Midcentral District Health Board and Whanganui District Health Board Health Needs Assessment 2015

MidCentral District Health Board and Whanganui District Health Board Health Needs Assessment 2015

CONTENTS

MIDCENTRAL DISTRICT HEALTH BOARD AND WHANGANUI DISTRICT HEALTH BOARD HEALTH NEEDS ASSESSMENT 2015 1

EXECUTIVE SUMMARY 4

1. INTRODUCTION 16

2. DEMOGRAPHIC PATTERNS (AND OTHER MATERIAL FROM 2013 CENSUS) 18

3. ALL CAUSE MORTALITY ANALYSIS 34

SUMMARY 34

INTRODUCTION 35

ALL CAUSE MORTALITY PATTERNS BY ETHNICITY 36

ALL CAUSE MORTALITY PATTERNS BY TERRITORIAL AUTHORITY 39

ALL CAUSE MORTALITY FOR SOCIO-ECONOMICALLY DISADVANTAGED AREAS 40

WHAT ARE THE CAUSES OF MORTALITY? 42

4. MAJOR CAUSES OF MORTALITY ANALYSIS 46

SUMMARY 46

INTRODUCTION 47

BY DISTRICT HEALTH BOARD OVERALL AND ETHNICITY 47

DISEASE MORTALITY PATTERNS BY TERRITORIAL AUTHORITY 53

SOCIO-ECONOMICALLY DISADVANTAGED AREAS 56

5. DISEASE GROUP BREAKDOWN 59

SUMMARY 59

INTRODUCTION 59

CIRCULATORY DISEASE 60

CANCERS 60

RESPIRATORY DISEASE 61

EXTERNAL CAUSES (ACCIDENTS AND INJURIES) 62

6. SOCIO-ECONOMIC DISADVANTAGE AND HEALTH 63

SUMMARY 63

INTRODUCTION 64

RECOGNISING HOUSEHOLDS WHO ARE SOCIO-ECONOMICALLY DISADVANTAGED 64

7. AMENABLE MORTALITY 67

SUMMARY 67

INTRODUCTION 68

WHAT IS AMENABLE MORTALITY? 68

AMENABLE MORTALITY FOR MIDCENTRAL AND WHANGANUI DISTRICT HEALTH BOARDS 69

AMENABLE MORTALITY BY ETHNICITY 70

AMENABLE MORTALITY BY TERRITORIAL AUTHORITY 70

AMENABLE MORTALITY BY NZDEP2001 9 AND 10 AREAS 71

WHAT SORT OF CONDITIONS MAKE UP AMENABLE MORTALITY? 72

8. SUICIDE 77

SUMMARY 77

MIDCENTRAL’S MENTION IN SUICIDE FACTS 2011 AS HAVING SUICIDE RATES HIGHER THAN NEW ZEALAND’S 78

APPENDIX ONE: CAUSES OF MORTALITY RANKED LISTS (2008 TO 2010) 81

APPENDIX TWO: MORTALITY RATES AND NUMBERS TABLES 91

ALL CAUSE MORTALITY 92

AMENABLE MORTALITY 95

CIRCULATORY DISEASE MORTALITY 98

CANCER MORTALITY 102

RESPIRATORY DISEASE MORTALITY 105

EXTERNAL CAUSES (INJURIES AND ACCIDENTS) 108

APPENDIX THREE: YEARLY AGE ADJUSTED RATES GRAPHS 111

ALL CAUSE MORTALITY 111

CIRCULATORY DISEASE 113

CANCER 114

RESPIRATORY DISEASE 116

EXTERNAL CAUSES 117

AMENABLE MORTALITY 119

APPENDIX: AMENABLE MORTALITY ICD-10 CODES 121

APPENDIX FIVE: SOURCES OF DATA 123

REFERENCES 124

Executive Summary

Introduction

This section attempts to summarise the main take-home messages of the health needs assessment report - not in terms of the order in which the chapters are organized - but in terms of what a health planner would like to know when planning services. Often, this involves pulling together information from different chapters.

Most of the information is expressed in a question and answer form. The questions focus on what a health planner would like to know about the health status of MidCentral District Health Board and Whanganui District Health Board populations. There are also some explanations of the logic behind the design of this report.

This report uses mortality patterns to comment on population health-status, to identify people experiencing health disadvantage, and to suggest which conditions have the greatest impact on population health. The lower the mortality rate, the better the health status of the population.

How does the health status of MidCentral and Whanganui DHB residents compare to New Zealand overall?

In general, the health statuses of MidCentral DHB and Whanganui DHB’s residents are worse than New Zealand overall. The health status of MidCentral’s residents is slightly worse than New Zealand overall; the health status of Whanganui residents is more markedly worse. This is based on comparing their age adjusted mortality rates.

The reason for this is both MidCentral and Whanganui district health boards have higher proportions of people who are known to have poorer health status than other New Zealanders. They are: people who are experiencing socio-economic disadvantage, Maori, and older people. Older people are at higher risk of long term illnesses (like diabetes, high blood pressure, heart disease, stroke and their effects).

Whanganui District Health Board has especially high proportions of people experiencing socio-economic disadvantage, and Maori residents – higher than both MidCentral DHB and New Zealand.

In general, is the health status of MidCentral and Whanganui District Health Board residents improving?

In general, the health statuses of MidCentral and New Zealand residents have been improving over time. This is suggested by reducing mortality rates between 2004 and 2010.

This trend is less apparent for Whanganui DHB residents, whose mortality rates have appeared more static over the same time period.

If we wanted to improve the health status of our populations, what conditions should we prioritise for attention?

Based on the causes of mortality, the conditions we should prioritise for attention are: 1. circulatory system disease (heart disease and diseases of the blood vessels), 2. cancers, 3. respiratory diseases, and 4. accidents and injuries.

Circulatory system diseases were responsible for 35% to 40% of all deaths; cancers for around 30% of deaths; respiratory diseases around 9% to 10% of deaths, and accidents and injuries around 6% to 8% of all deaths.

The main causes of circulatory system deaths were ischaemic heart disease (like angina and heart attacks) and stroke. Circulatory system diseases include strokes because the actual cause of a stroke originates in the blood vessels supplying the brain.

The main causes of cancer deaths were: prostate cancer, breast cancer, colorectal cancer, blood-related cancers (like lymphomas, and leukaemias), malignant melanoma, and cancer of the pancreas.

The main causes of respiratory deaths were: chronic obstructive pulmonary disease (COPD – emphysema and chronic bronchitis), lung infections, and interstitial lung disease (disease affecting the lung tissue between the air sacs).

The main causes of deaths from accidents and injuries were: motor vehicle accidents, falls, and intentional self-harm (suicide). Drowning was also a prominent cause for MidCentral residents.

For Whanganui DHB, circulatory system diseases and respiratory system diseases appear to be areas where more attention is warranted.

Although Whanganui DHB’s circulatory system diseases mortality has been falling over time, their rates are significantly higher than New Zealand. The number of Whanganui DHB circulatory system deaths was 26% higher compared to New Zealand when looking at 2006 to 2010 data combined together (age adjusted).

Whanganui DHB’s respiratory mortality rates were higher than both MidCentral DHB and New Zealand and appeared to be increasing over recent years. Whanganui DHB’s respiratory mortality numbers were 28% higher than expected, compared to New Zealand. MidCentral’s respiratory mortality numbers were more-or-less as expected, compared to New Zealand.

For both MidCentral and Whanganui District Health Boards, deaths from accidents and injuries were higher than expected, compared to New Zealand, by 25% and 27% respectively. This could be an area of attention.

Who are the population groups experiencing health status disadvantage within MidCentral and Whanganui District Health Boards?

The people experiencing health status disadvantage within both MidCentral DHB and Whanganui DHB are:  Maori  Pacific people  People experiencing socio-economic disadvantage  Horowhenua residents

The whole of Whanganui DHB could also be added to this list, because of their higher mortality rates (17% higher than expected, compared to New Zealand overall). Whanganui DHB’s population has high proportions of socio-economically disadvantaged people, Maori, and older people – groups who have higher health needs. The whole of Whanganui District Health Board’s population shows health status disadvantage.

Maori had statistically significant higher mortality numbers for New Zealand, MidCentral DHB, and Whanganui DHB. When deaths from 2006 to 2010 were accumulated and adjusted for differences in age balances of the populations, New Zealand Maori number of deaths was 90% higher than expected, when compared to New Zealand overall. MidCentral Maori number of deaths was 61% higher than expected, compared to New Zealand overall. Whanganui Maori number of deaths was 142% higher than expected, compared to New Zealand overall.

Although both MidCentral DHB and Whanganui DHB have small numbers of Pacific residents, New Zealand data shows they also experience health disadvantage. New Zealand Pacific deaths were 65% higher than expected, when compared to New Zealand overall (2006 to 2010 accumulated data, age adjusted). If the Pacific

6 populations of MidCentral and Whanganui District Health Boards were larger, they would probably show the same disadvantage.

People experiencing socio-economic disadvantage have higher mortality rates than generally. Areas with high levels of socio-economic disadvantage (NZDep 9 and 10 deciles) had higher mortality numbers when compared to New Zealand overall. For 2006 to 2010 data combined, the most disadvantaged areas for New Zealand, MidCentral DHB, and Whanganui DHB all had higher than expected number of deaths compared to New Zealand overall (by 24%, 31%, and 29% respectively).

The group who could also be added to this list is older people. This is because older people are at higher risk of major illness and disability - including the ones mentioned above. They have higher health needs than other groups.

This is important for both MidCentral DHB and Whanganui DHB because they both have higher proportions of older people (people aged 65 years and older) than New Zealand overall (16.5%, 18.2%, and 14.3% respectively).

Horowhenua also has higher proportions of older people, Maori, and people experiencing socio-economic disadvantage (as does nearby Otaki, which is part of Kapiti Coast District Council). Horowhenua’s mortality numbers were 12% higher than expected, when compared to New Zealand overall (age adjusted).

Although the Tararua did not have consistently high mortality rates or numbers across all the measures looked it, it does have some features suggesting higher health needs. They are: higher proportion of Maori residents (20.1% compared to NZ 14.1%), higher proportion of older people (16.9% compared to 14.1% for NZ), higher percentage of its population living in socio-economically disadvantaged areas, and rural character.

If we wanted to improve the health of disadvantaged populations, what conditions would have the greatest impact?

From a mortality perspective, the conditions with the greatest impact on health disadvantaged populations are the same as for MidCentral DHB, Whanganui DHB, and New Zealand overall: circulatory system disease, cancers, respiratory diseases, and accidents and injuries (including suicide). The same conditions but they have greater impact on these groups than the general population – their rates are higher.

When thinking of disadvantaged populations, consideration should also be made of other health measures outside of mortality. Mortality tends to apply more to adults. Maori and Pacific people are examples of two population groups with higher proportions of young people and children. The conditions affecting children/young people are less likely to cause death, so other measures, like use of health services, should be used instead.

There are three documents that are helpful for this information:  “The Health Status of Young People and Children in MidCentral and Whanganui” prepared by NZ Child and Youth Epidemiology Service

 “Health Needs Assessment – MidCentral” – prepared by Centre for Public Health Research, Massey University  “Health Needs Assessment – Whanganui District Health Board” – prepared by Centre for Public Health Research, Massey University

In what way does socio-economic disadvantage influence health patterns in MidCentral and Whanganui District Health Board?

The health sector makes extensive use of the NZDep socio-economic deprivation index, published multiple times since 1991 by the Wellington School of Medicine, Otago University – usually after every census. This work categorizes small areas by the level of socio-economic deprivation of residents living there. The areas are categorized as deciles, from 1 (least deprived) to 10 (most deprived).

According to the NZDep work, both MidCentral and Whanganui DHB have higher proportions of people living in the more disadvantaged deciles – Whanganui markedly so. The graphs of their population distributions across deciles are shown below, with the New Zealand graph for comparison.

MidCentral DHB Population by NZDep2013 Whanganui DHB Population by NZDep2013 Decile Decile 16.0% 20.0%

14.0% 18.0% 16.0% 12.0% 14.0% 10.0% 12.0% 8.0% 10.0%

6.0% 8.0% 6.0%

4.0% Percentage of population Percentage of population 4.0% 2.0% 2.0% 0.0% 0.0% 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile NZDep2013 decile

New Zealand Population by NZDep2013 Decile 12.0%

10.0%

8.0%

6.0%

4.0%

Percentage of population 2.0%

0.0% 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile

Within MidCentral District Health Board, there are some territorial authorities with high proportions of their populations living in socio-economically disadvantaged areas. They are Horowhenua, MidCentral’s portion of Kapiti Coast (Otaki and surrounds), and, to a lesser extent, Tararua.

Within Whanganui District Health Board, all of its territorial authorities show high proportions of their populations living in more socio-economically disadvantaged areas (Wanganui, Rangitikei, and Whanganui DHB’s portion of Ruapehu).

The reason this information is important is because socio-economically disadvantaged people have poorer health status – higher mortality rates and higher need for health services – than the general population (Ministry of Health, 2002).

Therefore, areas with higher proportions of socio-economically disadvantaged residents will have poorer health measures than otherwise.

Socio-economic disadvantage seems to amplify any negative health patterns. If there is a worsening disease or health trend for the overall population, it will be worse for people experiencing socio-economic disadvantage.

Socio-economically disadvantaged people are not just confined to NZDep 9 and 10 areas

In the health sector, it has become routine to think of socio-economically disadvantaged people as living only in the two most deprived deciles, deciles 9 and 10.

However, these grades are generalizations of the people living there. Not all the people living in deciles 9 and 10 are socio-economically disadvantaged. Also, socio- economically disadvantaged people live in other deciles too.

Therefore, it becomes important to recognize the likely characteristics of individual households experiencing socio-economic hardship, so they might be offered assistance.

Ministry of Social Development research shows households experience socioeconomic hardship because of multiple factors acting together, rather than a sole cause. The results were published in a report “New Zealand Living Standards 2004”. The factors include: o low income o low level of assets owned o housing rented rather than owned o people who have experienced marriage (or marriage-like relationship) breakup o adverse life event (“life shocks”—for example, bereavement, loss of job, etc) o personal health problems (multiple and enough to affect lifestyle) o children’s health problems (multiple and enough to affect lifestyle) o inability to afford childcare to work or study o when income is from income tested benefit rather than from employment or superannuation o having dependent children o Maori or Pacific ethnicities o people with multiple financial payments they find difficult to meet.

NZDep 9 and 10 areas have the highest concentrations of people experiencing socio- economic hardship. They also live in other deciles, in varying concentrations less than NZDep 9 and 10 areas (sometimes only slightly less).

What other characteristics of MidCentral and Whanganui DHBs’ populations should I know about when planning health services?

Both MidCentral and Whanganui DHBs have higher percentages of older people compared to New Zealand (16.5%, 18.2%, and 14.3% respectively). Older people have higher health needs because they are at higher risk of long-term illnesses and disability.

The distribution of older people is not even across MidCentral. The Horowhenua and Otaki have particularly high percentages (23% to 24% for both areas), with Tararua moderately high (16.9%).

For Whanganui DHB, Wanganui and Rangitikei have high proportions of older people (19.1% and 17.2% respectively.

The age balances of both district health boards, along with New Zealand overall, has been growing older. This will likely continue in the future.

This suggests growing numbers of people with chronic health conditions, age-related conditions, and disability in future years. Especially from those areas with particularly high percentages of older residents.

Both MidCentral DHB and Whanganui DHB have higher percentages of Maori residents than New Zealand overall (17.4%, 23.5%, and 14.1% respectively). Whanganui have particularly high percentages. Maori are recognized as a health- status disadvantaged group (Robson, 2007; Ministry of Health, 2010).

Maori and Pacific populations tend to have younger age balances than non-Maori, non-Pacific populations. They have high proportions of children and young people, and lower proportions of older people. This influences their need for health services – greater demand for services for children and young people.

What is amenable mortality and what does amenable mortality analysis tell us about MidCentral and Whanganui District Health Boards’ residents?

Amenable mortality is mortality from those conditions thought to be amenable to health service intervention. It is meant to be a broad and general measure of the effectiveness of health services towards the population they serve. It is restricted to age groups younger than 75 years, in order to include only premature deaths.

The Ministry of Health and Treasury have produced reports applying amenable mortality to district health boards, for example “Saving Lives” from the Ministry of Health, and “Health Projections and Policy Options for the 2013 Long-term Fiscal Statement” from the Treasury (Ministry of Health 2010, The Treasury 2012).

In general, the amenable mortality analysis, when applied to MidCentral and Whanganui District Health Boards show the same pattern as the all cause mortality analysis. However, the mortality gaps shown by all cause mortality widen further for amenable mortality.

This implies health services require more effort or a different type of effort to reach health disadvantaged groups of people, in order to close health inequality gaps.

This health needs assessment appears to be structured differently from others. What’s the difference and why was it done this way?

Most health needs assessment focus on a list of pre-selected diseases as the first frame of reference, and then considers how people are affected by each disease, for example, mortality rates and hospitalization rates for ischaemic heart disease (heart attacks and angina).

Unfortunately, disease-specific conclusions can only be applied to that disease, and not to anything else. Also, it’s difficult to see the disease’s relationship to all the other conditions affecting the population – how does it fit into the big picture?

This health needs assessments focuses on people as the first frame of reference, and then tries to find the diseases that have the greatest impact on those people.

Why people first? Because:  Healthy people is the ultimate end-goal of what district health boards are trying to achieve – the bottom line objective. Disease management is the means by which healthy people is achieved (among some others, like living healthy lifestyles, homes’ physical environments, etc).  The people patterns are more consistent and universally applicable than disease patterns. It’s always the same groups of people who experience disadvantage across almost every social and health issue. It’s much easier, for planning purposes, to consider these people at the forefront of thinking, rather than dividing everything up by individual diseases and re-considering the people-patterns afresh one disease at a time.

So should this health needs assessment replace the others? No, they are complementary. They all provide different perspectives of population health.

What are the limitations of the way this health needs assessment was done?

This health needs assessment emphasizes those conditions that can cause death. They are all major conditions that most people are familiar with, for example, heart disease, cancer, etc.

However, it under-emphasizes those conditions where death is rare yet still has a major affect on people’s health, quality of life, or ability to participate in society. Some examples are: disability, arthritis, most mental illnesses, most non-life threatening infections, most non-life threatening injuries, pregnancy and child birth, and sexual health issues.

That said, many of the people-patterns written about earlier can still be applied to non-life threatening conditions. For example, it’s the same groups of people experiencing health inequality, as shown by the mortality data, who experience inequality in non-life threatening health conditions too.

Why was mortality used as a health marker?

Mortality is used as a general marker of population health; the lower the mortality rate, the healthier the population.

A major advantage of mortality is there’s no confusion about what it means or its significance – more is bad; less is good; none is even better.

The other common type of data used in health analysis is service-use data, for example, hospitalization rates. It’s traditional to use hospitalizations as a proxy marker for levels of community illness. However, hospitalization is influenced by multiple factors, and it can be difficult to determine which factors (or balance of factors) led to a pattern or change.

The other factors include:  Access to health services If people are not accessing health services, their hospitalization rates will be lower (or they could be higher, if their condition worsens to the stage they require hospitalization).  Changes in medical technology or practice If a change in medical technology or practice means patients can be treated without admission to hospital, this will lead to a fall in hospitalization rates for that condition, even though there is no change in how common the condition is.  Changes in computer coding of conditions Sometimes the way conditions are coded when entered into the hospital’s

computer system changes, leading to changes in hospitalization rates. But this is purely an artifact.

Why wasn’t life expectancy used as a measure of population health, instead of mortality?

Life expectancy and mortality rates are basically the same thing, calculated in different ways. Life expectancy is also calculated from the number of deaths. So life expectancy and mortality rates will show the same patterns.

From a practical perspective, life expectancies are much more difficult to calculate than mortality rates. There are also many alternative methods of calculating life expectancy, for example, Chiang I, Chiang II, Silcocks, etc.

There’s very little mention of diabetes among the mortality analysis. Why is this?

The major cause of mortality for people with diabetes is circulatory disease – heart disease and disease of the blood vessels. Deaths from diabetes alone are less common. Death is usually from the complications of diabetes, for example, heart disease, strokes, kidney disease, etc.

Preventing and improving management of diabetes will reduce the prevalence of circulatory system disease (which is the most common cause of death for all New Zealanders, including MidCentral and Whanganui residents).

What is age adjustment, and why was it used in this document? What are the traps with interpreting age adjusted figures?

Age adjustment (also known as “age standardization”) is a series of mathematical methods for adjusting disease or death rates (or numbers), so any differences in age distributions of the populations being compared are compensated for. This is done because the risk of most diseases is uneven across the age span. For example, strokes are more common among older people than children and young people.

Most of the population disease or death comparisons made in this document refer to age adjusted figures.

However, there are some traps with age adjustment. They are:  The process essentially creates artificial numbers to allow comparisons between populations. In real life, populations are not age adjusted – they are as they are.  Age adjustment also compensates for population size. So this allows us to compare, say, Whanganui DHB against New Zealand (a population size of 60,000 to 4.5 million).  They can lead us to under-estimate the number of cases coming from older populations in real life. In the MidCentral DHB/Whanganui DHB contexts,

this is particularly important for Horowhenua and Whanganui territorial authorities.  They can lead us to over-estimate the number of cases coming from younger populations in real life.

When figures are being compared to each other, what does it mean when the comparison is “not statistically significant” or “not statistically different”?

“Not statistically significant” and “not statistically different” mean the same thing. They mean it’s not possible to say whether the difference between the two figures being compared is a true difference, or just due to a random chance occurrence of numbers.

The reason for this is because, in the natural world, it’s normal for figures to fluctuate randomly. For example, if the average daily highest temperature in July in Palmerston North is 13 degrees, each July, it won’t reach a high of exactly 13 degrees every day. It will fluctuate around 13 degrees – some days higher, and some days lower. This fluctuation will be within a certain range either side of 13, provided there are no abnormal, unexpected influences (like a storm, or heatwave).

If the difference in numbers is beyond a pre-determined boundary towards the extreme edges of the expected range of fluctuation (or outside of it) then the difference is considered statistically significant. The pre-determined boundary for this report is 5%.

The usual reason for differences not reaching statistical significance in this report is because the numbers of occurrences (in this report, usually deaths) is small.

Which leads us to the next point……

MidCentral District Health Board and Whanganui District Health Board are considered small populations as far as population health measures are concerned.

The populations of both MidCentral District Health Board and Whanganui District Health Boards are considered small from a population health measures’ perspective. That means the number of occurrences for a particular measure might be too small to reach statistical significance.

A good example of this, within this report, is the Ministry of Health’s suicide rates for each district health board. For many district health boards, the rate calculated is not statistically different from New Zealand. The main reason for this is because the number of suicides within that district health board is too small to show a difference.

Is it possible to do a separate health needs assessment specifically for my community/town? ( or how can the information in this document be used to plan health services for my community/town?)

Trying to do a data-based health needs assessment for a small community is very difficult. The numbers of occurrences of whatever health event being monitored (like

14 mortality, cancer diagnosis, or hospitalisations) are usually too small to show a reliable pattern or reach statistical significance. There’s also the danger of accidentally breaching the privacy of an individual through some identifying characteristic, like ethnicity and age.

Instead, the health needs of a community can be determined by the types of people making up the community. For example, if the population is older, then there would be greater need for disability services and services catering for long-term conditions. If the community has a high proportion of people experiencing socio-economic hardship, then the health needs are likely to be higher than the general population. More intensive social and health supports would also be required.

Most of the information and conclusions in this report are generalizations.

