ISSN OS48-944X DEPARTMENT OF HEALTH SPECIAL REPORT SERIES
A CANCER MORTALITY ATLAS OF' NEW ZEALAND
Issued by the National Health Statistics Centre Department ofHealth, Wellington New Zealand
p
2 1982
, , I I OJe to difficulties in the reproductive stage of printing, the shading for some maps does not precisely cover the areas for which they apply. I ISSN 0548-944X
. DEPARTMENT OFHEALTH
, . -A CANCER MORTALITYATLAS:OF NEW ZEALAND
, I /
by BARR Y BORltdAN MA
.National Health Statistics Centre Department ofHealth·
SPECIAL REPORT No. 63
096369'
Issued by the National Health Statistics Centre . Department of Health, Wellington . ., New Zealand . . . 1982
,. CONTENTS
ACKNOWLEDGMENTS
DISCLAIMER AND COPYRIGHT FOREWORD
INTRODUCTI ON 1 METHODOLOGY 3
CANCER OF THE BUCCAL CAVITY AND PHARYNX 11 CANCER OF THE OESOPHAGUS 15 CANCER OF THE STOMACH 19 CANCER OF THE LARGE INTESTINE 25 CANCER OF THE RECTUM 31 CANCER OF THE LARGE BOWEL 37 CANCER OF THE LIVER, GALLBLADDER AND BILE DUCTS 43 CANCER OF THE PANCREAS 49 CANCER OF THE LARYNX 53 CANCER OF THE TRACHEA, BRONCHUS AND LUNG, PLEURA AND MEDIASTINUM 57 MELANOMA OF THE SKIN 63 CANCER OF THE BREAST 67 CANCER OF THE CERVIX UTERI 71 CANCER OF THE UTERUS 75 CANCER OF THE OVARY, FALLOPIAN TUBE AND BROAD LIGAMENT 79 CANCER OF THE PROSTATE 83 CANCER OF THE BLADDER 87 CANCER OF THE BRAIN 91 LYMPHOSARCOMA 95 HODGKIN'S DISEASE 99 MULTIPLE MYELOMA 103 LEUKAEMIA 107 APPENDIX 111 ACKNOWLEDGMENTS· .
The co-operation and assistance of th~ following people is gratefu.lly acknowledged: * . DrNMcGlashan, Department of Geography, University of Tasmani.a, .who introduced the author to.the field of medical geography and . made constructive criticisms on the development of this project. *·DrA Smith and Mr N· Pearce, Department of·Community. Health, Wellington' Clinical School of Medicine,. who made available the computer program'to' conduct the temporal analysis,and willingly offered advice and suggestions. . . * Mr J Findlay and Mr J Fraser, National Health Statistics Centre, ,for their, continued encouragement and support throughout this, .. study. Also Mr F Foster, for allowing access to the data and permission to publish. * Mr HFleming, Mr C Mooney, Miss K Carson, MsA Johnston, Mrs S Leiataua, and Miss S McKenna, for programming, clerical, and typing assistance. * Ms G·Simmonds, and the staff of the General Draughting Section, . Department of Lands and Survey, who accommodated every demand .; n -the production of the maps and graphs. .
- -
/' DISCLAIMER
The views expressed in this report are those of the author and do not necessarily represent the views of the Department of Health.
COPYRIGHT
Provided the source is acknowledged information contained in this report may be freely used by any person. . FOREWORD
Whereas atlases of diseases, especially those of infectious and epidemic nature, started to appear at international scale in the nineteenth century, it has not been until comparatively recently that national atlases portraying death from cancer on a geographic basis have been produced. This apparent delay has been necessitated by the time taken to determine standard methods of dealing with problems of differential diagnosis, of recording and of presenting these generally unfamiliar data. Since Melvyn Howe's national atlas of mortality for the United Kingdom in 1963, atlases specialising in cancer deaths have been produced from as far afield as the United States and Japan, West Germany and mainland China. Each adopts its own system of geographic units and statistical classes to cope with large population numbers. In New Zealand Mr Borman has had the rather different problems stemming from the small numbers of deaths in individual geographic divisions of a nation of only 3 million people. The major questions, of course, are of selecting small enough units of space to retain realistic accuracy of locality and yet to have large enough populations for confidence in the findings. The time span selected relates to these twin aims: a longer period of years will increase the gross numbers in each unit but tend to disguise temporal shifts of incidence and become more subject to unrealities from the mobility of individuals. Barry Borman has steered a rational and explicable course through these professional problems in a way that presents the facts clearly and establishes for his readers both where significance in his geographic patterns may be placed and where less confidence lies. There can be few of us in the developed countries today whose families have not been touched by one of the many forms of cancer. Any advance in knowledge of these conditions is therefore to be welcomed and the underlying implication of defining cancer variations over space must be, in the long run, to explain those variations either in terms of environmental or other factors. This is a peculiarly geographic task and an approach to cancer elucidation validly complementary to those of medical and other researchers in the field. I am happy to commend Barry Borman's work to a readership which I would like to hope will extend beyond medicine, geography and kindred sciences to all those lay people who still have wonder about their world and can question the mechanisms behind the mysterious, even apparently quixotic, cancer distribution patterns of New Zealand.
