 1 Central region 2285 888 854 229 86 14 Source: NZHIS

Table A78: Leading causes of unintentional and intentional injuries by subregion, numbers, ages 75 years and older, 1995-1996, females

Cause

Subregion unintentional injury falls med surg comps adverse effects drugs MVC5 Intentional Injury Hawkes Bay 835 521 143 79 26 7 Wanganui 440 255 83 44 9 2 Manawatu 863 466 204 87 13 3 Porirua/Kapiti 496 273 107 47 19 4 Hutt Valley 639 443 90 39 10 3 Wellington 691 435 115 53 26 7 Wairarapa 221 144 25 15 10 Nelson/Marlborough 478 304 91 40 8 Central region 4663 2841 858 404 121 27 Source: NZHIS

Appendix Tables - Page 223 L

Table A79: Leading sites of cancer registration by subregion, numbers, ages 75 years and older, 1990-1993, males II Site A Subregion all sites prostate large bowel trachea, lung bladder melanoma Hawkes Bay 392 110 65 65 25 13 Wanganui 162 39 20 29 9 10 n Manawatu 392 116 68 56 31 14 Porinia/Kapiti 197 50 25 26 7 16 Hutt Valley 222 47 29 40 18 11 II Wellington 272 71 45 34 23 10 Wairarapa 105 30 22 13 1 7 11 Nelson/Marlborough 258 71 54 32 23 10 Central region 2000 534 328 295 137 91 Source: NZHIS 11 Table A80: Leading sites of cancer registration by subregion, numbers, ages 75 years and older, 1990-1993, females II Site Subregion all sites large bowel breast trachea, lung melanoma leukaemia II Hawkes Bay 289 69 51 17 15 7 Wanganui 167 31 17 15 13 6 Manawatu 341 87 55 17 24 15 II Porirua/Kapiti 165 44 21 13 16 4 Hutt Valley 243 58 32 24 10 13 Wellington 264 60 42 14 10 11 II Wairarapa 85 23 20 4 4 6 Nelson/Marlborough 222 59 51 15 5 9 Central region 1776 431 289 119 97 71 Source: NZHIS II II II 11

Page 224 - The Public Health of the Central Region