Although generalizations are, in general, true for the group they are applied to, they are not necessarily true for every individual from that group. For example, although Maori are described as a health disadvantaged group, there are plenty of healthy Maori individuals around. Using a non-health example: although it’s true New Zealand is a rugby-mad nation, not all New Zealanders like rugby.

Therefore, when considering individuals, they may or may not conform to general characteristics of the group. This is normal. Epidemiologists refer to the error of expecting every individual to conform to group characteristics as an “ecological fallacy”.

Some examples of the over-application of generalizations:  Expecting all residents in NZDep 9 and 10 areas to be socio-economically disadvantaged (or conversely, expecting the other eight deciles to have no socio-economically disadvantaged people living in them)  Expecting everyone living in the Horowhenua to have poor health, or to be socio-economically disadvantaged  Expecting everyone living in the relatively less disadvantaged areas, like Palmerston North and Manawatu District, to be well-off (there will be plenty of people living in those areas experiencing disadvantage or difficulty)

1. Introduction

This is the fourth internally produced health needs assessment for MidCentral District Health Board and Whanganui District Health.

This health needs assessment tries to give some insights into:  How are the health statuses of MidCentral District Health Board and Whanganui District Health Board changing?  What health conditions have the greatest impact on our populations?  Which population groups experience health status inequality?  How do the health statuses of MidCentral District Health Board and Whanganui District Health Board compared to New Zealand overall?

This report mainly uses mortality as a marker of population health status - the healthier a population, the lower its mortality rate.

Most population health reports use a disease-first approach. They focus on a pre- determined list of diseases and then analyses how people are affected by those diseases.

However, this report takes a people-first approach to measuring health status. It looks at people (and groups of people), their health status, and what conditions should receive attention to improve the health status of those groups of people. Why? Because:  Healthy people is the ultimate end-goal of what district health boards are trying to achieve Disease management is important as a means by which this ends is achieved (amongst others, like living healthy lifestyles, healthy homes and environments, etc)  The people patterns are more consistent and universally applicable than the disease patterns It’s always the same groups of people experiencing disadvantage across almost every social and health issue.  A disease pattern or trend is usually only applicable to that disease Changing focus to another disease requires re-examination all over again

The main groups of people looked at within the data analysis are:  MidCentral DHB population overall, Whanganui DHB population overall, and New Zealand overall  Main ethnic groups (Maori, Pacific, Other)  MidCentral DHB’s and Whanganui DHB’s territorial authorities  MidCentral DHB’s, Whanganui DHB’s, and New Zealand’s socio- economically disadvantaged areas

The type of analysis done are:  All cause mortality patterns Deaths from all causes. This is the equivalent of life expectancy, and helps identify changing health status across time, and also helps identify groups experiencing health status inequality.  Identifying the most common disease groups causing death  Identifying the most common individual diseases, within those disease groups  Looking at how the most common disease groups affect the population groups described above  Looking at how amenable mortality affects the population groups described above (Amenable mortality is mortality from causes amenable to health care or prevention.)  Examining the two most recent “Suicide Facts” reports published by the Ministry of Health (The 2014 report, examining suicides in 2011, identified MidCentral as one of the district health boards with higher suicide rate. However, the 2015 report, examining suicides in 2012, did not include MidCentral within the equivalent list - even though the MidCentral’s three year suicide rate was the same in both reports.)

2. Demographic Patterns (and other material from 2013 Census)

Summary

 The 2013 Census usual resident populations of: o New Zealand was 4,242,048 o MidCentral DHB was 162,564 o Whanganui DHB was 60,120

 The population of MidCentral has been rising, but slower than New Zealand overall. The population of Whanganui DHB has been declining – there was a 3.4% decline from 2006 to 2013.

 Both MidCentral and Whanganui DHB have higher proportions of older people than New Zealand overall (16.5%, 18.2%, and 14.3% respectively). Older people have higher health needs than people in other age groups.

 MidCentral, Whanganui DHB, and New Zealand’s populations have been ageing over time, with increasing proportions of older people and declining proportions of younger people and children. This is a long-standing trend.

 Of MidCentral’s territorial authorities, Horowhenua, Kapiti (basically Otaki and surrounding areas), and Tararua have high percentages of older people (23.4%, 23.5%, 16.9%). For Whanganui DHB, Wanganui and Rangitikei territorial authorities have high percentages of older residents (19.1% and 17.2%).

 Both MidCentral and Whanganui DHB have higher percentages of Maori residents than New Zealand overall (17.4%, 23.5%, and 14.1% respectively). MidCentral’s percentage of Maori in the population increased from 2006 to 2013, while Whanganui DHB and New Zealand’s remained roughly the same. (Maori are known to have poorer health status than non-Maori).

 All of Whanganui DHB’s territorial authorities have higher percentages of Maori residents than New Zealand. Of MidCentral’s territorial authorities, Horowhenua, Kapiti (Otaki and surrounds), and Tararua have higher proportion of Maori residents than New Zealand overall.

 MidCentral and Whanganui’s percentage of other non-European, non-Maori ethnicities is lower than New Zealand overall.

 Maori and Pacific populations have younger age balances than non-Maori, non-Pacific ethnicities. They have higher percentages of children and young people. This means they have higher need for health and social services associated with children and young people.

 Whanganui regular smoking proportions were slightly higher than 18

MidCentral’s, which in turn, were slightly higher than New Zealand’s (18.1%, 15.4%, 13.7% respectively). All three populations experienced declines in regular smoking percentages from 2006 to 2013.

 Both MidCentral and Whanganui DHB have higher proportions of their populations living in more socio-economically disadvantaged areas than New Zealand overall. The socio-economic disadvantage of Whanganui DHB’s population is particularly striking.

 Within MidCentral: Horowhenua, MidCentral’s portion of Kapiti (basically Otaki and surrounds), and to a lesser extent, Tararua, show high proportions of people living in socio-economically disadvantaged areas.

 All of Whanganui DHB’s territorial authorities show high proportions of people living in socio-economically disadvantaged areas.

Introduction

This chapter contains information from the 2013 Census conducted by Statistics New Zealand, and NZDep2013 Index of Socio-Economic Deprivation.

MidCentral and Whanganui District Health Boards and Their Territorial Authorities

MidCentral District Health Board area contains four complete territorial authorities and part of a fifth:  Manawatu (main township is Feilding)  Palmerston North (containing Palmerston North city and Ashhurst)  Tararua (main townships are Dannevirke, Pahiatua, Woodville, and Eketahuna)  Horowhenua (main townships are Levin and Foxton)  Part of Kapiti Coast (essentially Otaki township and surrounding areas)

Whanganui District Health Board are contains two complete territorial authorities and part of a third:  Wanganui (containing Wanganui city)  Rangitikei (main townships are Marton, Bulls, Hunterville, and Taihape)  Part of Ruapehu District (whose main towns within Whanganui DHB are Ohakune, Raetihi, and Waiouru)

Demography

Population counts

At the 2013 Census, the usually resident populations were recorded as:  MidCentral DHB 162,564  Whanganui DHB 60,120  New Zealand 4,242,048

Compared to 2006, MidCentral’s population increased, but at a lesser rate than New Zealand (2.3% and 5.3% increases respectively). Whanganui District Health Board’s population reduced by 3.4% compared to 2006.

MidCentral DHB, Whanganui DHB, and New Zealand Populations at 2006 Census and 2013 Census % change 2006 to 2006 2013 2013 MidCentral 158,841 162,564 2.3% Whanganui 62,208 60,120 -3.4% New Zealand 4,027,947 4,242,048 5.3%

Both MidCentral and Whanganui have higher proportions of people aged 65 years and older, compared to New Zealand (16.5%, 18.2%, and 14.3% respectively).

All three populations continue the trend of ageing population age balances. Their percentages of older people increased when 2013 is compared to 2006. In general, older people are more susceptible to illness and have greater health needs than younger people.

MidCentral DHB, Whanganui DHB, and New MidCentral DHB, Whanganui DHB, and New Zealand Population Aged 65+ Years at 2006 Zealand Percentage of Population Aged 65+ Census and 2013 Census Years at 2006 Census and 2013 Census 2006 2013 2006 2013 MidCentral 22,344 26,880 MidCentral 14.1% 16.5% Whanganui 9,792 10,932 Whanganui 15.7% 18.2% New Zealand 495,600 607,029 New Zealand 12.3% 14.3%

In contrast to the trend for older people, the proportion of younger people declined from 2006 to 2013 for all three populations.

Unlike the pattern for older people, the proportion of people aged 20 or less is similar for MidCentral, Whanganui, and New Zealand - 27% to 28%.

MidCentral DHB, Whanganui DHB, and New MidCentral DHB, Whanganui DHB, and New Zealand Population Aged 0 to 20 Years at 2006 Zealand Percentage of Population Aged 0 to Census and 2013 Census 20 Years at 2006 Census and 2013 Census 2006 2013 2006 2013 MidCentral 46,716 44,799 MidCentral 29.4% 27.6% Whanganui 18,474 16,407 Whanganui 29.7% 27.3% New Zealand 1,167,771 1,161,387 New Zealand 29.0% 27.4%

Ethnicity

Both MidCentral and Whanganui DHBs’ proportion of Maori residents is higher than New Zealand’s. Maori form 17.4% of MidCentral’s population (up from 16.8% in 2006). Whanganui Maori make up 23.5% of the population, which is a similar percentage to 2006 (23.2%). New Zealand Maori make up 14.1% of New Zealand’s population, very similar to the percentage in 2006 (14.0%).

Maori, as a group, are known to experience poorer health status than non-Maori ethnicities. Therefore, MidCentral, and especially Whanganui, will require greater commitment to Maori health issues because they have higher proportions of Maori residents than New Zealand overall.

MidCentral and Whanganui’s percentages of other non-European ethnicities are lower than New Zealand overall.

Population breakdown by ethnic groups is shown in the three tables below. Note that census respondents can affiliate with more than one ethnic group, so the percentages can add up to more than 100%. The category “Not Elsewhere Included” are for responses that are outside the provided categories.

The decline in the “New Zealander” category is probably due reduction in public concern that they were being labeled by their ethnicity and not considered as New Zealanders. There were a number of media stories raising this concern just before the 2006 Census.

MidCentral District Population by Ethnicity at 2006 Census and 2013 Census (percentages) Middle Other Ethnicity Eastern/ Total Latin people, Total Not Pacific Other Total Census European Māori Asian America New Other people Elsewhere Peoples Ethnicity people n/ Zealander Ethnici stated Included African(2 nec ty ) 16.8 4.4 97.3 100.0 2006 71.4% % 2.9% % 0.6% 12.5% 0.0% 12.6% % 2.7% % 17.4 5.8 95.1 100.0 2013 77.9% % 3.5% % 0.7% 2.0% 0.0% 2.1% % 4.9% %

Whanganui DHB District Population by Ethnicity at 2006 Census and 2013 Census (percentages) Middle Other Ethnicity Not Eastern/ Total Total Elsewh Pacific Latin people, Total Census European Māori Asian Other people ere Peoples American New Other people Ethnicity stated Include / Zealander Ethnicity d African(2) nec 23.2 2.0 96.4 100. 2006 69.9% % 2.2% % 0.2% 10.9% 0.0% 10.9% % 3.6% 0% 23.5 2.5 94.7 100. 2013 76.3% % 2.9% % 0.3% 1.9% 0.0% 1.9% % 5.3% 0%

New Zealand Population by Ethnicity at 2006 Census and 2013 Census (percentages) Middle Other Ethnicity Total Eastern/ Total Not Pacific people, Censu Europea Latin peopl Elsewher Total Māori People Asian New Other Other s n America e e people s Zealand Ethnicit Ethnicit n/ stated Included er y nec y African(2) 14.0 95.8 100.0 2006 64.8% % 6.6% 8.8% 0.9% 10.7% 0.0% 10.7% % 4.2% % 14.1 11.1 94.6 100.0 2013 70.0% % 7.0% % 1.1% 1.6% 0.0% 1.6% % 5.4% %

The following graphs demonstrate the differences between the age balances of Maori and Pacific populations compared to other ethnicities. Both Maori and Pacific populations have younger age balances: higher proportions of children and young people; and lower proportions of older people.

This is important to know about because diseases and conditions that affect children and young people will have greater impact on Maori and Pacific.

Conversely, diseases and conditions affecting mainly older people (for example, heart disease, cancers, and chronic obstructive pulmonary disease) have lesser impact in terms of absolute number of people affected.

However, this is a double-edged sword. It can be easy to under-estimate the significance of these diseases among the Maori or Pacific populations. The absolute numbers might be small, but they are still greater than expected, given the numbers of people in susceptible age groups.

MidCentral Maori Population by Age Group 2013 MidCentral Other Ethnicities Population (includes Asian) by Age Group 2013 85 Years And Over 80–84 Years 85 Years And Over 75–79 Years 80–84 Years 70–74 Years 75–79 Years 65–69 Years 70–74 Years 60–64 Years 65–69 Years 55–59 Years 60–64 Years 50–54 Years 55–59 Years 50–54 Years 45–49 Years 45–49 Years 40–44 Years 40–44 Years 35–39 Years 35–39 Years 30–34 Years 30–34 Years 25–29 Years 25–29 Years 20–24 Years 20–24 Years 15–19 Years 15–19 Years 10–14 Years 10–14 Years 5–9 Years 5–9 Years 0–4 Years 0–4 Years 0 500 1000 1500 2000 2500 3000 3500 4000 0 2000 4000 6000 8000 10000

Whanganui DHB Maori Population by Age Group Whanganui DHB Other Ethnicities Population 2013 (includes Asian) by Age Group 2013 85 Years And Over 85 Years And Over 80–84 Years 80–84 Years 75–79 Years 75–79 Years 70–74 Years 70–74 Years 65–69 Years 65–69 Years 60–64 Years 60–64 Years 55–59 Years 55–59 Years 50–54 Years 50–54 Years 45–49 Years 45–49 Years 40–44 Years 40–44 Years 35–39 Years 35–39 Years 30–34 Years 30–34 Years 25–29 Years 25–29 Years 20–24 Years 20–24 Years 15–19 Years 15–19 Years 10–14 Years 10–14 Years 5–9 Years 5–9 Years 0–4 Years 0–4 Years 0 200 400 600 800 1000 1200 1400 1600 1800 0 500 1000 1500 2000 2500 3000 3500 4000

Whanganui DHB Pacific Population by Age Group MidCentral Pacific Population by Age Group 2013 2013 85 Years And Over 85 Years And Over 80–84 Years 80–84 Years 75–79 Years 75–79 Years 70–74 Years 70–74 Years 65–69 Years 65–69 Years 60–64 Years 60–64 Years 55–59 Years 55–59 Years 50–54 Years 50–54 Years 45–49 Years 45–49 Years 40–44 Years 40–44 Years 35–39 Years 35–39 Years 30–34 Years 30–34 Years 25–29 Years 25–29 Years 20–24 Years 20–24 Years 15–19 Years 15–19 Years 10–14 Years 10–14 Years 5–9 Years 5–9 Years 0–4 Years 0–4 Years 0 50 100 150 200 250 300 350 0 200 400 600 800 1000

MidCentral and Whanganui’s Population by Territorial Authority

MidCentral District Health Board’s coverage consists of four complete territorial authorities and part of another. They are:  Palmerston North  Horowhenua  Manawatu  Tararua  Part of Kapiti Coast (essentially Otaki and surrounding areas)

Roughly half of MidCentral’s population live in Palmerston North (49.3%). Both Manawatu and Horowhenua are of similar size, comprising 16.9% and 18.5% of MidCentral’s population respectively. Tararua has just over half that proportion

(10%), with MidCentral’s portion of Kapiti trailing, with 5% of MidCentral’s population.

Except for Tararua, all of MidCentral’s territorial authorities showed population growth between the 2006 Census and 2013 Census. However, only Manawatu and MidCentral’s portion of Kapiti grew at the same percentage as New Zealand overall (5.3%) or better. Manawatu’s population increased by 5.3% and MidCentral’s portion of Kapiti by 6.9%.

Populations of MidCentral's Territorial Authorities 2001, 2006, Populations of MidCentral's Territorial Authorities 2001, 2006, and 2013 and 2013 (percentages) 2001 2006 2013 2001 2006 2013 Palmerston North 73965 77724 80082 Palmerston North 47.7% 48.9% 49.3% Horowhenua 29823 29865 30099 Horowhenua 19.2% 18.8% 18.5% Manawatu 25578 26070 27456 Manawatu 16.5% 16.4% 16.9% Tararua 17859 17634 16854 Tararua 11.5% 11.1% 10.4% Kapiti (MidCentral portion) 7761 7551 8073 Kapiti (MidCentral portion) 5.0% 4.8% 5.0% Total 154986 158844 162564 Total 100.0% 100.0% 100.0%

Whanganui District Health Board’s coverage consists of two complete territorial authorities and part of another:  Wanganui (which includes Whanganui city)  Rangitikei  Part of Ruapehu

Most of Whanganui District Health Board’s population resides in the Wanganui District Council boundaries (about 70%). Almost a quarter of its population lives in Rangitikei District, with just under 7% living in Whanganui DHB’s portion of Ruapehu District.

The population of all three areas have declined since the 2001 Census. The most striking is the almost 19% decline in Whanganui DHB’s portion of Ruapehu from 2006 to 2013.

Populations of Whanganui DHB's Territorial Authorities 2001, Populations of Whanganui DHB's Territorial Authorities 2001, 2006, 2013 2006, 2013 (percentages) 2001 2006 2013 2001 2006 2013 Wanganui TA 43269 42636 42150 Wanganui TA 68.0% 68.5% 70.1% Rangitikei 15102 14712 14019 Rangitikei 23.7% 23.6% 23.3% Ruapehu (Whanganui portion) 5229 4863 3945 Ruapehu 8.2% 7.8% 6.6% Total 63600 62211 60114 Total 100.0% 100.0% 100.0%

MidCentral's Territorial Authorities: Inter-Census Whanganui DHB's Territorial Authorities: Inter-Census Population Change (Percent) Population Change (Percent) 2001 - 2006 2006 - 2013 2001 - 2006 2006 - 2013 Palmerston North 5.1 3.0 Wanganui TA -1.5 -1.1 Horowhenua 0.1 0.8 Rangitikei -2.6 -4.7 Manawatu 1.9 5.3 Ruapehu (Whanganui portion) -7.0 -18.9 Tararua -1.3 -4.4 Total -2.2 -3.4 Kapiti (MidCentral portion) -2.7 6.9 Total 2.5 2.3 `

As stated earlier, the populations of both MidCentral and Whanganui district health boards have higher percentages of people aged 65 and over than New Zealand overall (16.5%, 18.2%, and 14.3% respectively).

However, this distribution is not even across the two district health boards. Both Wanganui territorial authority and Rangitikei have high proportions of older people; but Ruapehu has lower proportion.

Within MidCentral, except for Palmerston North, most territorial authorities have higher percentages of older people than New Zealand. Both Horowhenua and MidCentral’s portion of Kapiti have particularly high percentages – 23.4% and 23.5%.

Like New Zealand overall, the percentages of older people increased across all territorial authorities between the 2006 Census and 2013 Census – the population age balance is getting older.

MidCentral and Whanganui Territorial MidCentral and Whanganui Territorial Authorities' Percentage of Populations Aged 65 Authorities' Populations Aged 65 and Over and Over (Stats NZ estimates) (Stats NZ estimates) 2006 2013 2006 2013 Ruapehu 6.5 9.0 Ruapehu 330 380 Wanganui TA 17.1 19.1 Wanganui TA 7500 8300 Rangitikei 14.5 17.2 Rangitikei 2200 2500 Manawatu 13.4 15.8 Manawatu 3600 4500 Palmerston North 11.4 13.1 Palmerston North 9200 10900 Tararua 13.9 16.9 Tararua 2500 2950 Horowhenua 19.9 23.4 Horowhenua 6100 7300 Kapiti (MidCentral portion) 20.2 23.5 Kapiti (MidCentral portion) 1580 1960 New Zealand 12.2 14.1

Territorial Authorities’ Ethnicities

The two tables below describe the ethnic breakdown across both district health boards’ territorial authorities, firstly by percentage and then the actual counts. Census respondents can state more than one ethnic group, so the number of responses will add up to more than the number of people living in the area.

As previously mentioned, both MidCentral and Whanganui DHB have higher percentages of Maori residents than New Zealand overall.

Looking at the ethnicity breakdowns by MidCentral and Whanganui DHB’s territorial authorities showed:  European is the most dominant ethnic group across all territorial authorities  All of Whanganui DHB territorial authorities have higher percentages of Maori residents than New Zealand, especially Whanganui DHB’s portion of Ruapehu  Horowhenua, MidCentral’s portion of Kapiti, and Tararua have higher

proportion of Maori  All of the territorial authorities have lower proportions of Pacific, Asian, Middle Eastern/Latin American/African, and other ethnicities, compared to New Zealand overall

MidCentral and Whanganui DHB Territorial Authorities' Percentage of Population by Ethnic Group at 2013 Census Middle Eastern/Latin European Maori Pacific Asian Americian/African Other Not stated Total people Ruapehu District 66.6% 44.1% 2.6% 4.0% 0.1% 1.4% 2.6% 100.0% Wanganui District 77.0% 21.7% 2.6% 2.7% 0.4% 1.8% 5.9% 100.0% Rangitikei District 77.2% 23.3% 3.7% 1.5% 0.1% 2.3% 4.2% 100.0% Manawatu District 86.4% 14.3% 1.5% 1.8% 0.3% 2.6% 3.3% 100.0% Palmerston North City 75.0% 15.7% 4.2% 9.3% 1.2% 2.0% 5.0% 100.0% Tararua District 80.6% 20.1% 1.5% 2.0% 0.1% 1.9% 5.4% 100.0% Horowhenua District 77.9% 21.6% 4.6% 3.2% 0.3% 1.7% 5.5% 100.0% Kapiti (MidCentral portion) 72.9% 24.9% 3.9% 3.6% 0.4% 2.4% 5.6% 100.0% New Zealand 70.0% 14.1% 7.0% 11.1% 1.1% 1.6% 5.4% 100.0%

MidCentral and Whanganui DHB Territorial Authorities' Population by Ethnic Group at 2013 Census Middle Eastern/Latin European Maori Pacific Asian Americian/African Other Not stated Total people Ruapehu (Whanganui DHB portion) 2628 1743 102 156 3 57 102 3948 Wanganui District 32436 9141 1116 1149 159 774 2478 42150 Rangitikei District 10827 3270 522 210 15 327 588 14022 Manawatu District 23718 3924 420 483 69 714 897 27459 Palmerston North City 60045 12543 3399 7410 951 1596 4020 80079 Tararua District 13590 3381 246 330 21 324 912 16857 Horowhenua District 23454 6486 1380 954 99 519 1641 30096 Kapiti (MidCentral portion) 5886 2013 312 288 30 192 456 8076 New Zealand 2969391 598605 295944 471711 46956 67752 230649 4242048

Cigarette Smoking

Cigarette smoking data for the years 2006 and 2013 was obtained for MidCentral, Whanganui, and New Zealand.

Whanganui regular smoking proportions were slightly higher than MidCentral’s, which in turn, were slightly higher than New Zealand’s (18.1%, 15.4%, 13.7% respectively).

All three populations experienced declines in regular smoking percentages from 2006 to 2013.