Neil McGlashan Department of Geography University of Tasmania Tasmania INTRODUCTION
Cancer is the second leading cause of death in New Zealand, accounting for 20 percent of the total annual mortality. The national death rate for some sites (eg, large bowel and melanoma of the skin) are among the highest in the world. Although the aetiology of most human neoplasms remains elusive, the majority are believed to be attributable, directly or indirectly, to environmental factors. One initial approach to identifying these carcinogens, and hence facilitate primary prevention, is to describe the demographic, geographic, and temporal distributions of cancer in populations. Often this will provide clues to the underlying disease causative processes. This report presents the results of a study designed to define the spatial patterns and secular trends of cancer martality in the total New Zealand population. The principal objective in the cartographic and graphic portrayal of these data is to generate aetiological hypotheses for testing in subsequent research.
1 METHODOLOGY
SPATIAL ANALYSIS The age, sex, and domicile of persons registered [1] as dying from cancer in various sites (Table 1) between 1974-1978 (inclusive) were extracted from the computer tapes held by the ~lational Health Statistics Centre. .
The de jure population [2] of each areal unit at the time of the 1976 Census (held on 23 March 1976) was used as the denominator. This was supplied by the Department of Statistics. The following caveat must be applied to these data. Although both the numerator and denominator take as a person's domicile [3] their 'usual place of residence' there are no stipulated criteria as to what constitutes 'usual'. This may produce anomalous situations. For . example, two people will be coded as living (or dying) in the same area even if the former had resided there for 20 years and the latter only one year. A hierarchy of spatial divisions were employed, which permitted both regional and small-scale local patterns to be defined (Fig. 2): a) The 24 main urban areas. In addition to the central city or borough, these non-administrative units include neighbouring boroughs, town districts and parts of counties which are regarded. as suburban and thus belonging to that centre of population irrespective of their being under different local body administration [4J. Urban areas were used, in preference to cities, as their boundaries at the 1976 Census were, generally, unchanged from those at the 1971 Census [5J. b) Geographic counties (counties) excluding the main urban areas. These cover the county and any borough, or town district which may be geographically ""/ithin, or adjacent to, that county [6]. By the 1976 Census date the Thames and Coromandel Counties and Thames borough had been amalgamated under a single controlling authority - the Thames-Coromande1 District Council. However, in this report the Thames-Coromandel District, as it is officially titled, has been designated the Coromandel ..Thames County to avoid confusion with the Thames hospital board district. c) Hospital board districts (districts) which are amalgams of various counties. It should be noted that the Waiapu, Taumarunui, Mar"lborough, Vincent, and r~aniototo Counties and districts are synonymous. Accordingly, reference to these units implies the same mortality experience at both scales. The need to incorporate some form of stochastic test in spatial studies of morbidity or mortality has been previously emphasised [7J. It is crucial to distinguish between those areas in which disease or death results from random influences and those in which the occurrence is beyond being merely a chance event. A statistically significant variation implies that there is an underlying cause for which an explanation should be sought.
3 4
The indirect method of standardisation [8] was used to adjust for differences in the local population age structures. This permits the calculation, for each area, of a standardised mortality ratio (SMR) which expresses, as a percentage, the ratio of the observed number of deaths to those theoretically expected if the national age-specific death rates had been in operation. An SMR of 100, therefore, indicates a mortality level equal to that of the total New Zealand population; an SMR of less than 100 signifies a more favourable experience; and an SMR of over 100 represents an unfavourable experience. The actual confidence level, based on the Poisson distribution, of each local deviation of the observed from the expected number of deaths was determined [9J. As a probability value could, therefore, be placed on each area it became feasible to identify gradients of morta1i ty by compari ng the. experi ence of conti guous areas. .
TEMPORAL ANALYSIS Age and sex-specific mortality data for the years 1949-1973 were gleaned from the official health statistics publications [lOJ. Over this period there have been minor changes in the format of the published tables, but these do not affect the analysis. Data for 1974-1978 were obtained from the appropriate mortality computer tapes. Annua1 mortality rates for each site were age-adjusted [11 J, usi ng Segi1s world population [12] as the standard, and graphed. Further to elucidate the temporal pattern the data were aggregated into two periods, 1949-1958 and 1969-1978. Decade-specific mortality rates were age-adjusted as previously. For each age group the ratio of the rate in the latter decade to that in the earlier (the Relative Risk) was calculated [11] and also graphed. Unity, therefore, indicates no change in the mortality rate, while a relative risk greater than one signifies the extent of the rate increase. The converse duly applies. In addition, the Mantel-Haenszel odds ratio (OR), which is a weighted average of the age-specific odds ratios [13,14], was computed [llJ. This was tested by the Mantel-Haenszel chi-square test [11,14] to determine whether the mortality in the last period was Significantly above, or below, that in the fi rst. . '. 5
HOSPITAL BOARDS
~P'CHATHAM o ;SLANDS
\ .~.
COUNTIES/URBAN AREAS
1. Whangarei 13. Wanganui 2. West Auckland 14. Pelmerston North 3. North Auckland 15. Masterton 4. Central Auckland 16. Porirua 5. South Auckland 17. Upper Hutt 6. Tauranga 18. Wellington 7. Hamilton 19. Lower Hutt 8. Rotorua 20. Nelson 9. Gisbome 21. Christchurch 10. Napier 22. Timaru 11. Hastings 23. Dunedin 12. New Plymouth 24. Invercargill
~hot"'"Ot~IOI'Uh
Fig. 2 TABLE 1 NUMBERS OF DEATHS AND AGE~ADJUSTED (1) MORTALITY RATES PER 100 000 POPULATION FOR SELECTED SITE-SPECIFIC CANCERS, 1974-1978 Deaths(2) Rates ICD rubric Site of cancer (8th revision) Male Female Male Female 140-149 Buccal cavity and pharynx 287 135 3.6 1.3 150 Oesophagus 410 236 5.2 2.1 151 Stomach 1100 674 13.5 6.2 153 Large intestine 1270 1669 15.9 16.6 154 ' Rectum 736 648 9.2 6.4 153-154 Large bowel 2006 2317 25.1 22.9.. 155-156 Liver, gallbladder and bile ducts 296 287 3.7 2.8 157 Pancreas 681 547 8.5 5.3 161 Larynx 126 * 1.6 " 162-163 Trachea, bronchus and lung, pleura and mediastinum 4063· 1063 50~0 11.6 172 Melanoma of the. skin 299 237 3.9 2.8 174 Breast * 2216 .;,.. 24.5 180 Cervix uteri 473 . 5.5 . 182 Uterus, other 325 3.1 183 Ovary, fallopian tube and broad ligament 711 7.8 185 Prostate 1316 16.6 188 Bladder 462 170 5.8 1.6 191 Brain 396 277 5.1 3.4 200 Lymphosarcoma 238 183 3.0 1.9 201 Hodgkin's disease 84 83 1.1 0.9 203 Multiple myeloma 202 180 2.5 1.7 204-207 Leukaemia 542 407 6.8 4.2 (1) to Segi's world population; see [12] (2) These cancers accounted for 90.2% of the total male and 89.9% of the total female cancer deaths registered in the period 1974-78 * Not considered due to low numbers TABLE 2 : AGE-ADJUSTED (1) MORTALITY RATES PER 100 000 POPULATION FOR SELECTED SITE-SPECIFIC CANCERS, 1949-1958 AND 1969-1978 1949-1958 1969-1978 ICD rubric Site of cancer (8th revision) Male Female Male Female 140-149 Buccal cavity and pharynx 3.7 1.5 3.5 1.1 150 Oesophagus 4.0 1.9 4.6 2.0 151 Stomach 20.7 11.8 14.3 6.4 153 Large intestine 11.3 13.9 15.9 15.7 154 Rectum 7.6 5.2 9.2 5.8 153-154 Large bowel 18.9 19.0 25.0 21.5 155-156 Liver, gallbladder and bile ducts 2.9 3.1 3.8 2.8 157 Pancreas 7.0 4.4 8.2 4.7 161 Larynx 1.9 1.6 162-163 Trachea, bronchus and lung, pleura and mediastinum 23.4 3.4 47.9 10.4 172 Melanoma of the skin 1.5 1.2 3.4 2.5 174 Breast 22.6 24.4 180 Cervix uteri 7.2 5.5 182 Uterus, other 4.6 3.2 183 Ovary, fallopian tube and broad ligament 7.2 8.0 185 Prostate 14.0 16.0 188 Bladder 4.3 1.4 5.5 1.6 191 Brain 3.9 2.7 5.0 3.2 200 Lymphosarcoma 3.1 1.8 3.3 2.0 201 Hodgkin's disease 1.5 0.9 1.5 1.0 203 Multiple myeloma 1.0 0.8 2.3 1.6 204-207 Leukaemia 6.2 4.8 6.8 4.5 (1) to Segi's world population; see [12] NOrES AND REFERENCES
1. Throughout this report the mortality data pertain to the year in which a death was registered. This may not be the same year in which it actually occurred. In. New Zealand, the legal requirement is that a death must be registered within three days of burial, or when applicable, within three days of an inquest being held.
2. De jure population is the 'legal population of a locality' and is based on the usual residence of those counted in New Zealand on census night, (New Zealand census of population and dwellings, 1976. - v. Ie, p. 9) This contrasts with the de facto population which is the population present 'at the place of enumeration of census night'. (New Zealand census of population and dwellings, 1976. - v. lA, p. II) 3. The numerator was coded to the 1971 census area unit codes, but in coding the denominator the 1976 census domicile codes were utilised •. In this analysis the areal units at the time of the 1976 census have been used, with the domicile of those deceased being reaSSigned when necessary. 4. New Zealand census of population and dwellings, 1976. - v. lA, p. 11. . 5. There were some minor adjustments to urban area boundaries for the 1976 census, For details see New Zealand census of population and dwellings, 1976 - v. lA, p. 8. 6. New Zealand census of population and dwellings, 1976. - v. lA, p. 11. 7. CHOYNOWSKI, M. - 'Maps based on probabilities', in Journal of the American Statistical Association. - v. 54 (1959) p. 385-388. WHITE, R.R. - 'Probability maps of leukaemia morta 11 ti es in England and Wales', in Medical geography: techniques and field studies / edited by N.D. McGlashan. - London Methuen, 1972. p. 173-185 McGLASHAN, N.D. 'Spatial variations in cause-specific mortality in Australia.' , in Studies of Australian mortality / edited by N.D. McGlashan. - Hobart : University of Tasmania, 1977. (University of Tasmania, Environmental Studies occasional paper; no. 4) p. 1-28. BORMAN, B. - Medi ca1 geography and its contri buti on to the aetiology of rare systemiC connective tissue diseases, Thesis (MA) unpublished. - Department of Geography, Massey University, Palmerston North, New Zealand, 1975. 8. HILL, A.B. - Principles of medical statistics. - 9th ed. London : Lancet~ 1971.