MidCentral DHB, Whanganui DHB, and New Zealand: Cigarette Smoking at 2006 Census and 2013 Census

Never Not Regular Total people District Health Board Ex-Smoker Smoked Elsewhere Total people Smoker stated Regularly Included

MidCentral - 2006 26,322.00 25,737.00 64,017.00 116,076.00 8,838.00 124,917.00 Census 21.1% 20.6% 51.2% 92.9% 7.1% 100.0%

MidCentral - 2013 19,989.00 28,413.00 70,023.00 118,425.00 11,307.00 129,732.00 Census 15.4% 21.9% 54.0% 91.3% 8.7% 100.0%

Whanganui - 2006 11,562.00 10,272.00 22,197.00 44,034.00 4,380.00 48,411.00 Census 23.9% 21.2% 45.9% 91.0% 9.0% 100.0%

Whanganui - 2013 8,610.00 11,382.00 23,055.00 43,047.00 4,647.00 47,694.00 Census 18.1% 23.9% 48.3% 90.3% 9.7% 100.0%

New Zealand - 2006 597,792.00 637,293.00 1,653,924.00 2,889,009.00 271,365.00 3,160,371.00 Census 18.9% 20.2% 52.3% 91.4% 8.6% 100.0%

New Zealand - 2013 463,194.00 702,015.00 1,900,617.00 3,065,823.00 310,593.00 3,376,416.00 Census 13.7% 20.8% 56.3% 90.8% 9.2% 100.0%

Household Income

Both MidCentral and Whanganui have lower median household incomes than New Zealand. This is true at both the 2006 Census and 2013 Census. Whanganui median household income was lower than MidCentral’s.

These patterns are consistent with the NZDep2013 patterns described in the next section.

Of interest, both MidCentral and Whanganui median household incomes declined from 2006 to 2013, relative to New Zealand’s median household income. This

29 suggests growing income disparity, but probably requires more detailed analysis before such a conclusion can be made.

Median Household Income at 2006 Census and 2013 Census 2006 2013 As % of NZ Median As % of NZ Median Median Income Income Median Income Income MidCentral 43,000.00 83.7% 52,200.00 81.8% Whanganui DHB 37,800.00 73.5% 45,700.00 71.6% New Zealand 51,400.00 100.0% 63,800.00 100.0%

NZDep2013 Index of Socio-Economic Deprivation

The Wellington Medical School, Otago University, recently released NZDep2013 Index of Socio-Economic Deprivation, based on data from the 2013 Census (Salmond C, 2014).

NZDep2013 categorizes small geographical areas according to socio-economic deprivation of the people living in those areas. This was done using 2013 Census results.

The areas are graded into one of ten categories (deciles), with decile 1 being the least socio-economically disadvantaged and decile 10 being the most disadvantaged.

The deciles are comparative, so that approximately 10 percent of New Zealand’s population fits into each one. The graph below shows New Zealand’s total population distributed across the ten deciles.

New Zealand Population by NZDep2013 Decile 12.0%

10.0%

8.0%

6.0%

4.0%

Percentage of population 2.0%

0.0% 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile

The next two graphs show MidCentral District Health Board and Whanganui District Health Boards’ populations distributed across the same ten deciles.

MidCentral’s population shows greater socio-economic disadvantage than New Zealand. There are higher proportions of the population living in areas with decile ratings 7 to 10; and lower proportions living in decile 1 to 4 areas.

Whanganui’s population shows even greater socio-economic disadvantage than MidCentral. There is almost a straight line gradation, with very low percentages in decile 1 and very high in decile 10. Almost one in five Whanganui residents live in a decile 10 area (over 18%).

Socio-economic disadvantage is associated with poorer health status (Ministry of Health, 2002). This implies both MidCentral and especially Whanganui populations would have poorer health status than the New Zealand average.

MidCentral DHB Population by NZDep2013 Decile 16.0%

14.0%

12.0%

10.0%

8.0%

6.0%

4.0% Percentage of population 2.0%

0.0% 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile

Whanganui DHB Population by NZDep2013 Decile 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% Percentage of population 4.0% 2.0% 0.0% 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile

MidCentral

Of the MidCentral territorial authorities, Horowhenua and MidCentral’s portion of Kapiti show high proportions of their populations living in disadvantaged deciles. Tararua also show higher percentages living in disadvantaged deciles, although the imbalance is not as marked as for Horowhenua and Kapiti.

Palmerston North and Manawatu are relatively more balanced across the deciles compared to Horowhenua, Kapiti, and Tararua. Therefore, the concentration of socio- economic disadvantage is less.

Horowhenua Population by NZDep2013 Kapiti (MidCentral portion) Population by Decile NZDep2013 Decile 35.0% 45.0%

30.0% 40.0% 35.0% 25.0% 30.0%

20.0% 25.0%

15.0% 20.0% 15.0%

10.0% Percentage of population Percentage of population 10.0%

5.0% 5.0%

0.0% 0.0% 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile NZDep2013 decile

Tararua Population by NZDep2013 Decile Manawatu Population by NZDep2013 Decile 18.0% 16.0% 16.0% 14.0% 14.0% 12.0% 12.0% 10.0% 10.0%

8.0% 8.0%

6.0% 6.0% Percentage of population

4.0% Percentage of population 4.0%

2.0% 2.0%

0.0% 0.0% 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile NZDep2013 deciles

Palmerson North Population by NZDep2013 Decile 16.0%

14.0%

12.0%

10.0%

8.0%

6.0%

4.0% Percentage of population

2.0%

0.0% 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile

Whanganui DHB

All of Whanganui DHB’s territorial authorities show high proportions of their populations living in the most disadvantaged deciles.

Wanganui TA Population by NZDep2013 Decile Rangitikei Population by NZDep2013 Decile 25.0% 18.0%

16.0%

20.0% 14.0%

12.0% 15.0% 10.0%

8.0% 10.0%

6.0%

Percentage of populatoin Percentage of population 5.0% 4.0% 2.0%

0.0% 0.0% 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile NZDep2013 decile

Ruapehu Population by NZDep2013 Decile 25.0%

20.0%

15.0%

10.0% Percentage of population 5.0%

0.0% 1 2 3 4 5 6 7 8 9 10 NZDep2013 decile

3. All Cause Mortality Analysis

Summary

 All cause mortality is used as a general indicator of population health: the healthier a population, the lower its all cause mortality rate.

 Both MidCentral DHB and Whanganui DHB have higher all cause mortality rates than New Zealand overall. MidCentral DHB’s mortality numbers were 4% and Whanganui DHB’s 17% higher than expected, compared to New Zealand (2006 to 2010 accumulated mortality, age adjusted).

 Maori have higher mortality rates. This is true for New Zealand overall, MidCentral DHB, and Whanganui DHB. When deaths from 2006 to 2010 were accumulated and adjusted for differences in age balances of the populations, New Zealand Maori number of deaths was 90% higher than expected, when compared to New Zealand overall. MidCentral Maori number of deaths was 61% higher than expected, compared to New Zealand overall. Whanganui Maori number of deaths was 142% higher than expected, compared to New Zealand overall

 New Zealand Pacific peoples also had higher mortality rates than New Zealand overall. MidCentral DHB and Whanganui DHB Pacific peoples’ mortality numbers were too small to interpret. However, if their Pacific population numbers, then their mortality patterns would probably be similar to New Zealand’s.

 When MidCentral DHB and Whanganui DHB data is examined by their territorial authorities, Horowhenua and all of Whanganui’s territorial authorities (Wanganui, Rangitikei, and Ruapehu) had significantly higher mortality rates compared to New Zealand overall. Horowhenua by 12%, Wanganui territorial authority by 19%, Rangitikei by 11%, and Whanganui DHB’s portion of Ruapehu by 24%.

 Socio-economically disadvantaged areas have higher mortality rates than the corresponding overall population. This is true for MidCentral, Whanganui, and New Zealand. For 2006 to 2010 data combined, the most disadvantaged areas for New Zealand, MidCentral DHB, and Whanganui DHB all had higher than expected number of deaths compared to New Zealand overall (by 24%, 31%, and 29% respectively).

 The diseases/conditions with the biggest impact on population health are: o Circulatory diseases (diseases of the heart and blood vessels) Responsible for around 35% to 40% of all deaths o Cancers Around 30% of all deaths

o Respiratory diseases Around 9% to 10% of all deaths o External causes (accidents and injuries) Around 6% to 8% of all deaths

Introduction

All cause mortality is used as a marker of general health status of a population: the healthier a population, the lower its mortality rate.

This is equivalent to calculations of life expectancy. Life expectancies are actually derived from mortality rates, so they will both end up showing the same patterns and trends.

What influences all cause mortality?  Levels of disease and illness in the community  Lifestyle of the population (for example, diet, physical activity, tobacco use, alcohol use, risky activities)  Population health interventions which promote healthier lifestyles  Disease treatment services available to the population

Most of the data presented will be age adjusted – any differences in age balances of the populations has been compensated for. This is because mortality is more common among older people, so populations with older age balances are naturally going to have higher mortality rates, even if their population health status is the same as the others.

The graph above shows yearly all cause mortality for MidCentral, Whanganui DHB, and New Zealand from 2004 to 2010. MidCentral yearly rates have tended to be higher than New Zealand rates. Whanganui DHB rates have been higher than both MidCentral and New Zealand.

Both MidCentral and New Zealand rates show a declining trend across the period. This is not so clear for Whanganui DHB, which appears to be reasonably static from 2004 to 2010.

The patterns above suggest New Zealand population health is better than both MidCentral and Whanganui DHB. The difference between MidCentral and New Zealand is small; while the difference between Whanganui DHB and New Zealand is wider.

All Cause Mortality Patterns by Ethnicity

MidCentral, Whanganui, and New Zealand All Cause Mortality 2006 to 2010 by Ethnicity Crude Rate Age Adjusted Numbers LCL UCL (per 100,00 Ratio population) New Zealand Maori 14557 1.9 1.87 1.93 2270 New Zealand Pacific 5411 1.65 1.61 1.69 2121 New Zealand Other 124175 0.93 0.92 0.94 3762 MidCentral Maori 553 1.61 1.48 1.74 1936 MidCentral Pacific 38 0.87 0.59 1.15 1005 MidCentral Other 5910 0.98 0.96 1 4381 Whanganui Maori 469 2.42 2.2 2.64 2858 Whanganui Pacific 18 0.98 0.53 1.43 1782 Whanganui Other 2509 1.05 1.01 1.09 5385 MidCentral DHB 6501 1.04 1.01 1.07 3940 Whanganui DHB 2996 1.17 1.13 1.21 4836 New Zealand 144143 1 0 0 3413

The table above shows all cause mortality for the major ethnic groups for MidCentral, Whanganui DHB, and New Zealand. Data for five years has been combined to increase the numbers in the analysis. The five columns show:  Numbers The actual number of deaths for the ethnic group  Age adjusted ratio A ratio comparing the ethnic group’s deaths to New Zealand overall, adjusting for population size and age balance. (It actually compares the actual number of deaths to the expected number of deaths for that group, if they had occurred at the same rate as New Zealand overall. So a ratio of 1.25 means the actual number of deaths was 25% higher than expected – 1.25 is 25% larger than 1.0)  LCL and UCL The LCL (lower confidence limit) and UCL (upper confidence limit) are the borders of the 95% confidence intervals. The confidence interval is the range within which we are 95% certain the true value for the population lies. If the

confidence interval includes 1, the age adjusted ratio for New Zealand overall, then the age adjusted ratio for the ethnic group being considered is regarded as not statistically different from New Zealand overall. We can’t tell whether this difference is a true pattern, or just due to random, chance variation in numbers.  Crude rate This is the non-age adjusted mortality rate. It is the per capita rate for the population, as it exists. Crude rates are calculated by dividing the number of deaths by the population size of the ethnic group being considered, and then multiplying by 100,000, to give a crude rate per 100,000 people.

The age adjusted comparison shows MidCentral’s number of deaths was about 4% higher than expected, compared to New Zealand overall. Whanganui DHB’s number of deaths was 17% higher than expected, when compared to New Zealand.

Maori mortality for all three areas where higher than expected, compared to New Zealand overall:  by 61% for MidCentral Maori (age adjusted ratio of 1.61)  by 90% for New Zealand Maori (age adjusted ratio of 1.90)  by 142% for Whanganui Maori (age adjusted ratio of 2.42)

Pacific mortality for New Zealand Pacific peoples was 65% higher than expected, when compared to New Zealand overall. MidCentral Pacific and Whanganui DHB Pacific age adjusted ratios cannot be interpreted because they are based on low numbers (38 and 18 deaths respectively). Their confidence intervals (the gap bounded by their lower confidence limit [LCL] and upper confidence limit [LCL]) are wide and also include 1, the age adjusted ratio for New Zealand).

MidCentral and Whanganui DHB Pacific populations are small and often don’t generate enough case numbers to identify trends from the usual random fluctuation in numbers.

The graph above shows yearly age adjusted mortality rates for MidCentral, Whanganui DHB, and New Zealand’s ethnic groups. It is not as useful for showing disparities as the age adjusted ratios shown in the previous table. The only reason it is included here is to show progress across time. For most ethnic groups, mortality rates appear to be declining across the 2004 to 2010 period. An exception appears to be Whanganui Maori, who also consistently had the highest yearly mortality rate compared to all the other groups.

There are some ethnic group rates that change markedly across one or two years, for example, Whanganui DHB Pacific, MidCentral Pacific. This is usually because they are based on small yearly number of deaths. A change of one or two deaths can result in a large change in rate. Therefore, yearly Pacific mortality rates for Whanganui DHB and MidCentral DHB are not reliable indicators of Pacific population health for those district health boards.

All Cause Mortality Patterns by Territorial Authority

MidCentral and Whanganui DHBs Territorial Authorities All Cause Mortality 2006 to 2010 Age Adjusted Ratios Crude Rate Age Adjusted (per 100,000 Numbers Ratio LCL UCL population) Palmerston North 2644 1 0.96 1.04 3316 Horowhenua 1767 1.12 1.07 1.17 5777 Manawatu 1028 1 0.94 1.06 3521 Tararua 725 1.05 0.97 1.13 4044 Kapiti 337 0.99 0.88 1.1 4472 Wanganui TA 2296 1.19 1.14 1.24 5391 Rangitikei 589 1.11 1.02 1.2 4023 Ruapehu 111 1.24 1.01 1.47 2351 MidCentral 6501 1.04 1.01 1.07 3940 Whanganui DHB 2996 1.17 1.13 1.21 4836 New Zealand 144143 1 0 0 3413

The table above shows all cause mortality for MidCentral and Whanganui DHB’s territorial authorities from 2006 to 2010 combined. The table shows actual number of deaths, age adjusted ratios, the age adjusted ratio’s lower confidence limit (LCL) and upper confidence limit (LCL), and crude rate.

Of MidCentral’s territorial authorities, Horowhenua stands out as the territorial authority with higher than expected mortality. Its mortality was 12% higher than expected, when compared to New Zealand overall (age adjusted rate of 1.12). Although Tararua has slightly higher mortality, the confidence interval (the gap bounded by the lower confidence limit [LCL] and upper confidence limit [UCL] ) includes 1, New Zealand’s age adjusted ratio. Therefore, Tararua’s difference is not statistically different from New Zealand’s. It could be due to ordinary random fluctuation of numbers, rather than a difference in health status.

All of Whanganui DHB’s territorial authorities show higher than expected mortality, when compared to New Zealand overall. Whanganui DHB’s portion of Ruapehu had the largest difference from New Zealand’s mortality rate. It’s mortality was 24% higher than expected compared to New Zealand (age adjusted ratio of 1.24).

Comparison of crude rates show some interesting patterns. Crude rates are a straight per capita mortality rates, without age adjustment. Horowhenua, Wanganui territorial authority, and Whanganui DHB overall had high crude rates. This is likely because their populations have higher proportions of older people. All cause mortality rates rise among older age groups.

All Cause Mortality for Socio-Economically Disadvantaged Areas

This section analyses all cause mortality for the two most disadvantaged NZDep2001 deciles (deciles 9 and 10) for MidCentral, Whanganui DHB, and New Zealand. This is to examine the relationship of mortality to socio-economic disadvantage for our health districts, and compare these to national equivalents.

The two most disadvantaged deciles (9 and 10) were used as a proxy for socio- economic disadvantage. This is an arbitrary decision – in reality, not all the most socio-economically disadvantaged households in the districts live in these two deciles. However, it is suitable for a broad and general comparison.

The comparison should be used to symbolise the relationship between socio- economically disadvantaged households and the general population.

Mention should be made of small variances of the same measures across this document (and more noticeable in this section). For example, the age adjusted ratios for mortality of MidCentral overall and Whanganui DHB overall. These variations are because of the different inter-census population estimates used in these calculations. However, the general relationship between different groups should be preserved, even with these variations.

The following table shows all cause mortality information for the most disadvantaged areas of MidCentral, Whanganui DHB, and New Zealand for 2006 to 2010 combined. The equivalent data is also given for MidCentral overall, Whanganui overall, and New Zealand overall. The data shown includes: raw numbers, age adjusted ratios

(with their associated lower confidence limits [LCL] and upper confidence limits [UCL]), and crude rates.

The most obvious patterns from these tables are:  NZDep decile 9 and 10 areas have higher than expected mortality numbers than expected, compared to New Zealand overall. The age adjusted ratios for deciles 9 and 10 were: MidCentral, 1.31; Whanganui 1.29, and New Zealand 1.24.  Although MidCentral and Whanganui’s decile 9 and 10 mortality were higher than that for New Zealand’s decile 9 and 10 (higher age adjusted ratios), the differences are not statistically significant The differences are within the range of variation due to chance fluctuation.

MidCentral, Whanganui, New Zealand NZDep2001 9 & 10 All Cause Mortality 2006 to 2010 Indirect Age Adjusted Crude Rate Age Adjusted (per 100,000 Numbers Ratio LCL UCL population) MidCentral NZDep 9 & 10 2120 1.31 1.25 1.37 5933 MidCentral overall 6501 1.02 1 1.04 3887 Whanganui NZDep 9 & 10 723 1.29 1.2 1.38 4286 Whanganui overall 2996 1.15 1.11 1.19 4681 NZ NZDep 9 & 10 30092 1.24 1.23 1.25 3561 New Zealand 144143 1 0 0 3434

The graph below shows yearly age adjusted mortality rates for the same population groups from 2004 to 2010. The mortality rates for most of the groups, except for Whanganui overall, appeared to have been declining across the period.

Almost all other patterns can be more clearly seen in the table already discussed.

What Are The Causes of Mortality?

This section looks at the causes that make up our mortality figures. Why is it useful to know the causes of mortality? Knowing the causes of mortality on a population is important because they indicate the medical conditions with the greatest impact on population health.

The causes of mortality, by ICD-10 chapters, for MidCentral, Whanganui, and New Zealand are shown in the three tables shown below. The data combines deaths for the years 2008 to 2010.

The tables show the four the most common conditions affecting populations are:  Circulatory system disease (diseases of the heart and blood vessels) (around 35% to 40% of all deaths),  Cancers, (around 30% of all deaths)  Respiratory system diseases (lungs and associated organs) (around 9% to 10% of all deaths), and  Deaths due to “external causes” (around 6% to 8% of all deaths).

External causes are injuries and accidents. This category includes deaths from suicides, falls, and road traffic accidents. These are the same four most common causes described in the 2005 and 2009 MidCentral health needs assessments.

Diseases of the circulatory system and cancers are dominant, making up over 60% of deaths. Although circulatory system disease is still the most common cause of mortality, its percentage has fallen since the 2001 to 2004 mortality data, as described in MidCentral’s 2005 health needs assessment, when it was around 40%

The major cause of death of people with diabetes is circulatory system disease.

MidCentral Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 1400 35.6% Cancers 1195 30.4% Diseases of the respiratory system 338 8.6% External causes of morbidity and mortality 298 7.6% Diseases of the nervous system 142 3.6% Diseases of the digestive system 121 3.1% Endocrine, nutritional, and metabolic 116 3.0% Mental & behavioural disorders 104 2.6% Diseases of the genitourinary system 55 1.4% Diseases of the musculoskeletal system and connect 37 0.9% Certain infectious and parasitic diseases 35 0.9% Congenital malformations, deformations, and chromo 24 0.6% Certain conditions originating in the perinatal pe 18 0.5% Diseases of the blood, blood forming organs, & imm 16 0.4% Symptoms, signs and abnormal clinical and lab find 14 0.4% Diseases of the skin and subcutaneous tissue 12 0.3% Pregnancy, childbirth and the puerperium 2 0.1% Diseases of the ear and mastoid system 1 0.0% Total 3928 100.0%

Whanganui DHB Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 709 38.8% Cancers 513 28.1% Diseases of the respiratory system 185 10.1% External causes of morbidity and mortality 113 6.2% Endocrine, nutritional, and metabolic 65 3.6% Diseases of the digestive system 56 3.1% Diseases of the nervous system 48 2.6% Diseases of the genitourinary system 31 1.7% Mental & behavioural disorders 26 1.4% Certain infectious and parasitic diseases 19 1.0% Symptoms, signs and abnormal clinical and lab find 18 1.0% Diseases of the musculoskeletal system and connect 12 0.7% Congenital malformations, deformations, and chromo 9 0.5% Certain conditions originating in the perinatal pe 8 0.4% Diseases of the blood, blood forming organs, & imm 7 0.4% Diseases of the skin and subcutaneous tissue 5 0.3% Pregnancy, childbirth and the puerperium 2 0.1% Total 1826 100.0%

New Zealand Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 31081 35.7% Cancers 25776 29.6% Diseases of the respiratory system 7642 8.8% External causes of morbidity and mortality 5780 6.6% Diseases of the nervous system 3413 3.9% Endocrine, nutritional, and metabolic 3344 3.8% Mental & behavioural disorders 2711 3.1% Diseases of the digestive system 2651 3.0% Diseases of the genitourinary system 1452 1.7% Certain infectious and parasitic diseases 763 0.9% Diseases of the musculoskeletal system and connect 691 0.8% Congenital malformations, deformations, and chromo 533 0.6% Certain conditions originating in the perinatal pe 466 0.5% Symptoms, signs and abnormal clinical and lab find 379 0.4% Diseases of the skin and subcutaneous tissue 258 0.3% Diseases of the blood, blood forming organs, & imm 181 0.2% Pregnancy, childbirth and the puerperium 24 0.0% Diseases of the ear and mastoid system 7 0.0% Diseases of the eye and adnexa 1 0.0% Total 87153 100.0%

Maori have a higher percentage of deaths due to external causes. This pattern is true for New Zealand, MidCentral, and Whanganui DHB. External causes are the third most common cause of mortality for Maori. They range from 12% to 17% of deaths for MidCentral, Whanganui, and New Zealand Maori; compared to 6% to 8% for all ethnicities combined.