8 9. Using the POISSONPROB computer program supplied by N.D. McGlashan, Department of Geography, University of Ta~mania. 10. The 1949 data was published in Medical Statistics by the Department· of Statistics. Since, these data' have been collected, tabulated, and published by. the National Health Statistics Centre (formerly the Medical Statistics branch) of the Department of Health. Over this period the title of the relevant publication has changed: Data years Title 1950-1954 Report on the medical statistics of N~w Zealand~ 1955-1960 Annual report of the medical, statistician on the medical statistics of New Zealand. 1961-1963 Annual report of the medical statistics of New Zea1and : Part I - Mortality. , 1964-1970 Medical statistics report: Part I : Mortality and demographic data. 1971 Medical statistics report : Mortality and demographic data. 1972-1978 New Zealand health statistics report: Mortal ity , and demographic data. . 11. For details of the computer program used for this analysis see PEARCE, Neil and SMITH, Alan - A generalised computer program for analysis of New Zealand mortality (and ,incidence) rates : illustrated with large bowel cancer data. Paper presented to the annual conference of the New Zealand branch of' ANZSERCH, August, 1980. '
12. Cancer; nci dence in fi ve conti nents. - v. III / edited ,by J. Waterhouse et al. - Geneva : International Agency for Research on Cancer, 1976. - (IARC Scientific Publications ; no. 15) p. 456. 13. MANTEL, N., BROWN, C and BYAR, D. - 'Tests for homogeneity of, effect in an epidemiological investigation', in American Journal of Epidemiology. - v. 106 (1977) p.'125-129. 14. MANTEL, N. and HAENSZEl, W. 'Statistical aspects of the analysis of, data from retrospective studies of disease', in Journal of the, Nation~l Cancer Institute. - v. 22 (1959) p. 719-748.
9 0/0 of cancer mortality, 1974 - 78 3C m )lit "3C r ...... ~ » ... ..r. ~ ~ Co) m 0 (J1 0 (J1 0 r- 0 (J1 0 (J1 0 (J1 0 m en· en ..... Breast ..r. Lung
Large ~ ~ Prostate Intestine. Large Co) Co) Lung Intestine "" Ovary "" Stomach (J1 Stomach (J1 Rectum
0'1 Rectum 0'1 Pancreas
..... Pancreas ..... Leukaemia
Q) Cervix Q) Bladder
<0 Leukaemia <0 Oesophagus :zJ :zJ ..r. l> ... Uterus l> 0 Brain Z 0 Z Liver ..... Melanoma of " ..... " ..r. .. Gallbladder Skin ...... ~ Brain ~ Buccal Cavity ...... Liver Co) Oesophagus Co) Gallbladder ...... Melanoma of Lymphosarcoma "" Skin "" ...... Multiple (J1 Lymphosarcoma (J1 Myeloma ..... 0'1... Bladder 0'1 Larynx
...i. Mult.iple ..r...... Myeloma ..... Hodgkin's Disease
..r. Q) Buccal Cavity Other ..... <0 Hodgkin's Disease
Other
'TI cO' CANCER OF THE BUCCAL CAVITY AND PHARYNX
Cancer of the buccal cavity and pharynx was responsible for the deaths of 287 males and 135 females, or 1.7 percent of the total cancer mortality, in 1974-1978 (Fig. 1). The male death rate was 3.6 per 100 000 compared to 1.3 per 100 000 for females (Table 1).
Spatial patterns Males (Fig. 3b) With a few conspicuous exceptions, the regional and local mortality is generally either below, or only slightly above, the national average. The most favourable area is Nelson district (SMR 31, p Females (Fig. 3c) In contrast to the male pattern the risk of death for females is hiqhest outside the main urban areas: Dannevirke district (SMR 476, p Time trends (Figs. 3d &3e) The male death rate in 1969-1978 is not significantly different (OR=0.92, p>0.05) from that in the 1949-1958 period (Table 2). Although there has been an increase in the mortality rate for ages under 60 years, and especially between 40-49 years, this has been counterbalanced by the decline in risk at the older ages. There has been a significant decline (OR=O.77, p 11 12 Buccal Cavity - MALES ,0·05 obs,exp '0·10 '0·15 ,0·20 ,0-20 '0-15 '0-10 <0-05 p'O-01 Fig.3b 13 Buccal Cavity - FEMALES '0-05 '0·10 '0-15 ,0·20 ,0·20 '0·15 '0·10 ,0·05 p'0·01 Fig.3c Buccal Cavity 30 c: .2 iii 25 :; 0. 0 Cl.. 20 0 0 0 0 0 15 ~ Cl.. 10 Year Fig.3 d. Age standardised sex specific mortality rates, 1949-78. 200 100 ~ 5 rJI OR" 0.92 ,/ i ( OR= 0.77 / ~ § / I 4 § I I ..:.: 10 0) ~I ~, 3 ~ ,,~ a: Gl ;~ .2: ~ I I 0- 10- 20- 30- 40- 50- 60- 70- 85+ 30- 40- 50- 60- 70- 85+ Age Group Age Group Fig. 3 a. Age:- sex specific mortality rates, 1974.;.78 Fig. 3 e. Age - sex specific relative risks of death, (NB: the use, of a semi-logarithmiC grid). 1969-78 compared with 1949-58. CANCER OF THE OESOPHAGUS· ~ . In 1974-1978 deaths from oesophageal cancer comprised 3 percent and 2 percent of the total male and female cancer mortality respectively (Fig. 1). The death rates in this period were 5.2 per 100 000 for males and 2.1 per 100 000 for females (Table 1). Spatial patterns Males (Fig. 4b) The outstanding feature of this pattern is the dissimilar experience in the two major metropolitan districts of the North Island, Auckland (SMR 80, p<0.05) and Wellington (SMR143, p Females (Fig. 4c) For females, as for males, it is in Wellington district (SMR 138, p Time trends (Fi 9s. 4d & 4e) Neither the male (OR=1.12, p>O.OS) nor female (OR=1.04, p>0.05) mortality rates in 1969-1978 are significantly changed from those in 1949-1958 (Table 2). There has, however, been a twofold increase in the male rate forage groups 40",55 years~ 15 16 Oesophagus - MALES ,0·05 obs)exp '0·10 '0·15 .0·20 ·0·20 '0·15 '0·10 ·0·05 p·0·01 1[. Fig.4b 17 Oesophagus - FEMALES '0-05 obs)exp '0-10 '0-15 ,0·20 ,0·20 '0·15 '0·10 ,0·05 p,O·Ol Fig.4c ,. Oesophagus 30 25 20 15 10 5 ---c1 ...... ,~ ... -.:- ' ...... -..-...... ----- ...... ------...... --- ...------... -....------...... ---- ...-..-...... ----... ----- ...... 9 o~-r~~~--r-~,-~-r~--r-~,-~-r~~~r-~,-.--r-.i~i~ri~i~i~ri~i 1949 50 52 54 58 58 60 62 64 66 8 70 72 74 76 78 Years Fig. 4 d. Age - standardised sex specific mortality rates, 1949-78. 200 100 ;,,/ cf /9 5 cJI ORD 1.12 // OR= 1.04 J I! I 0- 10- 20- 30- 40- 50- 60- 70- 85+ 30- 40- 50- 60- 70- 85+ Age Group Age Group Fig.4 a. Age sex specific mortality rates, 1974-78 Fig.4 e. Age - sex specific relative risks of death. (NB: the use of a semi:-Iogarithmic grid). 1969 -78 compared with 1949-58. CANCER OF THE 'STOMACH ,Males cortlprised 62 percent of all deaths: (1774) attributable to stomach cancer;" the 'J974-1978 period (Fig. 1). The male mortality rate of 13.5 per 100' 000 is more than twice the female rate of 6.2 per 100 000 (Tabl~ 1). ' " ' " • ,I ' , . • Spatial patterns ~1a 1es, (Fi g. 5b) Dominating this pattern is the excess morta1ity'in the heavily populated Auckland district (SMR 116, p<0.05) •. Locally, however, it is only the urban areas, and especially West (SMR 158, p In Northland, a ~radient extends diagonally from Whangaroa County , (SMR 357, p<0.15), in the north-east, to the favourable Hobson County (SMR 0, p<0.05) in the south-west. A similar local variation'is evident in Thames district with Coromandel-Thames County (SMR 162, , p " The low mortality in the ,West Coast district (SMR 57, p<0.15) is a manifestation, at the gross scale, of the favourable experience in Grey County (SMR 17, p<0.05). Females (Fig. 5c) ,/ There are three scattered', but highly unfavourable, areas in the North Island: Otamatea County (SMR, 404, p<0.05), Gisborne urban area (SMR 192, p<0.05), and hence at the macro-scale, Cook district (SMR 173, p<0.10), and Eketahuna County (SMR 882,p<0.05). Although the West Coast district is a moderately favourable area for males, there is an excess female mortality (SMR 187, p<0.05), particularly in Westland County (SMR 272, p 19 ' 20 Stomach - MALES, 1!', D '0·05, obs)exp '0·10 '0·15 ,0·20 obs~exp ,0·20 " '0·15 '0·10 ,0·05 p'O·01 Fig. ·5b 21 Stomach - FEMALES ,0-05 obs)exp '0-10 '0-15 ,0-20 obs,a;exp '0-20 '0-15 '0-10 '0-05 p eO-01 Fig.5c 22 Stomach 30 25 c :E ~ 8 20 0.. § 15 ~ \ ...... , ~ 10 ~ , ,- - ...... _... -...... _" .... --...... cr~ 9 ------'... ---- ..... ;"'- ...... --_ 5 ... _- O~,_,_,_~~~~~._,-._~.-.-.-.-.-.-._.-._.-~~._~_r~~ 1949 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 Years Fig. 5 d. Age - standardised sex specific mortality rates, 1949-78. 1000 ,, , 1"/ / I / I I I /0 5 0' ORm 0.69 ,l " »OR= 0.54 I I I I I 4 ,I I ~ 10 I ""fJl I if I 3 Q) I > / "".!!! / Q,l I cr I 2 I I I I J d' I I I I .. _.... - --n~~------~ o t-~~-,~.--r-.---r-~~~~ . 0 10 20 30 40 50 60 70 85+ 30- 40- 50- 60- 70- 85+ Age Group Age Group. Fig.5 . a. Age - sex specific mortality rates, 1974-78 Fig. 5 e. Age sex specific relative risks of death. (NB: the use of a semi-logarithmic grid). 1969-78 compared with 1949-58. 23 There is a low mortality in South Canterbury district (SMR 47, p<0.05), Timaru urban area (SMR 43, p Time trends (Figs. 5d &5e) The male (OR=0.69, p During the 1974-1978 period 1669 female and 1270 male deaths were attributable to cancer of the large intestine (Fig. 1). Although the . female rate of 16.6 per 100 000 is higher'than t~emale rate of . 15.9 per·100 000 (Table 1) there is, a distinct"cross-over ' -effect in the age-sex specific rates (Fig. 6a):· in all age groups under 65 years the female rate is greater than thE!. male rate, but in older age. groups .thi s... trend is reversed. ,Spatial patterns _ With the notableexcepti6n of Whangarei urban,area (SMR 149,p~0.10), low frequencies generally prevail in the northern half of the North' Island'. The most favourable experience occurs in Wairoa County . (SMR 0, p<0.05), Piako County (SMR 27, p<0.05), and, within Auckland district (SMR 89, p Fema 1es( Fi g. 6c} Unlike the ~ale p~ttern in the South ,Island, th~ high risk areas f6r· females have a non-urban area distribution: Lake County (SMR 279, p<0.05), Eyre County (SMR 541, p<0.15), the contiguous Marlborough. (SMR 142, p 25 26 Large Intestine - MALES • ,0-05 obslexp '0-10 '0-15 ,0-20' obs:!l:exp '0-20. cO-15 '0-10 co-os p'O-01 Fig.6b 27 Large Intestine - FEMALES 1J .. (I Significance ,0-05 '0-10 '0-15 ,0·20 ,0·20 '0-15 '0-10 ,0·05 ,p'O-Q1 Fig. 6c. 26 Large Intestine 30 25 20 15 10 5 O+-r--'-T-r~.-~~~r-~~-r~'-~r-ro~~-r-r~'-~ 1949 50 52 54 56 58 60 62' 64 66 68 70 72 74 76 78 Years Fig. 6 d. Age - standardised sex specific mortality rales, 1949-78. 1000 100 :S I § 5 a OR= 1.38 9 OR.. 1.11 ~ 4 ~ ~ 10 .x ft. a:'" 3 Q) .~ Gi (i) 2 a: 0- 10- 20- 30- 40- 50- 60- 70- 85+ Age Group Age Group Fig.S s. Age - se)! specific mortality rates, 1974-78 Fig. 6 e. Age sex specific relative risks of death, (NB: the use of a semi-logarithmic grid). 1969 -78 compared with 1949- 58. 29 In contrast to the male experience Patea (SMR 226, p<0.15) and Hawera (SMR 182, p Time trends (Figs. 6d &6e) The male death rate significantly increased (OR=1.38, p Males comprised the majority (54.6 percent) of the 1348 deaths attributable to cancer of the rectum in 1974-1978 (Fig. 1). The mortality rate for males was 9.2 per 100 000 arid' 6.4 per 100 000 for females (Table 1). . Spatial patterns Males (Fig. 7b) This pattern exhibits a distinct inter-island asymmetry in experience. Much of the regional variation in the South Island is due to the high mortality in the urban areas of Christchurch (SMR 122, p<0.10), T;maru (SMR 167, p Females (Fig. 7c) Despite subtle variations at the local scale, the female pattern reinforces the concept of a North Island-South Island gradient in experience. The high mortality in South Canterbury district (SMR 161, p<0.05) is localised to the contiguous Timaru urban .area (SMR 185, p<0.05) and Strathallan County (SMR 228, p 31 32 Rectum - MALES 1J', '0-05 obs)exp '0-10 -0-15 ,0-20 ,0-20 '0-15 '0-10 '0-05 p'O-01 o. Fig. 7b 33 Rectum - FEMALES Significance Level p'O-Ol ,0-05 '0·10 '0·15 ,0·20 ,0·20 '0·15 '0-10 ,0-05 p'0·01 " Fig.7c Rectum' 30 25 20 15 10 ...... _ .../---- 5 - ...... - --'" ...... --,-.