New Zealand Maori Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Cancers 2634 29.9% Diseases of the circulatory system 2589 29.4% External causes of morbidity and mortality 1060 12.0% Diseases of the respiratory system 775 8.8% Endocrine, nutritional, and metabolic 670 7.6% Diseases of the digestive system 181 2.1% Certain conditions originating in the perinatal pe 166 1.9% Diseases of the nervous system 154 1.7% Diseases of the genitourinary system 120 1.4% Certain infectious and parasitic diseases 92 1.0% Symptoms, signs and abnormal clinical and lab find 92 1.0% Congenital malformations, deformations, and chromo 91 1.0% Mental & behavioural disorders 63 0.7% Diseases of the musculoskeletal system and connect 55 0.6% Diseases of the skin and subcutaneous tissue 36 0.4% Diseases of the blood, blood forming organs, & imm 12 0.1% Pregnancy, childbirth and the puerperium 9 0.1% Diseases of the ear and mastoid system 2 0.0% Total 8801 100.0%

MidCentral Maori Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Cancers 108 30.6% Diseases of the circulatory system 99 28.0% External causes of morbidity and mortality 61 17.3% Diseases of the respiratory system 29 8.2% Endocrine, nutritional, and metabolic 13 3.7% Diseases of the nervous system 8 2.3% Certain conditions originating in the perinatal pe 7 2.0% Diseases of the digestive system 7 2.0% Symptoms, signs and abnormal clinical and lab find 4 1.1% Certain infectious and parasitic diseases 3 0.8% Diseases of the genitourinary system 3 0.8% Mental & behavioural disorders 3 0.8% Diseases of the blood, blood forming organs, & imm 2 0.6% Diseases of the musculoskeletal system and connect 2 0.6% Congenital malformations, deformations, and chromo 1 0.3% Diseases of the ear and mastoid system 1 0.3% Diseases of the skin and subcutaneous tissue 1 0.3% Pregnancy, childbirth and the puerperium 1 0.3% Total 353 100.0%

Whanganui Maori Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 91 33.1% Cancers 69 25.1% External causes of morbidity and mortality 38 13.8% Diseases of the respiratory system 26 9.5% Endocrine, nutritional, and metabolic 17 6.2% Symptoms, signs and abnormal clinical and lab find 8 2.9% Certain conditions originating in the perinatal pe 5 1.8% Diseases of the nervous system 5 1.8% Diseases of the musculoskeletal system and connect 4 1.5% Congenital malformations, deformations, and chromo 3 1.1% Diseases of the digestive system 3 1.1% Certain infectious and parasitic diseases 2 0.7% Diseases of the genitourinary system 2 0.7% Diseases of the skin and subcutaneous tissue 1 0.4% Pregnancy, childbirth and the puerperium 1 0.4% Total 275 100.0%

4. Major Causes of Mortality Analysis

Summary

This chapter looks at the four major causes of mortality (circulatory disease, cancers, respiratory diseases, and accident and injuries) and sees how these conditions affect the three major population groupings looked at in this document: ethnicity, territorial authority, and NZDep 9 and 10 areas.

In general, the same patterns for all cause mortality are replicated for each of the disease groups (the following comments refer to age adjusted figures):  MidCentral mortality rates are slightly higher than New Zealand’s  Whanganui DHB death rates are higher than both MidCentral and New Zealand.  Maori number of deaths is higher than expected, compared to New Zealand overall. This is true for MidCentral, Whanganui DHB, and New Zealand  New Zealand Pacific number of deaths is higher than expected, compared to New Zealand. MidCentral Pacific and Whanganui DHB Pacific figures are too small to draw any conclusion.  Among MidCentral’s territorial authorities, Horowhenua’s mortality numbers were higher than expected, compared to New Zealand overall.  All of Whanganui DHB’s territorial authorities had higher than expected deaths, but only Wanganui’s differences reached statistical significance for all four disease groups. Rangitikei and Ruapehu (the two least populated) differences did not reach statistical significance (except for circulatory disease). This is probably related to their small population size and corresponding smaller number of deaths.  NZDep 9 and 10 areas had higher mortality rates than their corresponding overall populations. For example, New Zealand NZDep 9 and 10 areas had higher mortality than NZ overall; MidCentral NZDep 9 and 10 areas had higher mortality than MidCentral overall; and Whanganui NZDep 9 and 10 areas had higher mortality than Whanganui DHB overall.

There were also some other patterns which should be highlighted (all comparisons are age adjusted):  Whanganui Maori circulatory disease mortality numbers are particularly high. Their age adjusted number of deaths was over three times higher than expected, when compared to New Zealand overall (age adjusted ratio of 3.06)  Whanganui DHB and Whanganui Maori respiratory disease mortality were both particularly high. Whanganui DHB’s respiratory deaths were 28% higher than expected, compared to New Zealand overall. Whanganui Maori

respiratory deaths were 3.5 times higher than expected, compared to New Zealand.  Both MidCentral DHB and Whanganui DHB had higher than expected external cause (accidents and injury) deaths, compared to New Zealand overall. This was true for almost all MidCentral and Whanganui DHB sub- groups (ethnicity, territorial authorities, NZDep 9 and 10 areas), although not all reached statistical significance.  Respiratory mortality rates for MidCentral and Whanganui socio- economically disadvantaged areas were especially high.

Introduction

This chapter looks at the four main causes of mortality, and how they affect MidCentral and Whanganui DHBs’ ethnic groups, territorial authorities, and socio- economically disadvantaged areas.

The four main causes of mortality are:  Circulatory diseases (responsible for 35% to 40% of all deaths)  Cancers (responsible for around 30% of all deaths)  Respiratory diseases (responsible for around 9% to 10% of all deaths)  External causes (injuries and accidents, including suicides) (responsible for around 6% to 8% of all deaths)

By District Health Board Overall and Ethnicity

Circulatory Disease Mortality

The graph above shows the yearly age adjusted circulatory disease mortality rates for MidCentral, Whanganui DHB, and New Zealand from 2004 to 2010. All three populations showed declining mortality rates. MidCentral closed the period slightly higher than the national rates. Whanganui DHB rates were consistently higher than both MidCentral and New Zealand’s.

MidCentral, Whanganui, and New Zealand Circulatory Diseases Mortality 2006 to 2010 by Ethnicity Crude Rate (per Age Adjusted Numbers LCL UCL 100,000 Ratio population) New Zealand Maori 4421 2.19 2.13 2.25 689.5 New Zealand Pacific 1760 1.93 1.84 2.02 689.9 New Zealand Other 46142 0.93 0.92 0.94 1398 MidCentral Maori 165 1.8 1.53 2.07 577.7 MidCentral Pacific 12 1.01 0.44 1.58 317.5 MidCentral Other 2205 0.98 0.94 1.02 1634 Whanganui Maori 152 3.06 2.57 3.55 926.3 Whanganui Pacific 9 1.42 0.49 2.35 891.1 Whanganui Other 1033 1.14 1.07 1.21 2217 MidCentral DHB 2382 1.03 0.99 1.07 1444 Whanganui DHB 1195 1.26 1.19 1.33 1929 New Zealand 52404 1 0 0 1241

The table above shows circulatory disease age adjusted ratios for MidCentral, Whanganui DHB, and New Zealand’s main ethnic groups. New Zealand is the reference population, and is arbitrarily given the age adjusted ratio of 1. All the other ethnic groups are then compared to it.

LCL is the lower confidence limit and UCL the upper confidence limit of the age adjusted ratio. If the New Zealand’s age adjusted ratio (which is 1) lies within the range bounded by the LCL and UCL, then this is considered not statistically different from New Zealand.

The table’s age adjusted ratios show Maori have higher age adjusted circulatory mortality compared to New Zealand overall. Whanganui Maori have especially high circulatory disease mortality – their mortality numbers were over three times higher than expected, compared to New Zealand overall. New Zealand Maori circulatory disease mortality was over twice expected, compared to New Zealand (age adjusted ratio of 2.19). MidCentral Maori circulatory disease mortality was 80% higher than expected, compared to New Zealand (age adjusted ratio of 1.8).

New Zealand Pacific circulatory disease mortality was markedly higher than New Zealand overall, with mortality numbers 93% higher than New Zealand overall (age adjusted ratio 1.93).

The number of MidCentral Pacific and Whanganui Pacific deaths were too small to calculate stable age adjusted ratios. However, the same circulatory disease concerns for Pacific people in New Zealand overall are likely to apply to Whanganui and MidCentral.

MidCentral all ethnicities circulatory disease mortality numbers are close to what would be expected, if New Zealand’s rates were applied to MidCentral’s population. Whanganui DHB’s number of circulatory disease deaths was 26% higher than expected, compared to New Zealand.

Cancer Mortality

Yearly age adjusted cancer mortality for MidCentral, Whanganui DHB, and New Zealand is shown in the graph above. Across the period, yearly mortality rates appear to have declined to a small degree.

MidCentral, Whanganui, and New Zealand Cancer Mortality 2006 to 2010 by Ethnicity Crude Rate (per Age Adjusted Numbers LCL UCL 100,000 Ratio population) New Zealand Maori 4238 1.68 1.63 1.73 661 New Zealand Pacific 1518 1.42 1.35 1.49 595 New Zealand Other 36774 0.94 0.93 0.95 1114 MidCentral Maori 161 1.44 1.22 1.66 563.7 MidCentral Pacific 12 0.89 0.39 1.39 317.5 MidCentral Other 1786 1.02 0.97 1.07 1324 Whanganui Maori 125 1.89 1.56 2.22 761.7 Whanganui Pacific 3 0.59 -0.08 1.26 297 Whanganui Other 712 1.02 0.95 1.09 1528 MidCentral DHB 1959 1.07 1.02 1.12 1187 Whanganui DHB 840 1.11 1.03 1.19 1356 New Zealand 42530 1 0 0 1007

MidCentral overall and Whanganui DHB cancer mortalities were slightly higher than New Zealand overall (by 7% and 11% respectively).

When MidCentral, Whanganui DHB, and New Zealand major ethnic groups are examined, Maori have higher cancer mortality compared to New Zealand overall (age adjusted ratios from 1.44 to 1.89). New Zealand Pacific cancer mortality was also higher than New Zealand overall, by 42%. MidCentral DHB and Whanganui DHB Pacific figures are less interpretable, because of small numbers.

Respiratory Disease Mortality

MidCentral and New Zealand’s yearly age adjusted respiratory mortality rates across 2004 to 2010 were very similar to each other. There also might have been a slight decline in rates across the period.

Whanganui DHB’s rates were higher than MidCentral and New Zealand rates, and were increasing from 2007 onwards.

MidCentral, Whanganui, and New Zealand Respiratory Diseases Mortality 2006 to 2010 by Ethnicity

Age Adjusted Crude Rate (per Numbers LCL UCL Ratio 100,000 people) New Zealand Maori 1225 2.39 2.26 2.52 191.1 New Zealand Pacific 374 1.65 1.48 1.82 146.6 New Zealand Other 10771 0.93 0.91 0.95 326.3 MidCentral Maori 45 1.92 1.36 2.48 157.6 MidCentral Pacific 4 1.38 0.03 2.73 105.8 MidCentral Other 502 0.94 0.86 1.02 372.1 Whanganui Maori 45 3.5 2.48 4.52 274.2 Whanganui Pacific 2 1.4 -0.54 3.34 198 Whanganui Other 242 1.13 0.99 1.27 519.4 MidCentral DHB 551 1.01 0.93 1.09 334 Whanganui DHB 289 1.28 1.13 1.43 466.5 New Zealand 12370 1 0 0 292.9

When five years of respiratory disease mortality data is analysed by ethnicity and district health board overall, Whanganui DHB respiratory disease deaths were 28% higher than expected, compared to New Zealand overall (age adjusted ratio of 1.28).

The number of MidCentral respiratory deaths is close to what would be expected if MidCentral had the same respiratory disease mortality rates as New Zealand overall.

Maori have particularly high number of deaths compared to what would be expected, compared to New Zealand overall.  New Zealand Maori had over double the number of deaths compared to New Zealand rates (age adjusted ratio of 2.32).  Midcentral Maori had just under double the number of deaths compared to New Zealand (age adjusted ratio of 1.92)  Whanganui Maori had about three and a half times the number of deaths compared to New Zealand (age adjusted ratio of 3.5)

New Zealand Pacific experienced 65% higher number of respiratory disease deaths than expected, compared to New Zealand overall. MidCentral and Whanganui Pacific numbers were too small to draw any meaningful conclusions.

External Causes (Accidents and Injuries)

The graph above shows yearly age adjusted mortality rates for external causes from 2004 to 2010 for MidCentral District Health Board, Whanganui District Health Board, and New Zealand. External causes mortality is deaths from accidents and injuries.

Both MidCentral and Whanganui DHB have had consistently higher yearly rates than New Zealand overall. Whanganui DHB rates can fluctuate widely from year to year due to low numbers. Whanganui DHB’s average number of deaths per year across the seven year period shown was 36 (compared to 91 for MidCentral).

MidCentral, Whanganui, and New Zealand External Causes Mortality 2006 to 2010 by Ethnicity Crude Rate (per Age Adjusted Numbers LCL UCL 100,000 Ratio population) New Zealand Maori 1787 1.69 1.61 1.77 278.7 New Zealand Pacific 388 0.89 0.8 0.98 152.1 New Zealand Other 7199 0.92 0.9 0.94 218.1 MidCentral Maori 92 1.94 1.54 2.34 322.1 MidCentral Pacific 4 0.63 0.01 1.25 105.8 MidCentral Other 381 1.14 1.03 1.25 282.4 Whanganui Maori 64 2.4 1.81 2.99 390 Whanganui Pacific 1 0.51 -0.49 1.51 99.01 Whanganui Other 118 0.98 0.8 1.16 253.3 MidCentral DHB 477 1.25 1.14 1.36 289.1 Whanganui DHB 183 1.27 1.09 1.45 295.4 New Zealand 9374 1 0 0 222

When the MidCentral and Whanganui district health boards’ major ethnic groups were compared to New Zealand overall:  Maori had higher external cause mortality numbers than expected compared to New Zealand overall. This was true for New Zealand (69% higher), MidCentral (94% higher), and Whanganui DHB (140% higher).  Both MidCentral and Whanganui DHB had higher than expected external causes mortality compared to New Zealand overall. MidCentral by 25% (age adjusted ratio of 1.25) and Whanganui DHB by 27% (age adjusted ratio of 1.27).  New Zealand Pacific external mortality deaths were lower than expected, compared to New Zealand by 11% (age adjusted ratio of 0.89).

Disease Mortality Patterns by Territorial Authority

This section examines circulatory disease, cancer, respiratory disease, and external causes mortality patterns across MidCentral DHB and Whanganui DHB’s territorial authorities.

Circulatory Disease

MidCentral and Whanganui DHBs Territorial Authorities Circulatory Diseases Mortality 2006 to 2010 Age Adjusted Ratios Crude Rate (per Age Adjusted 100,000 Numbers Ratio LCL UCL population) Palmerston North 982 1.01 0.95 1.07 1232 Horowhenua 659 1.11 1.03 1.19 2154 Manawatu 383 1.02 0.92 1.12 1312 Tararua 262 1.02 0.9 1.14 1461 Kapiti 96 0.79 0.63 0.95 1274 Wanganui TA 919 1.26 1.18 1.34 2158 Rangitikei 227 1.19 1.04 1.34 1550 Ruapehu 49 1.73 1.25 2.21 1038 MidCentral 2382 1.03 0.99 1.07 1444 Whanganui DHB 1195 1.26 1.19 1.33 1929 New Zealand 52404 1 0 0 1241

The territorial authorities with greater than expected circulatory disease mortality compared to New Zealand overall were:  For MidCentral: Horowhenua (by 11%)  For Whanganui DHB: all of Whanganui DHB’s territorial authorities o Wanganui by 26% (age adjusted ratio of 1.26) o Rangitikei by 15% (age adjusted ratio of 1.19) o Ruapehu by 73% (age adjusted ratio of 1.73)

MidCentral’s portion of Kapiti had 21% fewer deaths than expected, compared to New Zealand.

Cancer

MidCentral and Whanganui DHBs Territorial Authorities Cancer Mortality 2006 to 2010 Age Adjusted Ratios Crude Rate Age Adjusted (per 100,000 Numbers Ratio LCL UCL population) Palmerston North 755 1 0.93 1.07 947 Horowhenua 527 1.14 1.04 1.24 1723 Manawatu 314 1.02 0.91 1.13 1075 Tararua 229 1.12 0.97 1.27 1277 Kapiti 134 1.21 1.01 1.41 1778 Wanganui TA 623 1.11 1.02 1.2 1463 Rangitikei 183 1.12 0.96 1.28 1250 Ruapehu 34 1.2 0.8 1.6 720.2 MidCentral 1959 1.07 1.02 1.12 1187 Whanganui DHB 840 1.11 1.03 1.19 1356 New Zealand 42530 1 0 0 1007

The territorial authorities with greater than expected cancer mortality compared to New Zealand overall were:  For MidCentral: o Horowhenua, 14% higher than expected o Kapiti (MidCentral portion only), 21% higher than expected  For Whanganui DHB: o Wanganui territorial authority, 11% higher than expected

Tararua, Rangitikei, and Ruapehu also had higher age adjusted ratios but they did not reach statistical significance – it’s not possible to say that this ratio represents a true pattern or occurred from a chance coincidence of numbers.

Respiratory Disease

MidCentral and Whanganui DHBs Territorial Authorities Respiratory Diseases Mortality 2006 to 2010 Age Adjusted Ratios Crude Rate (per Age Adjusted 100,000 Numbers Ratio LCL UCL population) Palmerston North 210 0.92 0.8 1.04 263.4 Horowhenua 182 1.29 1.1 1.48 595 Manawatu 74 0.84 0.65 1.03 253.5 Tararua 54 0.89 0.65 1.13 301.2 Kapiti 31 1.04 0.67 1.41 411.3 Wanganui TA 227 1.32 1.15 1.49 533 Rangitikei 52 1.14 0.83 1.45 355.2 Ruapehu 10 1.48 0.56 2.4 211.8 MidCentral 551 1.01 0.93 1.09 334 Whanganui DHB 289 1.28 1.13 1.43 466.5 New Zealand 12370 1 0 0 292.9

The territorial authorities with greater than expected respiratory disease mortality compared to New Zealand overall were:  For MidCentral: o Horowhenua, 29% higher than expected  For Whanganui DHB: o Wanganui territorial authority, whose respiratory mortality was 32% higher than expected, compared to New Zealand overall

Kapiti (MidCentral portion), Rangitikei, and Ruapehu also had higher than expected number of respiratory deaths when compared to New Zealand overall, but the differences did not reach statistical significance.

External Causes

MidCentral and Whanganui DHBs Territorial Authorities External Causes Mortality 2006 to 2010 Age Adjusted Ratios

Age Adjusted Crude Rate (per Numbers Ratio LCL UCL 100,000 people) Palmerston North 210 1.15 0.99 1.31 263.4 Horowhenua 103 1.35 1.09 1.61 336.7 Manawatu 83 1.29 1.01 1.57 284.3 Tararua 62 1.53 1.15 1.91 345.8 Kapiti 19 1.1 0.61 1.59 252.1 Wanganui TA 131 1.27 1.05 1.49 307.6 Rangitikei 40 1.24 0.86 1.62 273.2 Ruapehu 12 1.33 0.58 2.08 254.2 MidCentral 477 1.25 1.14 1.36 289.1 Whanganui DHB 183 1.27 1.09 1.45 295.4 New Zealand 9374 1 0 0 222

All of MidCentral’s territorial authorities had higher than expected external cause mortality ratios than New Zealand overall. However, Palmerston North and Kapiti (MidCentral portion) did not reach statistical significance. The ones that did were:  Horowhenua, whose external causes mortality deaths was 35% higher than expected, compared to New Zealand overall  Manawatu, with mortality 29% higher than expected, compared to New Zealand overall  Tararua, with external causes mortality 53% higher than expected, compared to New Zealand overall.

All of Whanganui DHB’s territorial authorities had higher than expected external causes deaths, but only Wanganui territorial authority’s difference reached statistical significance (27% higher than expected, compared to New Zealand overall).

Socio-Economically Disadvantaged Areas

This section examines circulatory disease, cancer, respiratory disease, and external cause deaths across socio-economically disadvantaged areas.

The disadvantaged areas considered are: MidCentral’s NZDep2001 9 & 10 areas, Whanganui DHB’s NZDep2001 9 & 10 areas, and New Zealand’s NZDep2001 9 & 10 areas.

Circulatory Diseases

MidCentral, Whanganui, New Zealand NZDep2001 9 & 10 Circulatory Diseases Mortality 2006 to 2010 Indirect Age Adjusted Crude Rate Age Adjusted (per 100,000 Numbers Ratio LCL UCL population) MidCentral NZDep 9 & 10 783 1.29 1.2 1.38 2191 MidCentral overall 2382 1.01 0.97 1.05 1424 Whanganui NZDep 9 & 10 265 1.34 1.18 1.5 1571 Whanganui overall 1195 1.24 1.17 1.31 1867 NZ NZDep 9 & 10 10510 1.23 1.21 1.25 1244 New Zealand 52404 1 0 0 1249

Circulatory diseases mortality analysis shows socio-economically disadvantaged areas had higher age adjusted mortality compared to New Zealand overall. This was true for all three areas considered: MidCentral, Whanganui, and New Zealand (by 29%, 34%, and 23% respectively).

It is interesting that Whanganui DHB’s circulatory disease mortality is similarly high as MidCentral NZDep 9 and 10 and New Zealand’s NZDep 9 and 10 areas. All comparisons are made using New Zealand overall as a benchmark.

Cancer

MidCentral, Whanganui, New Zealand NZDep2001 9 & 10 Cancer Mortality 2006 to 2010 Indirect Age Adjusted Crude Rate Age Adjusted (per 100,000 Numbers Ratio LCL UCL population) MidCentral NZDep 9 & 10 612 1.29 1.19 1.39 1713 MidCentral overall 1959 1.05 1 1.1 1171 Whanganui NZDep 9 & 10 203 1.18 1.02 1.34 1203 Whanganui overall 840 1.1 1.03 1.17 1312 NZ NZDep 9 & 10 8559 1.18 1.16 1.2 1013 New Zealand 42530 1 0 0 1013

The main patterns are:

All three NZDep 9 and 10 areas showed higher than expected numbers of cancer deaths, compared to New Zealand. MidCentral by 29%, Whanganui by 18%, and New Zealand by 18%.

Respiratory Disease

MidCentral, Whanganui, New Zealand NZDep2001 9 & 10 Respiratory Diseases Mortality 2006 to 2010 Indirect Age Adjusted Crude Rate Age Adjusted (per 100,000 Numbers Ratio LCL UCL population) MidCentral NZDep 9 & 10 212 1.47 1.27 1.67 593.3 MidCentral overall 551 0.99 0.91 1.07 329.5 Whanganui NZDep 9 & 10 85 1.78 1.4 2.16 503.9 Whanganui overall 289 1.27 1.12 1.42 451.6 NZ NZDep 9 & 10 2785 1.37 1.32 1.42 329.5 New Zealand 12370 1 0 0 294.7

Respiratory disease deaths were particularly high for Whanganui DHB’s socio- economically disadvantaged areas and MidCentral’s socio-economically disadvantaged areas. Higher than expected, compared to New Zealand, by 78% and 47% respectively.

Respiratory disease would appear to be a good area to improve the health of disadvantaged populations, for example, smoking health promotion, smoking cessation support, respiratory disease services, improving home environments (to reduce the risk of respiratory infections and exacerbations of chronic conditions).

External Causes

MidCentral, Whanganui, New Zealand NZDep2001 9 & 10 External Causes Mortality 2006 to 2010 Indirect Age Adjusted Crude Rate Age Adjusted (per 100,000 Numbers Ratio LCL UCL people) MidCentral NZDep 9 & 10 143 1.63 1.36 1.9 400.2 MidCentral overall 477 1.23 1.12 1.34 285.2 Whanganui NZDep 9 & 10 62 1.71 1.28 2.14 367.6 Whanganui overall 183 1.23 1.05 1.41 285.9 NZ NZDep 9 & 10 2260 1.28 1.23 1.33 267.4 New Zealand 9374 1 0 0 223.4

All the MidCentral and Whanganui DHB groups – both socio-economically disadvantaged areas and district health board overall – had higher than expected deaths from external causes, when compared to New Zealand.

MidCentral NZDep 9 & 10 and Whanganui DHB NZDep 9 & 10 areas had particularly higher number of deaths than expected – by 63% and 71% respectively.