-.------...-...... ----... ,....-- .."'... ~.- .. ,."," ",' ...... 9' ------..:. "- ... ,..- ----...... ---- ...... ""...... _, 0 1949 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 Years Fig. 7 d. Age. standardised sex specific mortality . rates, 1949-78. 500 5 d' OR = 1.21 « OR 1.12 4 ;,r.., ·3 .if Q) .iii: .i 2 a:(I) I I" iii I I I O+--r~--~~~~~~-r~--~ 0 10 20 30 40 50 60 70-. 85+ 30 40 50 60 70 85+ Age Group Age Group Fig. 7 a. Age sex specific mortality rates, 1974-78 Fig. 7 e. Age - sex specific relative risks of death, (NB: the use of a semi-logarithmic grid ). .1969-78 compared with 1949-58. 35 Time trends (Figs. 7d &7e) The mortality rate for both males (OR=1.2l, p During 1974-1978 almost one in every five female cancer deaths were attributable to cancer of the large bowel, compared to 14.5 percent of the total number of male cancer deaths (Fig. 1). The female rate (22.9 per 100 000) is, however, lower than the male rate of 25.1 per 100 000 (Table 1). While there is little difference between the sex-specific rates under the age of 65 years, the male rate at the older ages is, generally, at least 25 percent higher than the female rate (Fig. 8a). Spatial patterns Males (Fig. 8b) This pattern amplifies the north-south gradient and rural-urban contrast in mortality evident in the patterns for cancer of the large intestine and cancer of the rectum. The adverse experience in North Canterbury (SMR 115, p<0.05), Otago (SMR 132, p Females (Fig. 8c) The regional patterns for the sexes are broadly similar, but there are distinct local differences in experience. . Whereas high male mortality in the South Island is concentrated in 37 38 Large Bowel - MALES 1C, Slgnlficanee Level p'O-01 '0-05 '0-10 '0-15 ,0-20 ,0·20 '0'15 '0·10 ,0·05 p'0-01 Fig.8b 39 Large Bowel - FEMALES () ,0·05 '0·10 '0·15 ,0·20 ,0·20 '0·15 cO·l0 ,0·05 p'O·Ol D Fig.8e .'0 Large Bowel· 30 25 ,...... " '----- 20' /~~-' \ \ __ / ; 8 15 g,... £ 10 Q) 1ii II: 5 Years Fig. 8 d. Age standardised sex specific mortality rates, 1949 -78. 1000 I I I I I , I c: 100 .2 i :::I C. ~ 0 , 0 5 CJ' OR= 1.31 0 0 ~ OR-l.ll ,...0 £ 4 Q) 10 1ii II: 2 0- 10- 20- 30- 40- 50- 60- 70- 85+ 30- 40- 50- 60- 70- 85+ Age Group Age Group Fig. 8 a. Age - sex specific mortality rates, 1974-78 Fig. 8 e. Age - sex specific relative risks of death, (NB: the use of a semi:"logarithmic grid). 1969 -78 compared with 1949-58. 41 the urban areas, it is only Timaru (SMR 137, p Time trends (Figs. 8d &8e) For both males (OR=1.31, p Spatial patterns Males (Fig. 9b) Regi onally, thi s pattern ; s.domi nated by a broad band of hi gh mortality in each major island. Refining the areal scale reveals that the unfavourable experience in the North Island districts of Waikato (SMR 142, p<0.10) and Bay of Plenty (SMR 280, p<0.05) is most severe in the respective counties of Otorohanga (SMR 395, p Females (Fig. 9c) In Waikato district (SMR 144, p<0.10), which is also unfavourable for males, the female risk of death is greatest in Hamilton urban area (SMR 300, p Time trends (Figs. 9d &ge) The male rate in 1969-1978 is significantly hi~her (OR=1.28, p 43 44 Liver, gallbladder - MALES P'O'01 ,0·05 obslexp -0·10 '0·15 ,0-20 ob&o:exp '0-20 '0-115 '0·10 ,0-05 p'0-01 Fig. 9b 45 Liver, gallbladder - FEMALES r, D ,0·05 '0·10 '0·15 ,0·20 ' obs~exp .... h-..--.rl ,0·20 '0·15 '0·10 ,0·05 p'O·Ol Fig.9c •• .. liver. Gallbladder 25 g "i:::s 20 a. o 0.. g 15 o o o 10 5 O+-~~~~~~~r-r-r-~~~~~-T-T~~-r~-r-r~~~~, 194950 52 54 5658 60 62 64 66 68 70 72 74 76 . 78 Year Fig.9 d.. Age standardised sex specific mortality rates. .1949- 78. 200 100 c: .2 '.i:i "5 c- o 0.. / 5 ci" OR = 1.28 ·8 " 0 ~ OR", 0.89 a 0 I I 4 I 1» / 0.. 