5. Disease Group Breakdown

Summary

 From the previous chapter, the major disease groups causing mortality were: circulatory system diseases were responsible for 35% to 40% of all deaths; cancers for around 30% of deaths; respiratory diseases around 9% to 10% of deaths, and accidents and injuries around 6% to 8% of all deaths.

 The main causes of circulatory system deaths were ischaemic heart disease (like angina and heart attacks) and stroke. Circulatory system diseases include strokes because the actual cause of a stroke originates in the blood vessels supplying the brain.

 The main causes of cancer deaths were: prostate cancer, breast cancer, colorectal cancer, blood-related cancers (like lymphomas, and leukaemias), malignant melanoma, and cancer of the pancreas.

 The main causes of respiratory deaths were: chronic obstructive pulmonary disease (COPD – emphysema and chronic bronchitis), lung infections, and interstitial lung disease (disease affecting the lung tissue between the air sacs).

 The main causes of deaths from accidents and injuries were: motor vehicle accidents, falls, and intentional self-harm (suicide). Drowning was also a prominent cause for MidCentral residents.

Introduction

From the previous chapter, the main disease groups affecting population health are:  Circulatory diseases (responsible for 35% to 40% of all deaths)  Cancers (responsible for around 30% of all deaths)  Respiratory diseases (responsible for around 9% to 10% of all deaths)  External causes (injuries and accidents, including suicides) (responsible for around 6% to 8% of all deaths)

This chapter gives a breakdown of the individual diseases within those disease groups. This information will help picture which diseases have the greatest impact on population health, and therefore, the types of health services required.

The populations focused on are MidCentral District Health Board and Whanganui District Health Board.

Circulatory Disease

Ischaemic heart disease and strokes are the two dominant causes of circulatory disease deaths. Ischaemic heart disease are diseases caused by blockage of the arteries supplying the heart muscle, for example heart attacks (myocardial infarction) and angina. Strokes are brain damage caused by an interruption of the blood flow to the brain. Most of them are caused by the same disease process as ischaemic heart disease, except the blood vessels affected are those supplying the brain.

MidCentral DHB Circulatory Disease Mortality 2006 to 2010 Whanganui DHB Circulatory Disease Mortality 2006 to 2010 Disease group Number Percentage Disease group Number Percentage Ischaemic heart disease 1347 56.5% Ischaemic heart disease 693 58.0% Stroke 450 18.9% Stroke 206 17.2% Cerebral bleeding 106 4.5% Cerebral bleeding 54 4.5% Heart valve disease 102 4.3% Heart failure 51 4.3% Aortic aneurysm and dissection 77 3.2% Hypertension 48 4.0% Hypertension 73 3.1% Heart valve disease 37 3.1% Heart failure 70 2.9% Heart arrythmia 32 2.7% Heart arrythmia 54 2.3% Aortic aneurysm and dissection 26 2.2% Diseases of heart muscle 31 1.3% Diseases of heart muscle 20 1.7% Diseases of the arteries 29 1.2% Diseases of the arteries 10 0.8% Pulmonary embolism 15 0.6% Miscellaneous 7 0.6% Endocarditis and other heart infections 11 0.5% Endocarditis and other heart infections 6 0.5% Diseases of the veins 6 0.3% Pulmonary embolism 3 0.3% Miscellaneous 6 0.3% Lung related heart disease 2 0.2% Lung related heart disease 3 0.1% Total 1195 100.0% Rheumatic heart disease 2 0.1% Total 2382 100.0%

Cancers

The most common cancers are similar for both MidCentral and Whanganui DHB populations. They are: lung cancer, colo-rectal cancer, blood system-related cancers, prostate cancer, breast cancer, pancreatic cancer, and malignant melanoma. `

MidCentral DHB Cancer Mortality 2006 to 2010 Whanganui DHB Cancer Mortality 2006 to 2010 Disease group Number Percentage Disease group Number Percentage Lung cancer 374 19.1% Lung cancer 166 19.8% Cancers of the large intestine, rectum, and anus 295 15.1% Cancers of the large intestine, rectum, and anus 128 15.2% Cancers of the blood and lymphoid systems 196 10.0% Cancers of the blood and lymphoid systems 81 9.6% Prostate cancer 152 7.8% Breast cancer 59 7.0% Breast cancer 142 7.2% Prostate cancer 57 6.8% Cancers of the pancreas 118 6.0% Cancers of the pancreas 45 5.4% Malignant melanoma 114 5.8% Malignant melanoma 43 5.1% Miscellaneous 93 4.7% Cancers of kidneys and urinary tract 42 5.0% Cancers of kidneys and urinary tract 82 4.2% Cancers of female reproductive organs 32 3.8% Cancers of female reproductive organs 71 3.6% Miscellaneous 26 3.1% Cancers of the brain and nervous system 64 3.3% Cancers of the brain and nervous system 26 3.1% Cancers of the stomach 50 2.6% Cancers of oesophagus 23 2.7% Cancers of oesophagus 49 2.5% Cancers of the stomach 20 2.4% Cancers of gallbladder and bile ducts 32 1.6% Other digestive tract cancers 19 2.3% Cancers of ear, nose, mouth, and throat 26 1.3% Cancers of ear, nose, mouth, and throat 19 2.3% Other digestive tract cancers 22 1.1% Connective tissue cancers 19 1.0% Cancers of gallbladder and bile ducts 14 1.7% Mesothelioma 16 0.8% Liver cancer 10 1.2% Cancers of the face and head 14 0.7% Mesothelioma 9 1.1% Liver cancer 13 0.7% Connective tissue cancers 7 0.8% Cancers of thyroid and other endocrine glands 10 0.5% Bone cancers 4 0.5% Cancers of the eye 3 0.2% Cancers of the eye 3 0.4% Cancers of the small intestine 2 0.1% Cancers of the face and head 3 0.4% Bone cancers 2 0.1% Cancers of the small intestine 2 0.2% Total 1959 100.0% Cancers of male reproductive organs 1 0.1% Cancers of thyroid and other endocrine glands 1 0.1% Total 840 100.0%

Respiratory Disease

Chronic obstructive pulmonary disease (COPD) and lung infections were the two most dominant causes of death for both district health boards. Interstitial lung disease the third most common cause (approximately 5% of respiratory disease deaths).

Whanganui DHB Respiratory Disease Mortality 2006 to 2010 MidCentral DHB Respiratory Disease Mortality 2006 to 2010 Disease group Number Percentage Disease group Number Percentage Chronic obstructive pulmonary disease 343 62.3% Chronic obstructive pulmonary disease 221 76.5% Lung infection 131 23.8% Lung infection 33 11.4% Interstitial lung disease 27 4.9% Interstitial lung disease 15 5.2% Asthma 18 3.3% Lung infection due to aspiration 7 2.4% Bronchiecstasis 12 2.2% Asthma 3 1.0% Lung infection due to aspiration 9 1.6% Pneumoconiosis 3 1.0% Upper respiratory tract infection 6 1.1% Bronchiectatsis 3 1.0% Pneumoconiosis 3 0.5% Upper respiratory tract infection 2 0.7% Miscellaneous 2 0.4% Miscellaneous 2 0.7% Total 551 100.0% Total 289 100.0%

External Causes (accidents and injuries)

Motor vehicle crashes, falls injuries, and intentional self harm (suicide) were the three most dominant causes of external cause deaths. Drowning was also a prominent cause of death for MidCentral residents – just under 11%, and the fourth most common external cause of death.

MidCentral DHB External Cause Deaths 2006 to 2010 Whanganui DHB External Cause Deaths 2006 to 2010 Cause Number of deaths Percentage Cause Number of deaths Percentage Motor vehicle accident 121 25.4% Motor vehicle accident 51 27.9% Fall injuries 113 23.7% Falls injuries 42 23.0% Intentional self harm 77 16.1% Intentional self harm 36 19.7% Drowning 52 10.9% Miscellaneous 10 5.5% Accidental poisoning 26 5.5% Assault 7 3.8% Miscellaneous 18 3.8% Accidental poisoning 7 3.8% Pedestrian traffic injuries 13 2.7% Burns and fire-related injury 6 3.3% Suffocation 11 2.3% Pedestrian traffic injuries 6 3.3% Assault 11 2.3% Drowning 5 2.7% Motorcycle rider injuries 11 2.3% Motorcyle rider injuries 4 2.2% Burns and fire-related injury 9 1.9% Suffocation 4 2.2% Other transport accidents 9 1.9% Struck by object 3 1.6% Struck by object 6 1.3% Other transport accidents 2 1.1% Total 477 100.0% Total 183 100.0%

6. Socio-economic Disadvantage and Health

Summary

. NZDep findings are a generalisation applied to geographical areas, which makes it difficult to apply its findings to specific families or individuals. For example, not all socioeconomically disadvantaged people live in socioeconomically disadvantaged areas and not all people living in socioeconomically disadvantaged areas are socioeconomically disadvantaged.

. To be able to find and assist people experiencing socio-economic hardship, it is necessary to recognize what these people look like (rather than just areas where they are more likely to live)

. Ministry of Social Development research helps us identify people who are most at risk of socioeconomic hardship. The research has been written in the report “New Zealand Living Standards 2004”.

. “New Zealand Living Standards 2004” findings suggests hardship is not usually due to one factor alone, but multiple factors combining their effects. Therefore, assistance targeting just one factor is unlikely to completely relieve hardship.

. The factors associated with hardship described in New Zealand Living Standards 2004 include: o low income o low level of assets owned o housing rented rather than owned o people who have experienced marriage (or marriage-like relationship) break-up o adverse life event (“life shocks”—for example, marriage break- up, bereavement, loss of job, etc) o personal health problems (multiple and enough to affect lifestyle) o children’s health problems (multiple and enough to affect lifestyle) o inability to afford childcare to work or study o when income comes from income-tested benefit rather than from employment or superannuation o having dependent children o Maori or Pacific ethnicities o people with multiple financial payments they find difficult to meet

. “New Zealand Living Standards 2004” findings can be used to identify households most at risk of socioeconomic hardship, so they can be offered extra assistance.

. Ministry of Social Development research also shows socio-economically disadvantaged people who experience related health/social issues are likely to need support beyond just financial assistance.

. “Household incomes in New Zealand: Trends in indicators of inequality and hardship 1982 to 2013” (published by the Ministry of Social Development in 2014) indicates hardship increased with the global economic crisis, but there has been some recovery since then

Introduction

NZDep classifies the socio-economic disadvantage of areas and not individuals. Not all people who live in the most disadvantaged areas are socio-economically disadvantaged; and not all socio-economically disadvantaged people live in the most disadvantaged areas.

There is also difficulty applying the NZDep derived knowledge to day to day patient care situations. For example, how is it possible to identify people who are experiencing socio-economic disadvantage, so they can be offered assistance?

Recognising Households who are Socio-economically Disadvantaged Ministry of Social Development research, conducted in 2004, has identified household characteristics with a higher risk of socio-economic hardship. The results were published in the report “New Zealand Living Standards 2004”. These characteristics can help health planners and providers identify people at risk of socio- economic hardship (Jensen J, 2006). New Zealand Living Standards 2004 can be downloaded from the Ministry of Social Development’s Internet web site (www.msd.govt.nz).

The New Zealand Living Standards 2004 research was based on a survey which attempted to gauge whether the family answering the survey was experiencing socio- economic hardship or not. The survey questions and the way the answers were graded, called the Economic Living Standard Index, assessed a household’s living standards by looking at what people were consuming, their recreational and social activities, and household facilities they use. The results were then graded on a scale from 1 (severe hardship) to 7 (very good living standard).

There was a previous living standards survey, the “New Zealand Living Standards 2000”, which followed the same methods. The results of the 2000 and 2004 surveys can be compared to look for changes across time.

“New Zealand Living Standards 2004”, main general findings were:

. About three-quarters (76%) of New Zealanders have living standards which range from “fairly comfortable” (grade 4) to “very good” (grade

7). This is similar to results from 2000. . Although the Economic Living Standard Index average score was the same in 2004 compared to 2000, the proportion of people experiencing “severe hardship” increased slightly. . Disparities have increased between people with the best living standards and those with the worst. Living standards have declined for sole parents, people on income tested benefits, and large families.

New Zealand Living Standards 2004 also identified household characteristics that increased the risk of socio-economic hardship. A key finding was that hardship is usually caused by multiple factors acting together and not by one factor alone. The factors identified by the report associated with hardship were:

. low income . low level of assets owned . housing rented rather than owned . marriage (or marriage-like relationship) break-up. Women appeared to be worse affected than men . adverse live event (“life shock”, for example, loss of job, bereavement, victim violence, house burgled, loss of home, etc) . personal health problems (especially when they are multiple and enough to affect lifestyle) . children’s health problems (especially when they are multiple and enough to affect lifestyle) . inability to afford childcare to work or study . income coming from income-tested benefit rather than from employment or superannuation (even when income amount is the same) . having dependent children . Maori or Pacific ethnicity (usually because Maori or Pacific households are likely to experience the other factors mentioned here) . multiple financial payments that people find difficult to meet.

Again, hardship is usually caused by multiple factors acting together rather than one factor alone. Therefore, any assistance which targets just one factor is unlikely to completely solve hardship. Also, changes in people’s circumstances can change their situation from a comfortable one to hardship and vice versa.

The table below was copied from “Pockets of Significant Hardship and Poverty”, a report prepared by the Centre for Social Research and Evaluation, Ministry of Social Development in 2007 (Centres for Social Research and Evaluation, 2007). The table illustrates how those experiencing hardship, which come to the attention of health services, are likely to come from the more serious end of the poverty continuum. They don’t just require financial assistance, but also other types of support, including health.

Poverty Continuum (from “Pockets of Significant Hardship and Poverty”) Category Examples Support required 1. Just coping, but no reserves Power bills, car repairs, dental Increased income addresses for big bills treatment, rates problem 2. Costs higher than income High housing and/or transport costs, high power costs, high food costs, health costs, debt repayment 3. Life shocks and accumulated Ill-health, job-loss, separation, Need for additional support adversity funeral costs, poor start in life increases 4. ‘Diseases’ of poverty Poor mental and physical health, diabetes, obesity, smoking, drug and alcohol abuse, gambling, debt, family violence, transience, low attachment to education and work 5. Poverty entrenched and Long-term benefit receipt, inter- Intensive, wraparound transferred generational dependency services needed

The Ministry of Social Development has not repeated research defining the characteristics of households experiencing socio-economic hardship. Those characteristics probably have not changed since then. However, they have published progress reports on hardship and inequality over time.

“Household incomes in New Zealand: Trends in indicators of inequality and hardship 1982 to 2013”, published by the Ministry of Social Development in 2014 gives some indication of hardship patterns over recent years.

Material hardship rates increased from 2007 to 2011, especially for children and older working adults. This coincides with the economic downturn because of the global financial crisis. There has been some recovery from 2011 to 2012. For example, 15% of children were experiencing material hardship in 2007, increasing to 21% in 2011. The rate in 2012 reduced to 17% (Ministry of Social Development, 2014).

7. Amenable Mortality

Summary

 Amenable mortality is mortality from those conditions thought to be amenable to health service intervention. Therefore, it is meant to be a broad and general measure of the effectiveness of health services towards the population they serve.

 The amenable mortality data in this chapter was analysed in the same way as was done for all cause mortality: age adjusted, and then by ethnicity, territorial authority, and for socio-economically disadvantaged areas.

 In general, the same patterns of disadvantage were shown as for the all cause mortality analysis.

 However, the gap between these groups and New Zealand overall is wider when looking at their amenable mortality compared to all cause mortality.

 This implies health services require a greater amount of effort to reach health disadvantaged peoples than all cause mortality analysis suggests.

 Both MidCentral DHB and Whanganui DHB had higher number of deaths due to amenable causes than expected, when compared to New Zealand overall. MidCentral by 11% and Whanganui DHB by 33%.

 MidCentral Maori, Whanganui Maori, and New Zealand Maori all had higher than expected numbers of amenable deaths, compared to New Zealand overall (by 113%, 169%, and 129% respectively).

 When examined by MidCentral and Whanganui DHB’s territorial authorities, Horowhenua and all of Whanganui DHB’s territorial authorities had higher than expected number of amenable deaths, compared to New Zealand overall.

 As expected, NZDep 9 and 10 (socio-economically disadvantaged) areas had higher amenable mortality compared to their base population groups

 Therefore, in summary, the populations experiencing health status disadvantage are (comparing them to New Zealand oveall): o Maori (in Whanganui DHB, MidCentral, and New Zealand overall) o Pacific peoples o Horowhenua residents o Residents in all of Whanganui DHB’s territorial authorities (Wanganui, Rangitikei, and Ruapehu) o People experiencing socio-economic disadvantage

 The disease groups causing the highest percentages of amenable deaths were the same as for all cause mortality, namely: o Circulatory disease Mainly ischaemic heart disease and cerebrovascular disease (heart attacks, angina, and strokes) o Cancers (sometimes referred to as neoplasms in this chapter) The main cancers were breast cancer, prostate cancer, and colo-rectal cancer o External causes The main causes were transport accidents and intentional injuries (suicides).

Introduction

This chapter looks at amenable mortality as applied to MidCentral and Whanganui district health boards. It starts by describing what amenable mortality is. Then amenable mortality rates are calculated for MidCentral and Whanganui District Health boards overall, then by ethnicity, territorial authority, and NZDep 9 and 10 areas. Finally, the main causes of amenable mortality (by disease or condition) are determined.

What is Amenable Mortality?

The concept of amenable mortality for New Zealand mortality analysis was described in a Ministry of Health report published in 2010 called “Saving Lives – Amenable Mortality in New Zealand, 1996 to 2006” (Ministry of Health, 2010).

Amenable mortality is defined as “deaths from those conditions for which variation in mortality rates (over time or across populations) reflects variation in the coverage and quality of health care (itself defined as preventive or therapeutic services delivered to individuals or families)”. It is restricted to age groups younger than 75 in order to include only premature deaths.

It is therefore meant to be a general measure of effectiveness of health services to a population.

Amenable Mortality for MidCentral and Whanganui District Health Boards

The graph above shows yearly age adjusted amenable mortality for MidCentral, Whanganui DHB, and New Zealand. It shows MidCentral yearly rates consistently higher than national rates. Whanganui DHB rates are higher than both MidCentral and New Zealand. Both MidCentral and New Zealand yearly rates suggest declining mortality across the period.

Amenable mortality is analysed by ethnicity, territorial authority, and for NZDep 9 and 10 areas for the rest of this chapter.

In general, the same patterns of disparity identified in the all cause mortality analysis were present in the amenable mortality analysis. However, the degree of disparity widened for amenable mortality.

Amenable Mortality by Ethnicity

Amenable mortality for the main ethnic groups for the years 2006 to 2010 was analysed in the table below. Multiple years’ data was combined to increase the numbers in the analysis, improving the likelihood of seeing statistically significant results (separating out trends from random variation).

MidCentral, Whanganui, and New Zealand Amenable Mortality 2006 to 2010 by Ethnicity Crude Rate Age Adjusted Numbers LCL UCL (per 100,000 Ratio population) New Zealand Maori 6278 2.29 2.23 2.35 991.6 New Zealand Pacific 2146 1.94 1.86 2.02 853.6 New Zealand Other 19027 0.81 0.8 0.82 621.4 MidCentral Maori 254 2.13 1.87 2.39 901.3 MidCentral Pacific 14 0.93 0.44 1.42 374.3 MidCentral Other 978 0.97 0.91 1.03 790.4 Whanganui Maori 193 2.69 2.31 3.07 1191 Whanganui Pacific 9 2.16 0.75 3.57 913.7 Whanganui Other 395 1.04 0.94 1.14 940.7 MidCentral DHB 1246 1.11 1.05 1.17 811.2 Whanganui DHB 597 1.33 1.22 1.44 1043 New Zealand 27451 1 0 0 691

The key features of the analysis are:  Both MidCentral and Whanganui DHB have higher than expected number of deaths due to amenable causes compared to New Zealand overall. MidCentral by 11% and Whanganui DHB by 33%.  Maori have over double the expected number of amenable deaths compared to New Zealand overall. This is true for MidCentral, Whanganui DHB, and New Zealand.  New Zealand Pacific peoples amenable mortality was almost twice expected, compared to New Zealand overall (age adjusted ratio of 1.94). MidCentral Pacific and Whanganui Pacific had too few deaths to reach statistical significance.  When compared to the equivalent table in the all cause mortality chapter, the gaps mentioned in the bullet points above are in the same direction, but wider for amenable mortality. This reinforces the pattern of disparity that exists and the importance of our health services in addressing them.

Amenable Mortality by Territorial Authority

Amenable mortality by MidCentral and Whanganui DHB’s territorial authorities 2006 to 2010 were examined, in a similar format to the ethnicity analysis.

The main patterns are:

 All of Whanganui DHB’s territorial authorities had higher amenable deaths than expected, compared to New Zealand overall. Whanganui DHB’s portion of Ruapehu had almost double the expected mortality (age adjusted ratio of 1.76 – 76% higher).  Of MidCentral’s territorial authorities, Horowhenua had 25% higher than expected amenable mortality numbers (compared to New Zealand). Palmerston North, Tararua, and MidCentral’s portion of Kapiti also had higher age adjusted ratios, but they were not statistically significant – we can’t tell if this is a real difference or just a chance pattern of numbers.

MidCentral and Whanganui DHBs Territorial Authorities Amenable Mortality 2006 to 2010 Age Adjusted Ratios Crude Rate (per Age Adjusted 100,000 Numbers Ratio LCL UCL population) Palmerston North 498 1.06 0.97 1.15 664.3 Horowhenua 326 1.25 1.11 1.39 1181 Manawatu 198 0.99 0.85 1.13 720.6 Tararua 149 1.19 1 1.38 892.5 Kapiti 75 1.1 0.85 1.35 1093 Wanganui TA 412 1.29 1.17 1.41 1058 Rangitikei 142 1.33 1.11 1.55 1036 Ruapehu 43 1.76 1.23 2.29 935.2 MidCentral 1246 1.11 1.05 1.17 811.2 Whanganui DHB 597 1.33 1.22 1.44 1043 New Zealand 27451 1 0 0 691

Amenable Mortality by NZDep2001 9 and 10 Areas

Amenable mortality by MidCentral, Whanganui DHB, and New Zealand’s NZDep2001 9 and 10 areas were examined.

The main patterns of this analysis are:  Amenable mortality for socio-economically disadvantaged areas (New Zealand, MidCentral, and Whanganui DHB) were about 50 – 60% higher than expected, compared to New Zealand overall.  MidCentral overall and Whanganui DHB age adjusted ratios show a small variation to the ones calculated in the ethnicity section. This is because the population number estimates used in their calculations came from a different set of computations. The mortality calculations are therefore similar but not identical to the ones calculated for the MidCentral DHB and Whanganui DHB in other parts of this document.

MidCentral, Whanganui, New Zealand NZDep2001 9 & 10 Amenable Mortality 2006 to 2010 Indirect Age Adjusted Crude Rate Age Adjusted (per 100,000 Numbers Ratio LCL UCL population) MidCentral NZDep 9 & 10 407 1.47 1.33 1.61 1245 MidCentral overall 1246 1.09 1.03 1.15 800.5 Whanganui NZDep 9 & 10 183 1.62 1.39 1.85 1155 Whanganui overall 597 1.3 1.2 1.4 1009 NZ NZDep 9 & 10 7887 1.57 1.54 1.6 981.2 New Zealand 27451 1 0 0 695.5

Yearly age adjusted amenable mortality rates for the same groups were calculated and plotted on a graph. The years covered were from 2004 to 2010. In general, this shows a decline in mortality rates for most of the groups across the period.

What Sort of Conditions Make Up Amenable Mortality?

The main disease/condition groups are the same for all cause mortality, namely:  Circulatory disease (diseases of the heart and blood vessels) – over 40% of amenable deaths  Cancers – 16% to 18% of amenable deaths  Respiratory diseases – 10% to 15% of amenable deaths  External causes – injuries and accidents (including suicide) – 15% to 20% of amenable deaths

Therefore, the greatest improvement in population health can be made by reducing the incidence or effect of these four disease groups.

MidCentral Amenable Mortality by ICD-10 Disease Category 2006 to 2010 Whanganui Amenable Mortality by ICD-10 Disease Category 2006 to 2010 Disease Category Deaths Percentage Disease Category Deaths Percentage Diseases of the circulatory system 537 43.1% Diseases of the circulatory system 265 44.4% External causes of morbidity and mortality 256 20.5% Neoplasms 100 16.8% Neoplasms 229 18.4% External causes of morbidity and mortality 92 15.4% Diseases of the respiratory system 120 9.6% Diseases of the respiratory system 88 14.7% Endocrine, nutritional, and metabolic 51 4.1% Endocrine, nutritional, and metabolic 32 5.4% Certain conditions originating in the perinatal pe 24 1.9% Certain conditions originating in the perinatal pe 9 1.5% Diseases of the digestive system 11 0.9% Certain infectious and parasitic diseases 4 0.7% Congenital malformations, deformations, and chromo 5 0.4% Diseases of the digestive system 4 0.7% Diseases of the genitourinary system 5 0.4% Pregnancy, childbirth and the puerperium 2 0.3% Certain infectious and parasitic diseases 4 0.3% Diseases of the genitourinary system 1 0.2% Pregnancy, childbirth and the puerperium 3 0.2% Total 597 100.0% Diseases of the nervous system 1 0.1% Total 1246 100.0%

New Zealand Amenable Mortality by ICD-10 Disease Category 2006 to 2010 Disease Category Deaths Percentage Diseases of the circulatory system 11514 41.9% Neoplasms 5622 20.5% External causes of morbidity and mortality 4558 16.6% Diseases of the respiratory system 2635 9.6% Endocrine, nutritional, and metabolic 1910 7.0% Certain conditions originating in the perinatal pe 675 2.5% Diseases of the digestive system 196 0.7% Certain infectious and parasitic diseases 108 0.4% Diseases of the genitourinary system 107 0.4% Congenital malformations, deformations, and chromo 71 0.3% Pregnancy, childbirth and the puerperium 44 0.2% Diseases of the nervous system 11 0.0% Total 27451 100.0%

What sort of conditions make up circulatory disease amenable mortality?

For MidCentral, Whanganui DHB, and New Zealand overall, the pattern is consistent: the most common condition is ischaemic heart disease, making up about 70% of circulatory disease amenable deaths. These are a group of conditions characterised by blockage of blood supply to the heart muscles, for example myocardial infarction (heart attack), and angina.

Cerebrovascular disease – diseases of the blood vessels supplying the brain – are the second most common cause. These are related to the ischaemic heart disease because, in most cases, it’s the same changes that occur in the blood vessels of both disease types.

Together, ischaemic heart disease and cerebrovascular disease make up close to 90% of circulatory amenable deaths.

MidCentral Circulatory Diseases Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage I20-I25 Ischaemic heart diseases 381 70.9% I60-I69 Cerebrovascular diseases 103 19.2% I05-I09 Chronic rheumatic fever 22 4.1% I10-I15 Hypertensive diseases 13 2.4% I30-I52 Other forms of heart disease 11 2.0% I26-I28 Pulmonary heart disease and diseases of pulmonary circulation 7 1.3% Total 537 100.0%

Whanganui DHB Circulatory Diseases Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage I20-I25 Ischaemic heart diseases 185 70.3% I60-I69 Cerebrovascular diseases 47 17.9% I10-I15 Hypertensive diseases 13 4.9% I30-I52 Other forms of heart disease 12 4.6% I05-I09 Chronic rheumatic fever 4 1.5% I26-I28 Pulmonary heart disease and diseases of pulmonary circulation 2 0.8% Total 263 100.0%

New Zealand Circulatory Diseases Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage I20-I25 Ischaemic heart diseases 7797 67.7% I60-I69 Cerebrovascular diseases 2473 21.5% I30-I52 Other forms of heart disease 404 3.5% I05-I09 Chronic rheumatic fever 400 3.5% I10-I15 Hypertensive diseases 378 3.3% I26-I28 Pulmonary heart disease and diseases of pulmonary circulation 62 0.5% Total 11514 100.0%

What are the most common types of cancers making up amenable cancer (neoplasm) mortality?

Breast cancer, prostate cancer, and cancers of the colon, rectum, and anus were consistently the most common amenable cancers for MidCentral, Whanganui DHB, and New Zealand. Stomach cancer was also relatively common for MidCentral and New Zealand.

Whanganui’s percentage of colo-rectal cancer was higher than either MidCentral or New Zealand (34% versus 17.5% and 19.5% respectively).

MidCentral Cancers Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage C50-C58 Cancers of the breast 94 41.0% C61 Prostate cancer 49 21.4% C18-C21 Cancers of the colon, rectum, and anus 40 17.5% C16 Cancer of the stomach 24 10.5% C81-C96 Cancers of the blood, lymphoid, and related tissues 14 6.1% C53-C55 Cervical cancer 4 1.7% C40 Cancers of bone and articular cartilage 2 0.9% C73-C75 Cancer of thyroid and other endocrine organs 2 0.9% Total 229 100.0%

Whanganui DHB Cancers Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage C50-C58 Cancers of the breast 37 37.0% C18-C21 Cancer of the colon, rectum, and anus 34 34.0% C61 Prostate cancer 11 11.0% C81-C96 Cancers of the blood, lymphoid, and related tissues 6 6.0% C16 Cancer of the stomach 5 5.0% C53-C55 Cervical cancer 3 3.0% C40 Cancers of bone and articular cartilage 2 2.0% C60-C63 Other cancers of the male genitals 1 1.0% C73-C75 Cancer of thyroid and other endocrine organs 1 1.0% Total 100 100.0%

New Zealand Cancers Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage C50-C58 Cancers of the breast 2164 38.5% C18-C21 Cancer of the colon, rectum, and anus 1096 19.5% C61 Prostate cancer 912 16.2% C16 Cancer of the stomach 780 13.9% C81-C96 Cancers of the blood, lymphoid, and related tissues 304 5.4% C53-C55 Cervical cancer 191 3.4% C40 Cancers of bone and articular cartilage 73 1.3% C73-C75 Cancer of thyroid and other endocrine organs 71 1.3% C60-C63 Other cancers of the male genitals 31 0.6% Total 5622 100.0%

What are the most common types of external causes of amenable mortality (deaths from injuries and accidents)?

Transport accidents (such as motor vehicle crashes) and intentional self-harm are the two dominant causes of amenable external cause deaths. The proportion for each of these varies from around 40% to 50% in MidCentral, Whanganui DHB, and New Zealand. Falls come a distant third (between 2% and 5% of amenable external cause deaths). MidCentral External Causes (Accidents & Injuries) Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage V01-V99 Transport accidents 125 48.8% X60-X84 Intentional self-harm 119 46.5% W01-W19 Falls 7 2.7% X00-X09 Exposure to smoke, fire, and flames 4 1.6% Y40-Y84 Complications of medical and surgical care 1 0.4% Total 256 100.0%

Whanganui DHB External Causes (Accidents & Injuries) Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage X60-X84 Intentional self-harm 49 53.3% V01-V99 Transport accidents 34 37.0% W01-W19 Falls 5 5.4% X00-X09 Exposure to smoke, fire, and flames 4 4.3% Total 92 100.0%

New Zealand External Causes (Accidents & Injuries) Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage X60-X84 Intentional self-harm 2306 52.3% V01-V99 Transport accidents 1905 43.2% W00-W19 Falls 112 2.5% X00-X09 Exposure to smoke, fire, and flames 69 1.6% Y40-Y84 Complications of medical and surgical care 19 0.4% Total 4411 100.0%

What sort of conditions make up respiratory disease amenable mortality?

Most of the respiratory disease amenable deaths are from chronic obstructive pulmonary disease – around 90%. Asthma is a distance second most common cause – from 3% to 7% of respiratory amenable deaths.

MidCentral Respiratory Diseases Amenable Mortality 2006 to 2010 by ICD-10 Sub- Groups ICD-10 Codes Disease grouping Deaths Percentage J40-J44 Chronic obstructive pulmonary disease 106 88.3% J45-J46 Asthma 9 7.5% J20-J22 Other acute lower respiratory infections 3 2.5% J09-J18 Influenza and pneumonia 1 0.8% J30-J39 Other diseases of upper respiratory tract 1 0.8% J00-J06 Acute upper respiratory infections 0 0.0% Total 120 100.0%

Whanganui Respiratory Diseases Amenable Mortality 2006 to 2010 by ICD-10 Sub- Groups ICD-10 Codes Disease grouping Deaths Percentage J40-J44 Chronic obstructive pulmonary disease 83 94.3% J45-J46 Asthma 3 3.4% J09-J18 Influenza and pneumonia 2 2.3% J00-J06 Acute upper respiratory infections 0 0.0% J20-J22 Other acute lower respiratory infections 0 0.0% J30-J39 Other diseases of upper respiratory tract 0 0.0% Total 88 100.0%

New Zealand Respiratory Diseases Amenable Mortality 2006 to 2010 by ICD-10 Sub-Groups ICD-10 Codes Disease grouping Deaths Percentage J40-J44 Chronic obstructive pulmonary disease 2388 90.6% J45-J46 Asthma 186 7.1% J20-J22 Other acute lower respiratory infections 26 1.0% J09-J18 Influenza and pneumonia 20 0.8% J30-J39 Other diseases of upper respiratory tract 15 0.6% Total 2635 100.0%

8. Suicide

Summary

 In “Suicide Facts 2011”, a report released by the Ministry of Health in 2014, MidCentral was identified as one of three district health boards with suicide rates significantly higher than New Zealand’s rate.

 In “Suicide Facts 2012, released by the Ministry of Health in 2015, MidCentral was no longer among the district health boards with suicide rates significantly higher than New Zealand’s, even though MidCentral’s suicide rate was the same as reported the previous year.

 The difference is because MidCentral’s suicide rate sits at the margin of statistical significance – one year it’s outside statistical significance, another year it’s within

 Because suicide numbers are comparatively low, most district health boards’ suicide rates do not reach statistical significance when compared against the New Zealand rate. MidCentral is not the “worst in New Zealand”.

 However, activities to prevent suicide should still receive priority

 In “Suicide Facts 2012”, MidCentral’s hospitalisation rate for self-harm was significantly lower than New Zealand’s rate. It’s interpretation, in view of MidCentral’s higher suicide rate, is uncertain.

 Demographic patterns revealed by national data showed: o Population groups with the highest suicide rates were: . Maori . Male youth . People living in the most socio-economically deprived areas . Maori male and Maori youth had especially high rates o Male are more likely to commit suicide than females (3.5 to 1); but females are more likely to be hospitalised for self-harm (1.8 to 1 ratio) o The age group with the highest suicide rate are youth (people aged 15 to 24 years). o Suicide rates then decline with age

MidCentral’s mention in Suicide Facts 2011 as having suicide rates higher than New Zealand’s

Suicide is covered specifically here because MidCentral was identified by a Ministry of Health report as one of three district health boards which had suicide rates statistically higher than New Zealand. The other district health boards were Bay of Plenty and Tairawhiti. The publication was “Suicide Facts 2011”, which was released by the Ministry of Health in 2014.

Since then, the Ministry of Health released a new edition of the same publication, “Suicide Facts 2012” (released in May 2015). In this new edition, MidCentral is no longer amongst those district health boards highlighted as having significantly higher suicide rates than New Zealand. However, MidCentral’s three year suicide rate (combining suicides from three years increase numbers in the rate calculations, and to compensate for yearly random fluctuation) was the same on both publications.

MidCentral’s suicide rate for combined years of 2007 to 2011 was 14.9 per 100,000 population. New Zealand’s suicide rate for the same period was 11.3 per 100,000 population. This information was taken from the Ministry of Health publication “Suicide Facts 2011”. MidCentral’s suicide rate for combined years 2008 to 2012 was 14.8 per 100,000 population – which was not statistically different from New Zealand’s rate of 11.6 per 100,000 for the same time period.

The district health boards graphs taken from “Suicide Facts 2011” and “Suicide Facts 2012” are copied below. Many other district health boards also had higher suicide rates than New Zealand overall. However, most of their rates did not reach statistical significance – it was impossible to say whether or not the difference was a true pattern or just due to chance fluctuation. The Suicide Facts reports only state that a district health board’s rates are higher or lower than New Zealand’s rate if the difference is statistically significant.

Suicide numbers per district health board are comparatively small, even when three year’s figures are accumulated together. Rates calculated from them have wide confidence limits, so it’s difficult to reach statistical significance – where it’s possible to differentiate a trend from random chance fluctuation. This can be seen in the graph below.

MidCentral’s suicide rate sits at the margin of statistical significance. For 2011, the difference between MidCentral’s rate and New Zealand’s rate was beyond the margin of statistical significance and for 2012, was just inside.

Whanganui DHB’s suicide rate for the years 2007 to 2011 was also high – 17.5 per 100,000 population – but the comparison to New Zealand’s rate did not reach statistical significance. Whanganui DHB’s suicide rate for 2008 to 2012 was 15.3 per 100,000 population. This rate was also not statistically different from New Zealand’s equivalent rate.

DHB age adjusted suicide rate graphs are shown for each of the two Suicide Fact publications are shown on the next page.

Most district health boards’ suicide rates are not statistically different from New Zealand’s rates, probably due to small numbers.

DHBs’ Age Adjusted Suicide Death Rates 2007 to 2011 (from Suicide Facts 2011)

DHBs’ Age Adjusted Suicide Death Rates 2008 to 2012 (from Suicide Facts 2012)

Each district health boards’ suicide numbers are too small to reveal any demographic or ethnic patterns or trends within the data. However, New Zealand’s patterns would also be applicable to individual district health boards. The main conclusions were the same for both Suicide Facts 2011 and Suicide Facts 2012. They are:  National suicide numbers and rates increased from 2011 to 2012, but the publication made no comment on this – probably because this is likely due to random fluctuation  Population groups with the highest suicide rates were: o Maori o Male youth o People living in the most socio-economically deprived areas o Maori male and Maori youth had especially high rates  Male are more likely to commit suicide than females (3.5 to 1); but females are more likely to be hospitalised for self-harm (1.8 to 1 ratio)  The age group with the highest suicide rate are youth (people aged 15 to 24 years).  Suicide rates then decline with age  Youth suicide rate has declined 32.8% since peaking in 1995  Youth self-harm hospitalisation rate has also been declining  Maori self-harm hospitalisation rates are higher than non-Maori rates  Maori self-harm hospitalisation rate has remained approximately static since 1996, although non-Maori hospitalisation rate has declined 32.7% over the same period  Self-harm hospitalisation rates were higher for people living in the most socio- economically disadvantaged areas, compared with less disadvantaged areas

In “Suicide Facts 2012”, MidCentral DHB’s self-harm hospitalisation rate for 2010 to 2012 (combined) was significantly lower than the New Zealand rate. Its interpretation, considering MidCentral’s suicide rate, is uncertain.

Appendix One: Causes of Mortality Ranked Lists (2008 to 2010)

This appendix contains tables showing the ICD-10 chapter causes of mortality, ranked lists. The ICD-10 chapters roughly correspond to body organ systems.

This information would be useful for finding conditions that would improve population health the most. The most common conditions will have the greatest population health impact. However, these conditions only include those that can result in death. Those conditions that are unlikely to cause death, but have great impact on quality of life would be under-represented or absent from this type of data.

New Zealand overall, New Zealand Maori, New Zealand Pacific

New Zealand Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 31081 35.7% Cancers 25776 29.6% Diseases of the respiratory system 7642 8.8% External causes of morbidity and mortality 5780 6.6% Diseases of the nervous system 3413 3.9% Endocrine, nutritional, and metabolic diseases 3344 3.8% Mental & behavioural disorders 2711 3.1% Diseases of the digestive system 2651 3.0% Diseases of the genitourinary system 1452 1.7% Certain infectious and parasitic diseases 763 0.9% Diseases of the musculoskeletal system and connective tissue 691 0.8% Congenital malformations, deformations, and chromosomal abnormalities 533 0.6% Certain conditions originating in the perinatal period 466 0.5% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 379 0.4% Diseases of the skin and subcutaneous tissue 258 0.3% Diseases of the blood, blood forming organs, & immune mechanism 181 0.2% Pregnancy, childbirth and the puerperium 24 0.0% Diseases of the ear and mastoid system 7 0.0% Diseases of the eye and adnexa 1 0.0% Total 87153 100.0%

New Zealand Maori Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Cancers 2634 29.9% Diseases of the circulatory system 2589 29.4% External causes of morbidity and mortality 1060 12.0% Diseases of the respiratory system 775 8.8% Endocrine, nutritional, and metabolic diseases 670 7.6% Diseases of the digestive system 181 2.1% Certain conditions originating in the perinatal period 166 1.9% Diseases of the nervous system 154 1.7% Diseases of the genitourinary system 120 1.4% Certain infectious and parasitic diseases 92 1.0% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 92 1.0% Congenital malformations, deformations, and chromosomal abnormalities 91 1.0% Mental & behavioural disorders 63 0.7% Diseases of the musculoskeletal system and connective tissue 55 0.6% Diseases of the skin and subcutaneous tissue 36 0.4% Diseases of the blood, blood forming organs, & immune mechanism 12 0.1% Pregnancy, childbirth and the puerperium 9 0.1% Diseases of the ear and mastoid system 2 0.0% Total 8801 100.0%

New Zealand Pacific Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 1051 31.9% Cancers 934 28.3% Endocrine, nutritional, and metabolic diseases 366 11.1% External causes of morbidity and mortality 243 7.4% Diseases of the respiratory system 227 6.9% Diseases of the digestive system 80 2.4% Certain conditions originating in the perinatal period 71 2.2% Diseases of the nervous system 68 2.1% Congenital malformations, deformations, and chromosomal abnormalities 53 1.6% Diseases of the genitourinary system 53 1.6% Mental & behavioural disorders 47 1.4% Certain infectious and parasitic diseases 31 0.9% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 22 0.7% Diseases of the musculoskeletal system and connective tissue 21 0.6% Diseases of the skin and subcutaneous tissue 13 0.4% Diseases of the blood, blood forming organs, & immune mechanism 9 0.3% Pregnancy, childbirth and the puerperium 7 0.2% Diseases of the ear and mastoid system 1 0.0% Total 3297 100.0%

MidCentral DHB, MidCentral Maori, MidCentral Pacific

MidCentral Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 1400 35.6% Cancers 1195 30.4% Diseases of the respiratory system 338 8.6% External causes of morbidity and mortality 298 7.6% Diseases of the nervous system 142 3.6% Diseases of the digestive system 121 3.1% Endocrine, nutritional, and metabolic diseases 116 3.0% Mental & behavioural disorders 104 2.6% Diseases of the genitourinary system 55 1.4% Diseases of the musculoskeletal system and connective tissue 37 0.9% Certain infectious and parasitic diseases 35 0.9% Congenital malformations, deformations, and chromosomal abnormalities 24 0.6% Certain conditions originating in the perinatal period 18 0.5% Diseases of the blood, blood forming organs, & immune mechanism 16 0.4% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 14 0.4% Diseases of the skin and subcutaneous tissue 12 0.3% Pregnancy, childbirth and the puerperium 2 0.1% Diseases of the ear and mastoid system 1 0.0% Total 3928 100.0%

MidCentral Maori Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Cancers 108 30.6% Diseases of the circulatory system 99 28.0% External causes of morbidity and mortality 61 17.3% Diseases of the respiratory system 29 8.2% Endocrine, nutritional, and metabolic diseases 13 3.7% Diseases of the nervous system 8 2.3% Certain conditions originating in the perinatal period 7 2.0% Diseases of the digestive system 7 2.0% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 4 1.1% Certain infectious and parasitic diseases 3 0.8% Diseases of the genitourinary system 3 0.8% Mental & behavioural disorders 3 0.8% Diseases of the blood, blood forming organs, & immune mechanism 2 0.6% Diseases of the musculoskeletal system and connective tissue 2 0.6% Congenital malformations, deformations, and chromosomal abnormalities 1 0.3% Diseases of the ear and mastoid system 1 0.3% Diseases of the skin and subcutaneous tissue 1 0.3% Pregnancy, childbirth and the puerperium 1 0.3% Total 353 100.0%

MidCentral Pacific Mortality by ICD-10 2008 to 2010 ICD-10 Chapter Number Percentage Cancers 8 34.8% Diseases of the circulatory system 5 21.7% External causes of morbidity and mortality 3 13.0% Diseases of the respiratory system 2 8.7% Certain conditions originating in the perinatal period 1 4.3% Certain infectious and parasitic diseases 1 4.3% Diseases of the digestive system 1 4.3% Endocrine, nutritional, and metabolic diseases 1 4.3% Pregnancy, childbirth and the puerperium 1 4.3% Total 23 100.0%

Whanganui DHB, Whanganui Maori, Whanganui Pacific

Whanganui DHB Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 709 38.8% Cancers 513 28.1% Diseases of the respiratory system 185 10.1% External causes of morbidity and mortality 113 6.2% Endocrine, nutritional, and metabolic diseases 65 3.6% Diseases of the digestive system 56 3.1% Diseases of the nervous system 48 2.6% Diseases of the genitourinary system 31 1.7% Mental & behavioural disorders 26 1.4% Certain infectious and parasitic diseases 19 1.0% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 18 1.0% Diseases of the musculoskeletal system and connective tissue 12 0.7% Congenital malformations, deformations, and chromosomal abnormalities 9 0.5% Certain conditions originating in the perinatal period 8 0.4% Diseases of the blood, blood forming organs, & immune mechanism 7 0.4% Diseases of the skin and subcutaneous tissue 5 0.3% Pregnancy, childbirth and the puerperium 2 0.1% Total 1826 100.0%

Whanganui Maori Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 91 33.1% Cancers 69 25.1% External causes of morbidity and mortality 38 13.8% Diseases of the respiratory system 26 9.5% Endocrine, nutritional, and metabolic diseases 17 6.2% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 8 2.9% Certain conditions originating in the perinatal period 5 1.8% Diseases of the nervous system 5 1.8% Diseases of the musculoskeletal system and connective tissue 4 1.5% Congenital malformations, deformations, and chromosomal abnormalities 3 1.1% Diseases of the digestive system 3 1.1% Certain infectious and parasitic diseases 2 0.7% Diseases of the genitourinary system 2 0.7% Diseases of the skin and subcutaneous tissue 1 0.4% Pregnancy, childbirth and the puerperium 1 0.4% Total 275 100.0%

Whanganui Pacific Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 6 46.2% Diseases of the respiratory system 2 15.4% Cancers 2 15.4% Diseases of the musculoskeletal system and connective tissue 1 7.7% External causes of morbidity and mortality 1 7.7% Mental & behavioural disorders 1 7.7% Total 13 100.0%

MidCentral DHB and Whanganui DHB Territorial Authorities

Palmerston North Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 585 36.8% Cancers 441 27.7% Diseases of the respiratory system 131 8.2% External causes of morbidity and mortality 124 7.8% Endocrine, nutritional, and metabolic diseases 64 4.0% Diseases of the nervous system 63 4.0% Mental & behavioural disorders 53 3.3% Diseases of the digestive system 51 3.2% Diseases of the genitourinary system 14 0.9% Certain infectious and parasitic diseases 13 0.8% Congenital malformations, deformations, and chromosomal abnormalities 12 0.8% Diseases of the musculoskeletal system and connective tissue 12 0.8% Diseases of the blood, blood forming organs, & immune mechanism 9 0.6% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 8 0.5% Certain conditions originating in the perinatal period 7 0.4% Diseases of the skin and subcutaneous tissue 2 0.1% Pregnancy, childbirth and the puerperium 2 0.1% Total 1591 100.0%

Horowhenua Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 388 35.9% Cancers 341 31.5% Diseases of the respiratory system 111 10.3% External causes of morbidity and mortality 66 6.1% Diseases of the digestive system 37 3.4% Diseases of the nervous system 35 3.2% Mental & behavioural disorders 24 2.2% Diseases of the genitourinary system 19 1.8% Endocrine, nutritional, and metabolic diseases 19 1.8% Certain infectious and parasitic diseases 10 0.9% Diseases of the musculoskeletal system and connective tissue 10 0.9% Diseases of the skin and subcutaneous tissue 6 0.6% Congenital malformations, deformations, and chromosomal abnormalities 5 0.5% Diseases of the blood, blood forming organs, & immune mechanism 4 0.4% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 4 0.4% Certain conditions originating in the perinatal period 1 0.1% Diseases of the ear and mastoid system 1 0.1% Total 1081 100.0%

Manawatu Causes of Mortality by ICD10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 223 35.5% Cancers 203 32.3% External causes of morbidity and mortality 54 8.6% Diseases of the respiratory system 43 6.8% Diseases of the nervous system 24 3.8% Endocrine, nutritional, and metabolic diseases 17 2.7% Diseases of the digestive system 14 2.2% Diseases of the genitourinary system 14 2.2% Mental & behavioural disorders 11 1.7% Diseases of the musculoskeletal system and connective tissue 7 1.1% Certain conditions originating in the perinatal period 4 0.6% Certain infectious and parasitic diseases 4 0.6% Diseases of the skin and subcutaneous tissue 4 0.6% Congenital malformations, deformations, and chromosomal abnormalities 3 0.5% Diseases of the blood, blood forming organs, & immune mechanism 3 0.5% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 1 0.2% Total 629 100.0%

Tararua Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 147 34.8% Cancers 137 32.5% External causes of morbidity and mortality 37 8.8% Diseases of the respiratory system 33 7.8% Diseases of the digestive system 15 3.6% Diseases of the nervous system 15 3.6% Mental & behavioural disorders 10 2.4% Endocrine, nutritional, and metabolic diseases 9 2.1% Diseases of the musculoskeletal system and connective tissue 5 1.2% Certain infectious and parasitic diseases 4 0.9% Diseases of the genitourinary system 4 0.9% Certain conditions originating in the perinatal period 3 0.7% Congenital malformations, deformations, and chromosomal abnormalities 3 0.7% Total 422 100.0%

Kapiti (MidCentral portion) Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Cancers 73 35.6% Diseases of the circulatory system 57 27.8% Diseases of the respiratory system 20 9.8% External causes of morbidity and mortality 17 8.3% Endocrine, nutritional, and metabolic diseases 7 3.4% Mental & behavioural disorders 6 2.9% Diseases of the nervous system 5 2.4% Certain infectious and parasitic diseases 4 2.0% Diseases of the digestive system 4 2.0% Diseases of the genitourinary system 4 2.0% Certain conditions originating in the perinatal period 3 1.5% Diseases of the musculoskeletal system and connective tissue 3 1.5% Congenital malformations, deformations, and chromosomal abnormalities 1 0.5% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 1 0.5% Total 205 100.0%

Wanganui Territorial Authority Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 549 39.1% Cancers 377 26.8% Diseases of the respiratory system 143 10.2% External causes of morbidity and mortality 83 5.9% Endocrine, nutritional, and metabolic diseases 55 3.9% Diseases of the digestive system 48 3.4% Diseases of the nervous system 39 2.8% Diseases of the genitourinary system 29 2.1% Mental & behavioural disorders 17 1.2% Certain infectious and parasitic diseases 16 1.1% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 12 0.9% Diseases of the musculoskeletal system and connective tissue 10 0.7% Congenital malformations, deformations, and chromosomal abnormalities 9 0.6% Diseases of the blood, blood forming organs, & immune mechanism 7 0.5% Certain conditions originating in the perinatal period 5 0.4% Diseases of the skin and subcutaneous tissue 4 0.3% Pregnancy, childbirth and the puerperium 2 0.1% Total 1405 100.0%

Rangitikei Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 127 36.0% Cancers 116 32.9% Diseases of the respiratory system 37 10.5% External causes of morbidity and mortality 24 6.8% Diseases of the nervous system 9 2.5% Mental & behavioural disorders 9 2.5% Endocrine, nutritional, and metabolic 8 2.3% Diseases of the digestive system 6 1.7% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 6 1.7% Certain conditions originating in the perinatal period 3 0.8% Certain infectious and parasitic diseases 3 0.8% Diseases of the genitourinary system 2 0.6% Diseases of the musculoskeletal system and connective tissue 2 0.6% Diseases of the skin and subcutaneous tissue 1 0.3% Total 353 100.0%

Ruapehu (Whanganui DHB portion) Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 33 48.5% Cancers 20 29.4% External causes of morbidity and mortality 6 8.8% Diseases of the respiratory system 5 7.4% Diseases of the digestive system 2 2.9% Endocrine, nutritional, and metabolic 2 2.9% Total 68 100.0%

NZDep2006 9 and 10 Deciles

MidCentral NZDep2006 9 & 10 Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 515 35.9% Cancers 420 29.2% Diseases of the respiratory system 138 9.6% External causes of morbidity and mortality 104 7.2% Diseases of the nervous system 54 3.8% Diseases of the digestive system 50 3.5% Mental & behavioural disorders 44 3.1% Endocrine, nutritional, and metabolic diseases 37 2.6% Diseases of the genitourinary system 25 1.7% Diseases of the musculoskeletal system and connective tissue 11 0.8% Certain infectious and parasitic diseases 10 0.7% Certain conditions originating in the perinatal period 7 0.5% Congenital malformations, deformations, and chromosomal abnormalities 6 0.4% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 6 0.4% Diseases of the skin and subcutaneous tissue 4 0.3% Diseases of the blood, blood forming organs, & immune mechanism 3 0.2% Diseases of the ear and mastoid system 1 0.1% Pregnancy, childbirth and the puerperium 1 0.1% Total 1436 100.0%

Whanganui DHB NZDep2006 9 & 10 Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 241 40.7% Cancers 146 24.7% Diseases of the respiratory system 66 11.1% External causes of morbidity and mortality 41 6.9% Endocrine, nutritional, and metabolic diseases 26 4.4% Diseases of the digestive system 16 2.7% Diseases of the genitourinary system 12 2.0% Diseases of the nervous system 10 1.7% Certain infectious and parasitic diseases 6 1.0% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 6 1.0% Certain conditions originating in the perinatal period 5 0.8% Congenital malformations, deformations, and chromosomal abnormalities 5 0.8% Mental & behavioural disorders 5 0.8% Diseases of the blood, blood forming organs, & immune mechanism 4 0.7% Diseases of the musculoskeletal system and connective tissue 2 0.3% Diseases of the skin and subcutaneous tissue 1 0.2% Total 592 100.0%

New Zealand NZDep2006 9 & 10 Causes of Mortality by ICD-10 Chapter 2008 to 2010 ICD-10 Chapter Number Percentage Diseases of the circulatory system 6547 34.7% Cancers 5344 28.3% Diseases of the respiratory system 1804 9.6% External causes of morbidity and mortality 1365 7.2% Endocrine, nutritional, and metabolic diseases 1078 5.7% Diseases of the digestive system 589 3.1% Diseases of the nervous system 548 2.9% Mental & behavioural disorders 424 2.2% Diseases of the genitourinary system 321 1.7% Certain conditions originating in the perinatal period 180 1.0% Certain infectious and parasitic diseases 173 0.9% Congenital malformations, deformations, and chromosomal abnormalities 145 0.8% Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 120 0.6% Diseases of the musculoskeletal system and connective tissue 117 0.6% Diseases of the skin and subcutaneous tissue 62 0.3% Diseases of the blood, blood forming organs, & immune mechanism 43 0.2% Pregnancy, childbirth and the puerperium 9 0.0% Diseases of the ear and mastoid system 3 0.0% Total 18872 100.0%

Appendix Two: Mortality Rates and Numbers Tables

The following appendix shows mortality data by age adjusted rates, crude rates, and actual numbers. The types of mortality looked at are basically all cause mortality, amenable mortality, and the four top causes of death (by ICD-10 chapter):  All cause mortality  Amenable mortality  Circulatory disease mortality  Cancer mortality  Respiratory disease mortality  External causes (injuries and accidents)

The types of measures are:  Age adjusted rates  Crude rates  Actual numbers of deaths

Age Adjusted Rates Age adjusted rates are population rates which have been adjusted for any differences in the age distributions of the populations. All the population groups have been standardized so that they have the same age balance as the WHO standard population.

All age adjusted rates are expressed as the number of deaths per 100,000 population.

Because of the adjustment calculations, the resulting rate is an artificial number and cannot be used to calculate the actual number of cases in the population.

Wikipedia has a straight-forward description of age adjustment at this link: http://en.wikipedia.org/wiki/Age_adjustment

Crude Rates Crude rates are population rates which have not been adjusted for any differences in age distributions of the populations. They are basically the per capita rate for the population.

They are calculated by dividing the number of deaths by the number of people in the population being measured, and then multiplying by 100,000 to give the number of deaths per 100,000 people.

Actual Number of Deaths Actual number of deaths, called “mortality numbers” in the tables, is the number of deaths experienced by the populations being looked at.

All Cause Mortality

By Ethnicity

MidCentral, Whanganui, New Zealand Ethnic Groups All Cause Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 828.8 796.2 795.8 785.2 749.8 759.6 680.3 New Zealand Pacific 733.8 667.7 724 703.5 688.3 680.5 609.8 New Zealand Other 420.9 387.5 389.5 383.2 384.1 370.8 356.1 MidCentral Maori 874.5 785.8 629.6 597.7 653.8 681.8 524.8 MidCentral Pacific 537.5 396.7 355 506.8 429.3 189.7 415.9 MidCentral Other 465.1 415.3 446.3 396.4 400.5 410.5 397.8 Whanganui Maori 830.3 978.7 1169 939.6 1087 1233 822.6 Whanganui Pacific 0 305.6 472.6 591.8 925.7 577.1 556.3 Whanganui Other 460.4 437.4 443 407.4 449.3 439.2 422.5

MidCentral, Whanganui, New Zealand Ethnic Groups All Cause Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 448.9 439.2 452.3 462.2 451 466.8 438.6 New Zealand Pacific 410 384.9 429.5 420 430.8 434.8 406.8 New Zealand Other 774.3 723.7 750.1 749.8 767.1 755 740.6 MidCentral Maori 449.7 450.9 348.3 364.9 399.2 438.8 382 MidCentral Pacific 310.7 222.8 163.9 241.3 211.6 104.7 282.1 MidCentral Other 937.2 834.2 914.2 834.3 870.2 889.1 874.2 Whanganui Maori 463.7 590.8 607.2 589.3 585 533.3 546.9 Whanganui Pacific 0 306.1 300 201 297 495 483.1 Whanganui Other 1041 1004 1073 980.2 1099 1110 1123

MidCentral, Whanganui, New Zealand Ethnic Groups All Cause Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 2737 2712 2829 2927 2892 3029 2880 New Zealand Pacific 978 934 1060 1054 1099 1127 1071 New Zealand Other 24929 23495 24500 24620 25321 25046 24688 MidCentral Maori 122 124 97 103 114 127 112 MidCentral Pacific 11 8 6 9 8 4 11 MidCentral Other 1256 1122 1233 1125 1174 1199 1179 Whanganui Maori 74 95 98 96 96 88 91 Whanganui Pacific 0 3 3 2 3 5 5 Whanganui Other 499 479 510 461 512 513 513

By Territorial Authority

MidCentral, Whanganui DHBs' Territorial Authorities All Cause Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 481.6 447.7 469.5 396.8 411.8 419.3 389.8 Horowhenua 597 481.3 532.2 464.4 507.2 476.5 505.2 Manawatu 471.8 428 439.7 382.1 378.1 474 431.7 Tararua 466.5 473.8 428.7 499.5 480.8 425.7 436 Kapiti 504 431.1 405.2 476.1 450.1 421.9 497.8 Wanganui TA 487.3 523.7 508.3 508.4 527.7 534.1 482.1 Rangitikei 520.8 411.1 510 448.1 452.7 403.9 558 Ruapehu 647.3 707.7 524.7 502.2 748.7 458.9 354.8

MidCentral, Whanganui DHBs' Territorial Authorities All Cause Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 729.2 672.6 718.3 621.3 667.3 675.3 636 Horowhenua 1298 1062 1180 1057 1154 1179 1208 Manawatu 723 678.3 734 638.8 664.5 761.6 721.7 Tararua 791.2 793.8 784.6 893.9 825.5 767.7 770.9 Kapiti 995.6 858.8 743.5 989.9 915.6 895.1 926.7 Wanganui TA 946.9 1032 1071 1004 1099 1136 1077 Rangitikei 860.9 648.1 856.2 740.1 765 706.4 951.1 Ruapehu 574.5 646 470.5 417.4 656.6 450.9 349.4

MidCentral, Whanganui DHBs' Territorial Authorities All Cause Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 Palmerston North 561 522 562 491 532 543 516 Horowhenua 399 326 362 324 353 360 368 Manawatu 208 196 213 186 194 223 212 Tararua 144 144 142 161 148 137 137 Kapiti 77 66 57 75 69 67 69 Wanganui TA 414 448 461 430 468 482 455 Rangitikei 130 97 127 109 112 103 138 Ruapehu 29 32 23 20 31 21 16

By NZDep2001 9 and 10 Deciles

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 All Cause Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 676 598.7 632.7 548.3 582.5 536.6 560.2 MidCentral overall 497.8 449.6 459.9 418.8 424.4 437.2 419.3 Whanganui NZDep 9 & 10 594.2 642.7 551 663.8 560.7 548.8 543.7 Whanganui overall 501 507.7 503.1 480.1 505.6 490.4 486.9 NZ NZDep 9 & 10 619.4 557.8 569.7 558.2 556.4 529.8 487.2 NZ overall 460.5 426.2 431.2 424.7 422.9 411.5 392.2

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 All Cause Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 1327 1169 1239 1126 1240 1132 1196 MidCentral overall 843.6 757.3 803 741.6 774.9 793.5 774.7 Whanganui NZDep 9 & 10 840.5 916.4 827.4 942 835.9 855.4 827.5 Whanganui overall 883.2 891 944.9 869.3 954.7 951.3 961.4 NZ NZDep 9 & 10 765.8 698.5 725.5 722.6 735.4 711.5 667.4 NZ overall 704.2 660.9 685.9 686.2 698.4 691.1 673.3

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 All Cause Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 460 409 437 400 443 407 433 MidCentral overall 1389 1254 1336 1237 1296 1330 1302 Whanganui NZDep 9 & 10 142 155 140 159 141 144 139 Whanganui overall 573 577 611 559 611 606 609 NZ NZDep 9 & 10 6229 5742 6022 6052 6215 6065 5738 NZ overall 28644 27141 28389 28601 29312 29202 28639

Amenable Mortality

By Ethnicity

MidCentral, Whanganui, New Zealand Ethnic Groups Amenable Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 people) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 308.4 282.4 292.2 290.1 260.9 258.3 230.8 New Zealand Pacific 228.9 221.8 245.8 234.9 226.2 227.1 206.4 New Zealand Other 107.1 98.9 93.17 94.55 90.69 88.57 85.15 MidCentral Maori 300.9 292.7 232.6 279.8 225.4 255.9 213 MidCentral Pacific 234.4 250.4 92.3 117.9 33.52 138.7 170.7 MidCentral Other 124.3 119.5 118.6 107 104.4 119.4 100.8 Whanganui Maori 254.5 381.3 383 314.2 278.7 271.4 316.5 Whanganui Pacific 0 156.4 117.3 610.5 0 281.9 400.9 Whanganui Other 131.2 115.8 132.3 103.7 114.9 128.7 97.24

MidCentral, Whanganui, New Zealand Ethnic Groups Amenable Mortality Crude Rates 2004 to 2010 (per 100,000 people) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 210 197.8 207.2 210.5 194.9 195.3 184.2 New Zealand Pacific 158.7 159.9 176.2 170.9 167.9 174.3 164.8 New Zealand Other 141.7 131.2 125.9 128.1 124.3 123.7 119.5 MidCentral Maori 186.3 194.9 167 197.3 166.8 196.3 173.3 MidCentral Pacific 142.9 169 55.1 81.3 26.74 79.37 129.9 MidCentral Other 179.2 163.6 165.9 150.9 149.5 177.2 146.6 Whanganui Maori 190 270.6 263.3 230.1 209.9 220.9 268 Whanganui Pacific 0 104.7 102.6 206.2 0 304.6 298.5 Whanganui Other 192.4 186.9 213.7 164.7 192.9 197.4 170.6

MidCentral, Whanganui, New Zealand Ethnic Groups Amenable Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 1268 1209 1282 1318 1234 1251 1193 New Zealand Pacific 374 383 429 423 422 445 427 New Zealand Other 4252 3965 3822 3905 3805 3804 3691 MidCentral Maori 50 53 46 55 47 56 50 MidCentral Pacific 5 6 2 3 1 3 5 MidCentral Other 222 203 206 187 185 219 181 Whanganui Maori 30 43 42 37 34 36 44 Whanganui Pacific 0 1 1 2 0 3 3 Whanganui Other 84 81 92 70 81 82 70

By Territorial Authority

MidCentral, Whanganui DHBs' Territorial Authorities Amenable Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 people) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 136.6 136.1 144.8 111.4 102.5 127.8 107.6 Horowhenua 176.5 146.9 151.9 158.7 138.9 152.9 141.6 Manawatu 137.4 127 107.3 110.8 107.7 151.4 103.9 Tararua 127.6 157.6 102.7 136.7 186.2 127.6 149.2 Kapiti 191.7 129.8 147.2 129.2 171.4 159.8 176 Wanganui TA 147.6 153.7 143.5 157.5 133.7 161.6 141.3 Rangitikei 149.2 141.9 217.1 113.3 139.4 135.9 168 Ruapehu 172.7 316.3 235.4 197.5 332.5 133.3 124.4

MidCentral, Whanganui DHBs' Territorial Authorities Amenable Mortality Crude Rates 2004 to 2010 (per 100,000 people) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 150.1 147.5 157.4 122.3 116.1 144.3 124.7 Horowhenua 253.6 229.3 230 263.2 188.4 276.5 222.7 Manawatu 169.3 154.1 131.6 142.2 134.7 177.9 134 Tararua 170.1 200.4 142 166.7 239.6 162.7 181.7 Kapiti 310 199 199.8 202.6 247.8 249.7 192.1 Wanganui TA 193.9 218.2 212.8 204 195.2 235 210.3 Rangitikei 196.8 170.5 294.4 159.4 189.7 168.8 221.5 Ruapehu 162.5 289.9 210 150 282.7 154.4 134.5

MidCentral, Whanganui DHBs' Territorial Authorities Amenable Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 Palmerston North 109 108 116 91 87 109 95 Horowhenua 71 64 64 73 52 76 61 Manawatu 46 42 36 39 37 49 37 Tararua 29 34 24 28 40 27 30 Kapiti 22 14 14 14 17 17 13 Wanganui TA 78 87 84 80 76 91 81 Rangitikei 28 24 41 22 26 23 30 Ruapehu 8 14 10 7 13 7 6

By NZDep2001 9 and 10 Deciles

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Amenable Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 200.2 202 212.5 175.9 147.1 181.7 161.9 MidCentral overall 140.6 137.1 130.5 124.3 116 137.1 116.6 Whanganui NZDep 9 & 10 208.5 221.2 178.7 217.9 167.2 150.4 197.7 Whanganui overall 150.5 156.7 162.7 141.4 138.6 152.7 145.7 NZ NZDep 9 & 10 206.8 185.5 190.1 185 182.7 170.2 159.1 NZ overall 129.4 120.6 117.5 118.1 112.3 110.7 105.2

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Amenable Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 294.4 276.7 281 242.7 208 273.8 238.9 MidCentral overall 179.6 169.2 163.5 157.6 149.7 178.4 151.2 Whanganui NZDep 9 & 10 250.7 269.7 225.9 258.2 227.1 208.7 234.6 Whanganui overall 188.7 207.7 225.1 183 194.3 205.7 200.2 NZ NZDep 9 & 10 217.8 196.2 204.5 201.4 202.4 191.3 182.1 NZ overall 153.5 143.5 141.9 143.9 138.4 138.5 133

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Amenable Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 94 89 91 79 68 90 79 MidCentral overall 277 262 254 245 233 278 236 Whanganui NZDep 9 & 10 40 43 36 41 36 33 37 Whanganui overall 114 125 135 109 115 121 117 NZ NZDep 9 & 10 1691 1538 1617 1606 1627 1550 1487 NZ overall 5894 5557 5533 5646 5461 5500 5311

Circulatory Disease Mortality

By Ethnicity

MidCentral, Whanganui, New Zealand Ethnic Groups Circulatory Disease Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 303.5 288.6 288.8 285.7 248.3 255.6 226.9 New Zealand Pacific 286 267.9 262.5 264.3 234.6 224.2 217.9 New Zealand Other 151 134.9 133 123.5 121.8 116.1 111.1 MidCentral Maori 307.4 215 209.3 235.7 190.1 212 168.2 MidCentral Pacific 335.5 188.5 89.47 300 32.49 110.5 65.51 MidCentral Other 179.8 152.7 149.2 127.9 126.3 130.3 119.4 Whanganui Maori 239.8 326 372.7 383.8 474.7 531.1 337.3 Whanganui Pacific 0 305.6 113.7 591.8 743.8 152 258.6 Whanganui Other 171.2 157.5 175.2 129.2 149.7 148.4 139.1

MidCentral, Whanganui, New Zealand Ethnic Groups Circulatory Disease Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 140.4 137.3 143.7 147.3 132.9 137.6 128.5 New Zealand Pacific 146.3 136.4 141 143.8 136.8 134.7 134.1 New Zealand Other 313.4 287.3 293.1 278 282.8 275.3 269.3 MidCentral Maori 136.4 109.1 111.3 124 105 124.4 112.6 MidCentral Pacific 141.2 83.57 54.64 134 26.46 52.36 51.28 MidCentral Other 400 346.5 361.8 312.2 326.9 327.7 306.2 Whanganui Maori 131.6 192.8 179.7 196.4 188.9 175.8 186.3 Whanganui Pacific 0 306.1 100 201 198 99.01 289.9 Whanganui Other 454.6 429.6 486 404 431.4 456.7 437.7

MidCentral, Whanganui, New Zealand Ethnic Groups Circulatory Disease Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 856 848 899 933 852 893 844 New Zealand Pacific 349 331 348 361 349 349 353 New Zealand Other 10089 9327 9573 9128 9334 9131 8976 MidCentral Maori 37 30 31 35 30 36 33 MidCentral Pacific 5 3 2 5 1 2 2 MidCentral Other 536 466 488 421 441 442 413 Whanganui Maori 21 31 29 32 31 29 31 Whanganui Pacific 0 3 1 2 2 1 3 Whanganui Other 218 205 231 190 201 211 200

By Territorial Authority

MidCentral, Whanganui DHBs' Territorial Authorities Circulatory Disease Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 187.8 156.2 149.9 140.2 141.5 132.5 122.5 Horowhenua 219.5 161.9 186.9 154.5 146.6 150.1 157.4 Manawatu 187.1 174.7 154 129.5 129.5 155.4 113.2 Tararua 151.4 147.2 165.5 143.1 125.3 129.6 137.1 Kapiti 180 156.9 121.4 94.68 98.18 126.6 110.2 Wanganui TA 179.9 203.4 190.2 155.7 169.4 176.6 152.6 Rangitikei 189.2 118.4 195 174.1 137.5 140.7 184.4 Ruapehu 161.4 187.9 248.2 161.8 375.6 219 194.2

MidCentral, Whanganui DHBs' Territorial Authorities Circulatory Disease Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 317.2 270.6 262 242.9 263.4 243.7 220.6 Horowhenua 517.4 420.1 479 404.5 402.1 425.8 443 Manawatu 312.8 290.7 296.4 254.2 253.5 283.5 224.7 Tararua 291.2 270.1 348.1 288.7 262.2 269 292.6 Kapiti 413.7 351.3 260.9 250.8 238.8 307.3 214.9 Wanganui TA 411.7 460.8 462.2 399.1 427.4 452.5 414.3 Rangitikei 344.4 207.1 350.6 325.9 252.7 274.3 344.6 Ruapehu 138.7 161.5 204.6 125.2 317.7 193.3 196.5

MidCentral, Whanganui DHBs' Territorial Authorities Circulatory Disease Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 Palmerston North 244 210 205 192 210 196 179 Horowhenua 159 129 147 124 123 130 135 Manawatu 90 84 86 74 74 83 66 Tararua 53 49 63 52 47 48 52 Kapiti 32 27 20 19 18 23 16 Wanganui TA 180 200 199 171 182 192 175 Rangitikei 52 31 52 48 37 40 50 Ruapehu 7 8 10 6 15 9 9

100

By NZDep2001 9 and 10 Deciles

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Circulatory Disease Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 253.8 212.7 217.5 183.9 174.1 171.1 163.4 MidCentral overall 189.4 159.3 156.6 137.9 133.3 138.8 125.3 Whanganui NZDep 9 & 10 227.7 268.1 202.6 195.6 190.9 204.9 155.8 Whanganui overall 181.6 185.7 191.9 155.7 167.9 165.8 160.4 NZ NZDep 9 & 10 219.5 192.7 195.4 185.3 178.1 166.1 151.5 NZ overall 164.5 148.2 147.2 138.9 134.4 128.8 122.5

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Circulatory Disease Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 542.4 480.4 487.6 433.7 461.8 403.3 406.1 MidCentral overall 351 301.4 313.2 276.4 282.2 286.4 266.6 Whanganui NZDep 9 & 10 349.2 396.1 325.1 319.9 308.3 344.5 273.8 Whanganui overall 368.4 369.1 403.6 349.9 365.6 378.3 369.4 NZ NZDep 9 & 10 287.8 258 267.5 256.5 254.4 240.8 225.5 NZ overall 277.7 255.8 262 251.5 251 245.5 239.2

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Circulatory Disease Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 188 168 172 154 165 145 147 MidCentral overall 578 499 521 461 472 480 448 Whanganui NZDep 9 & 10 59 67 55 54 52 58 46 Whanganui overall 239 239 261 225 234 241 234 NZ NZDep 9 & 10 2341 2121 2220 2148 2150 2053 1939 NZ overall 11296 10506 10843 10480 10535 10373 10173

101

Cancer Mortality

By Ethnicity

MidCentral, Whanganui, New Zealand Ethnic Groups Cancer Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 228 229.6 224.7 212.1 216.8 217.9 203.6 New Zealand Pacific 199.3 170.5 196.6 181.7 189.3 178.2 176.6 New Zealand Other 131.8 125.7 124.2 127.6 124 118.8 118.2 MidCentral Maori 249 310.8 180.4 155 219.5 212.5 161.5 MidCentral Pacific 67.85 0 211.1 89.37 223.9 0 155.8 MidCentral Other 140.7 124.7 138.3 136 124.7 129.9 135.8 Whanganui Maori 298 317.3 388.4 243.2 243.5 245.9 168.2 Whanganui Pacific 0 0 295.9 0 0 75.48 76.69 Whanganui Other 137 139.5 126 136.8 151.6 132.4 124.5

MidCentral, Whanganui, New Zealand Ethnic Groups Cancer Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 126.6 124 127.6 127.3 134.6 136.7 134.6 New Zealand Pacific 113.2 103 119.9 114.8 121.1 118.8 120.4 New Zealand Other 222.8 216.3 216.7 228 225.4 220.2 223.9 MidCentral Maori 132.7 160 93.36 95.64 126.1 134.8 112.6 MidCentral Pacific 56.5 0 54.64 53.62 105.8 0 102.6 MidCentral Other 259.7 232 260.3 264 254.2 257.3 288.4 Whanganui Maori 156.6 192.8 179.7 165.7 164.5 127.3 126.2 Whanganui Pacific 0 0 100 0 0 99.01 96.62 Whanganui Other 275.3 287.1 281.9 289.2 332.7 309.5 315.2

MidCentral, Whanganui, New Zealand Ethnic Groups Cancer Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 772 766 798 806 863 887 884 New Zealand Pacific 270 250 296 288 309 308 317 New Zealand Other 7172 7021 7078 7488 7441 7304 7463 MidCentral Maori 36 44 26 27 36 39 33 MidCentral Pacific 2 0 2 2 4 0 4 MidCentral Other 348 312 351 356 343 347 389 Whanganui Maori 25 31 29 27 27 21 21 Whanganui Pacific 0 0 1 0 0 1 1 Whanganui Other 132 137 134 136 155 143 144

102

By Territorial Authority

MidCentral, Whanganui DHBs' Territorial Authorities Cancer Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 143.8 142.9 154.7 129.4 117.9 123.6 130.6 Horowhenua 169.6 131.1 139.7 134.5 158.6 149.3 174.2 Manawatu 144.4 131.3 117.5 132.1 112.4 162.2 143.6 Tararua 148.4 155.3 117.5 180.9 159.9 140.3 129.6 Kapiti 194.4 111.8 191.6 189.2 155.1 124.1 131.2 Wanganui TA 153.4 166.8 148.5 147.7 158.2 156.6 132.7 Rangitikei 138.3 138.7 136 157 175.2 88.56 168.8 Ruapehu 206.7 152.7 83.72 243.6 224.7 112.9 89.54

MidCentral, Whanganui DHBs' Territorial Authorities Cancer Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 196.3 185.5 217.3 182.2 179.4 172.9 196 Horowhenua 351.4 286.6 299.8 306.6 362.9 337.4 416.8 Manawatu 205.1 204.2 172.3 209.5 185 259.6 248.5 Tararua 225.3 259.1 204.4 305.4 267.7 257.8 242 Kapiti 349.1 234.2 391.3 409.1 358.3 293.9 322.3 Wanganui TA 260.7 294.9 292.7 280.1 298.2 313.4 277 Rangitikei 225.2 220.5 229.2 224.1 307.4 178.3 310.1 Ruapehu 178.3 141.3 81.82 208.7 211.8 128.8 87.34

MidCentral, Whanganui DHBs' Territorial Authorities Cancer Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 Palmerston North 151 144 170 144 143 139 159 Horowhenua 108 88 92 94 111 103 127 Manawatu 59 59 50 61 54 76 73 Tararua 41 47 37 55 48 46 43 Kapiti 27 18 30 31 27 22 24 Wanganui TA 114 128 126 120 127 133 117 Rangitikei 34 33 34 33 45 26 45 Ruapehu 9 7 4 10 10 6 4

103

By NZDep2001 9 and 10 Deciles

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Cancer Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 194.5 156.8 180.2 163.9 185.1 141.3 186.7 MidCentral overall 149.4 135.3 139.7 138.4 131.8 135.7 140.5 Whanganui NZDep 9 & 10 187.5 178.6 170.1 193.2 154.9 145.6 127.7 Whanganui overall 149.8 159.8 142.4 151.7 161.6 138 137.2 NZ NZDep 9 & 10 179.3 162.8 164.3 164 162.8 156.1 149.6 NZ overall 140.7 133.7 133.2 136 133.2 128.1 127

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Cancer Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 360.6 297.4 337.4 329.5 375 278.2 392.3 MidCentral overall 234.4 215 227.8 230.8 229 230.3 253.5 Whanganui NZDep 9 & 10 254.5 242.4 254.1 284.4 231.2 225.7 208.4 Whanganui overall 242 259.4 253.6 253.5 284.4 259 262.1 NZ NZDep 9 & 10 212.4 196.9 200.7 205.7 207.7 202.5 196.4 NZ overall 201.9 195.7 197.5 205.9 205.2 201.1 203.7

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Cancer Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 125 104 119 117 134 100 142 MidCentral overall 386 356 379 385 383 386 426 Whanganui NZDep 9 & 10 43 41 43 48 39 38 35 Whanganui overall 157 168 164 163 182 165 166 NZ NZDep 9 & 10 1728 1619 1666 1723 1755 1726 1689 NZ overall 8214 8037 8172 8582 8613 8499 8664

104

Respiratory Disease Mortality

By Ethnicity

MidCentral, Whanganui, New Zealand Ethnic Groups Respiratory Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 77.58 74.45 65.31 72.26 78.81 71.85 64.18 New Zealand Pacific 62.09 46.82 57.76 52.47 54.24 60.7 40.43 New Zealand Other 33.22 27.99 29.97 27.85 31.09 29.53 27.47 MidCentral Maori 60.33 85.57 44.4 50.68 52.76 64.91 47.8 MidCentral Pacific 62.98 0 22.71 26.47 90.97 0 62.98 MidCentral Other 33.89 27.98 33.13 27.81 31.04 31.15 28.74 Whanganui Maori 95.84 69.21 174.1 69.66 151.2 93.04 52.02 Whanganui Pacific 0 0 0 0 0 101.1 220.9 Whanganui Other 35.31 35.14 42.08 30.31 38.92 38.57 43.56

MidCentral, Whanganui, New Zealand Ethnic Groups Respiratory Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 36.41 34.98 33.57 37.9 41.02 41.15 37.31 New Zealand Pacific 27.67 23.9 30.79 28.29 30.58 32.41 24.69 New Zealand Other 67.68 57.84 64.29 61.85 69.17 66.65 64.38 MidCentral Maori 29.49 47.27 25.13 31.88 31.51 34.55 34.11 MidCentral Pacific 28.25 0 27.32 26.81 26.46 0 25.64 MidCentral Other 73.13 62.45 74.15 70.45 80.05 75.63 71.92 Whanganui Maori 50.13 24.88 74.35 42.97 54.84 60.61 42.07 Whanganui Pacific 0 0 0 0 0 99.01 96.62 Whanganui Other 91.76 94.3 105.2 74.42 105.2 103.9 131.3

MidCentral, Whanganui, New Zealand Ethnic Groups Respiratory Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 222 216 210 240 263 267 245 New Zealand Pacific 66 58 76 71 78 84 65 New Zealand Other 2179 1878 2100 2031 2283 2211 2146 MidCentral Maori 8 13 7 9 9 10 10 MidCentral Pacific 1 0 1 1 1 0 1 MidCentral Other 98 84 100 95 108 102 97 Whanganui Maori 8 4 12 7 9 10 7 Whanganui Pacific 0 0 0 0 0 1 1 Whanganui Other 44 45 50 35 49 48 60

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By Territorial Authority

MidCentral, Whanganui DHBs' Territorial Authorities Respiratory Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 33.4 25.1 31.07 27.91 29.94 31.95 32.76 Horowhenua 56.8 41.38 58.86 48.78 46.46 44.15 36.14 Manawatu 30.51 18.19 39.3 21.2 27.53 27.57 20.76 Tararua 23.73 57.57 23.94 29.8 43.95 27.43 21.63 Kapiti 14.73 39.61 33.83 37.32 20.36 25.83 60.64 Wanganui TA 38.68 37.03 49.96 42.93 41.89 49.69 49.58 Rangitikei 38.3 32.42 40.36 14.18 48.79 38.62 53.15 Ruapehu 130.2 68.28 94.93 32.57 54.06 55.54 18.51

MidCentral, Whanganui DHBs' Territorial Authorities Respiratory Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 52 41.23 49.85 50.61 48.92 57.21 56.7 Horowhenua 136.7 104.2 123.8 107.6 140.6 117.9 105 Manawatu 48.67 27.69 68.92 37.78 58.23 51.23 37.45 Tararua 43.96 99.23 44.2 72.18 83.66 56.03 45.02 Kapiti 38.79 91.09 39.13 105.6 53.08 66.8 147.7 Wanganui TA 84.62 85.25 109.2 86.36 101 110.8 125.5 Rangitikei 59.6 60.13 74.16 27.16 88.79 68.58 96.48 Ruapehu 118.9 60.56 81.82 20.87 42.36 42.95 21.84

MidCentral, Whanganui DHBs' Territorial Authorities Respiratory Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 Palmerston North 40 32 39 40 39 46 46 Horowhenua 42 32 38 33 43 36 32 Manawatu 14 8 20 11 17 15 11 Tararua 8 18 8 13 15 10 8 Kapiti 3 7 3 8 4 5 11 Wanganui TA 37 37 47 37 43 47 53 Rangitikei 9 9 11 4 13 10 14 Ruapehu 6 3 4 1 2 2 1

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By NZDep2001 9 and 10 Deciles

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Respiratory Disease Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 50.16 47.24 56.77 57.28 40.83 47.22 46.35 MidCentral overall 35.91 32.56 36.04 31.9 33.61 32.87 31.29 Whanganui NZDep 9 & 10 58.1 52.86 56.96 68.53 41.03 62.47 83.4 Whanganui overall 42.33 36.43 49.07 34.75 43.16 46.14 49.2 NZ NZDep 9 & 10 55.19 44.5 48.23 43.51 51.09 46.29 43.94 NZ overall 36.6 31.28 33.36 31.69 34.68 33.29 30.6

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Respiratory Disease Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 109.6 105.8 121.9 126.7 109.1 122.4 113.3 MidCentral overall 64.98 58.58 64.92 62.95 70.56 66.82 64.26 Whanganui NZDep 9 & 10 82.87 88.69 94.56 106.6 65.21 101 136.9 Whanganui overall 80.15 75.66 95.89 65.31 90.62 92.62 107.3 NZ NZDep 9 & 10 72.29 58.75 66.51 60.18 71.47 66.28 65.13 NZ overall 60.65 52.4 57.65 56.19 62.52 60.63 57.74

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 Respiratory Disease Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 38 37 43 45 39 44 41 MidCentral overall 107 97 108 105 118 112 108 Whanganui NZDep 9 & 10 14 15 16 18 11 17 23 Whanganui overall 52 49 62 42 58 59 68 NZ NZDep 9 & 10 588 483 552 504 604 565 560 NZ overall 2467 2152 2386 2342 2624 2562 2456

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External Causes (Injuries and Accidents)

By Ethnicity

MidCentral, Whanganui, New Zealand Ethnic Groups External Causes Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 67.05 60.22 68.52 61.77 58.47 59.97 63.89 New Zealand Pacific 24.25 39.39 33.35 34.33 35.64 36.49 33.31 New Zealand Other 33.1 32.64 31.17 33.41 35.38 34.03 32.4 MidCentral Maori 65.99 64.91 89.9 48.51 98.86 79 51.72 MidCentral Pacific 43.7 134.6 0 90.97 22.71 24.02 26.47 MidCentral Other 31.03 44.18 46.25 40.43 41.93 44.53 49.01 Whanganui Maori 60.19 86.02 91.78 100.9 56.21 72.06 160.7 Whanganui Pacific 0 0 0 0 0 96.68 0 Whanganui Other 34.27 44.44 28.93 45.03 35.25 42.99 44.62

MidCentral, Whanganui, New Zealand Ethnic Groups External Causes Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 58.71 55.87 59.15 56.37 52.4 54.71 56.19 New Zealand Pacific 23.06 31.73 29.58 28.69 30.58 33.95 29.25 New Zealand Other 40.57 39.7 40.23 42.88 45.57 44.43 44.97 MidCentral Maori 51.6 61.82 64.63 46.05 84.03 76.02 51.16 MidCentral Pacific 56.5 111.4 0 26.81 26.46 26.18 25.64 MidCentral Other 40.3 51.3 57.09 51.91 51.89 60.8 60.8 Whanganui Maori 62.66 74.63 74.35 85.94 54.84 66.67 108.2 Whanganui Pacific 0 0 0 0 0 99.01 0 Whanganui Other 41.71 56.58 37.87 55.28 42.93 56.28 61.28

MidCentral, Whanganui, New Zealand Ethnic Groups External Causes Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 New Zealand Maori 358 345 370 357 336 355 369 New Zealand Pacific 55 77 73 72 78 88 77 New Zealand Other 1306 1289 1314 1408 1504 1474 1499 MidCentral Maori 14 17 18 13 24 22 15 MidCentral Pacific 2 4 0 1 1 1 1 MidCentral Other 54 69 77 70 70 82 82 Whanganui Maori 10 12 12 14 9 11 18 Whanganui Pacific 0 0 0 0 0 1 0 Whanganui Other 20 27 18 26 20 26 28

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By Territorial Authority

MidCentral, Whanganui DHBs' Territorial Authorities External Causes Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 28.18 50.57 53.03 39.59 37.64 49.9 35.12 Horowhenua 43.95 58.28 56.33 47.88 83.21 53.13 58.76 Manawatu 34.38 40.62 43.6 41.93 36.59 68.21 75.75 Tararua 53.97 45.55 48.19 63.66 78.25 55.24 74.93 Kapiti 66.22 73.67 35.73 10.13 106.1 27.24 97.63 Wanganui TA 47.01 46.88 31.68 76.94 52.38 48.67 54.16 Rangitikei 34.28 70.48 60.1 25.54 19.79 60.35 89.86 Ruapehu 65.42 67.64 56.28 64.13 45.29 53.01 32.15

MidCentral, Whanganui DHBs' Territorial Authorities External Causes Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 Palmerston North 31.2 55.4 62.63 46.82 43.9 62.18 48.07 Horowhenua 58.57 58.62 61.91 58.71 85 78.62 52.51 Manawatu 38.24 41.53 51.69 48.08 41.1 64.89 78.3 Tararua 60.44 60.64 60.78 77.73 78.09 50.43 78.78 Kapiti 77.58 78.07 13.04 13.2 106.2 40.08 80.59 Wanganui TA 48.03 57.6 39.49 72.35 56.35 63.63 75.76 Rangitikei 39.74 66.82 67.41 40.74 20.49 54.87 89.59 Ruapehu 59.43 80.75 61.37 62.61 42.36 64.42 21.84

MidCentral, Whanganui DHBs' Territorial Authorities External Causes Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 Palmerston North 24 43 49 37 35 50 39 Horowhenua 18 18 19 18 26 24 16 Manawatu 11 12 15 14 12 19 23 Tararua 11 11 11 14 14 9 14 Kapiti 6 6 1 1 8 3 6 Wanganui TA 21 25 17 31 24 27 32 Rangitikei 6 10 10 6 3 8 13 Ruapehu 3 4 3 3 2 3 1

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By NZDep2001 9 and 10 Deciles

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 External Causes Mortality Age Adjusted Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 58.32 77.05 77.54 56.51 70.43 75.57 72.38 MidCentral overall 35.93 50.14 47.98 43.32 49.69 53.15 50.17 Whanganui NZDep 9 & 10 55.36 50.2 46.75 118.4 55.88 47.86 76.38 Whanganui overall 45 53.44 38.74 60.41 40.34 50.68 59.95 NZ NZDep 9 & 10 51.62 52.18 51.37 50.58 51.84 47.85 47.67 NZ overall 37.79 37.48 36.74 38.12 39.15 38.67 37.21

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 External Causes Mortality Crude Rates 2004 to 2010 (per 100,000 population) 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 69.24 82.92 82.22 59.14 83.96 91.79 82.87 MidCentral overall 42.51 54.35 57.1 50.36 56.8 62.65 58.31 Whanganui NZDep 9 & 10 59.19 47.3 47.28 112.6 59.28 59.4 89.3 Whanganui overall 46.24 60.22 46.4 62.2 45.31 59.65 72.62 NZ NZDep 9 & 10 54.22 54.13 53.86 53.97 55.5 51.03 53.15 NZ overall 42.26 41.66 42.45 44.08 45.7 45.37 45.73

MidCentral, Whanganui DHB, New Zealand NZDep2001 9 & 10 External Causes Mortality Numbers 2004 to 2010 2004 2005 2006 2007 2008 2009 2010 MidCentral NZDep 9 & 10 24 29 29 21 30 33 30 MidCentral overall 70 90 95 84 95 105 98 Whanganui NZDep 9 & 10 10 8 8 19 10 10 15 Whanganui overall 30 39 30 40 29 38 46 NZ NZDep 9 & 10 441 445 447 452 469 435 457 NZ overall 1719 1711 1757 1837 1918 1917 1945

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Appendix Three: Yearly Age Adjusted Rates Graphs

This appendix shows the yearly age adjusted rates for the different groups looked at in this report: ethnic groups, territorial authorities, and NZDep 9 and 10 areas.

They are useful when looking for patterns across time, for example, to see whether rates are increasing or reducing.

Rates for some population groups can be unstable – they jiggle up and down markedly from one year to the next. This is usually because the rates are based on a small number of deaths. In this situation, the patterns across time usually cannot be interpreted, and it is better to rely on analysis that accumulates multiple years into each calculation, for example, the age adjusted ratios described in the main text.

All Cause Mortality

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Circulatory Disease

113

Cancer

114

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Respiratory Disease

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External Causes

117

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Amenable Mortality

119

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Appendix: Amenable Mortality ICD-10 Codes (from Tupu Ola Moui: Pacific Health Chart Book 2012, Ministry of Health 2012)

Infections Respiratory tuberculosis A15 – A16 Meningococcal infection A39 Pneumococcal disease A403, G001, J13 Cancers Stomach cancer C16 Rectal cancer C19-C218 Bone and cartilage cancer C40-C41 Melanoma of skin C43 Female breast cancer C50 Cervical cancer C53 Prostate cancer C61 Testis cancer C62 Thyroid cancer C73 Hodgkin lymphoma C81 Acute lymphoblastic leukaemia C910 Maternal and newborn Complications of pregnancy O01-O99 Complications of prenatal period P02-P94 Congenital malformations of cardiac septa Q210-Q219 CVD and diabetes Diabetes E101-E149 Valvular heart disease I01, I05-I09, I33-I37 Hypertensive diseases I10-I15 Ischaemic heart diseases I20-I25 Heart failure I50 Cerebrovascular diseases I60-I69 Other chronic disorders Pulmonary embolism I26 Unspecified chronic bronchitis J41-J42 Asthma J45-J46 Peptic ulcer disease K25-K27 Cholelithiasis K800-K808 Renal failure N17-N19 Injuries Selected land transport accidents V01-V79, V87, V89 Accidental falls W00-W19

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Exposure to smoke, fire, and flames X00-X09 Suicide X60-X84 Misadventures to patients during surgical Y60-Y69 and medical care

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Appendix Five: Sources of Data

Mortality data was sourced from the Ministry of Health. Population data was sourced from the Statistics New Zealand.

Age adjusted and non-age adjusted mortality data were calculated using mortality data and population data ingredients. These calculations were carried out using R statistical and data analysis programming language.

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