10 ... r:J ., (I;) /S? 3 I a: '.i:i I / Q) a: /" I .2: I '.i:i I Q; 2 I a: ,,I I I I ,, ,I \' 0- 10- 20-' 30- 40- 50- 60- 70- 85+ 30- 40 50- 60- 70- 85+ Age Group Age Group Fig.9 a. Age - sex specific mortality rates, 1974-78 Fig.9 e. Age sex specific relative risks of death, (NB: the use of a semi-logarithmic grid). 1969-78 compared with 1949-58. 47 In contrast, the female death rate has declined (OR=O.89, p>O.05) over time (Table 2). CANCER OF THE PANCREAS Almost 5 percent of the total number of cancer deaths for each sex in 1974-1978 were attributable to cancer of the pancreas (Fig. 1). The male rate was 8.5 per 100 000 compared to 5.3 per 100 000 for females (Table 1). Spatial patterns Males (Fig. lOb) The feature of this pattern is the intense spatial clustering of high risk areas in the south-west of the North Island. Although all constituents of Wellington district (SMR 151, p Females (Fig. lac) Unlike the male pattern the high mortality areas for females are well dispersed throughOut New Zealand: Raglan County (SMR 320, p Time trends (Figs. lad &10e) The 1969-1978 male rate of 8.2 per 100 000 was 17 percent higher (OR=1.17, p Pancreas - MALES p'0'01 ,0'05 '0·10 '0·15 ,0·20 ,0·20 '0·15 '0·10 ,0·05 p'0·01 Fig.10b 51 Pancreas - FEMALES Significance Level p'0·01 ,0·05 '0·10 '0·15 ,0·20 ,0·20 '0·15 <0·10 ,0·05 p'0·01 Fig.10c '" Pancreas ::1 20 I 15 10 O+-.-~r-~.-r-.-~~~~~~~~-r-r-r-r~~~'-~~~~ 194950 52 54 56 58 60 62 64 66 68 70 72 74 76 78 Year Fig. 10 d. Age - standardised sex 'specific mortality rates, 1949- 78. 200 100 c: .2 ~c. 0 5 d OR= 1.17 0... 0 OR= 1.05 0 <:; 0 0 4 ..0 ... Q) 10 Il. '"III 3 (J) a: -; III a: .2: -; 2 Qi a: 0 10 20 30 40 50 60 70 85+ 30 40 50 60 70 85+ Age GrOUp Age GrOUp Fig.10 a. Age - sex specific mortality rates, 1974-78 Fig.10 e. Age - sex specific relative risks of death, (NB: the use of a semi-logarithmiC grid). 1969-78 compared with 1949-58. CANCER OF THE LARYNX In the 1974-1978 period cancer of the larynx was responsible for the deaths of 126 men, or 0.9 percent of the total male cancer mortality (Fig. 1). The death rate was 1.6 per 100 000 (Table 1). Spatial pattern (Fig. llb) There is little significant spatial variation in the mortality experience from laryngeal cancer. However, the number of deaths in the urban areas of Whangarei (SMR 313, p<0.05), Palmerston North (SMR 256, p Time trends (Figs. llc &11d) The rate in the second period is not significantly different (OR=O.84, p>O.05) from that in the first (Table 2). There has, however, been a slight increase in the rate for ages 40-54 years. 53 54 Larynx - MALES '0-05 '0-10 '0-15 ,0·20 obs:!l:exp ,0·20 '0·15 '0-10 '0-05 p,0·01 Fig. 11b S5 Larynx 30 25 20 15 10 5 O;--r~-'~~r-~~-T-'--~r-~~~~~--r-~~---~~~-r-T-'~~~~-r 194950 52 54 56 58 60 62 64 66 68 70 72 74 76 78 Years Fig.11 c. Age - standardised sex specific mortality rates. 1949-78. 200 100 :3~ 1. 5 d' OR=O.84 0 8 4 § 10 ,:,t; ., 3 ~ if Q) &! j 2 Ci" .. _,._,,_.. 0 0- 10- 20- 30 - 40- 50 - 60- 70- 85+ 30- 40- 50- BO- 70- 85+ Age Group Age Group Fig.11 a. Age sex specific mortality rates. 1974-78 Fig.11 d. Age - sex specific relative risks of death. (NB: the use of a semi-logarithmic grid). 1969-78 compared with 1949-58. CANCER OF THE TRACHEi~, BRONCHUS . AND LUNG, PLEURA AND MEDIASTINUM •. In the 1974-1978.period, 29.3 percent of the total male, and 9.1 percent of the total female, cancer mortality was attributable to . cancer in these sites (Fig. 1). The male death rate was SO per 100 000 compared to 11.6 per 100·000 for females (Table 1). Figure 12a shows that after 45 years the difference between the age-sex specific rates increases with age. Spatial patterns Males (Fig. 12b) In Northland, Whangarei urban area (SMR 124, p 57 58 .Lung - MALES . Significance Level p'0-01 '0-05 '0-10 '0-15 ,0-20 obs-!2:;exp ,0-20 '0-15 '0-10 '0-05 p,O-01 Fig. 12b 59 Lung - FEMALES 1C, '0'05 '0·10 '0·15 ,0·20 ,0·20 '0·15 '0·10 ,0·05 p'O·01 Fig.12c 60 , Lung 60 50 40 30 20 .,-- 10 <;> ..., ..._-,,""'------_...... ,.;' ,~-~~------~------~' ------~;-~~------04-~~~~~~~~~~~~~~~~~~_.-r_._r_r_._.~_r_r~ 194950 52 54 56 58 60 62 64 66 68 70 72 74 76 78 Years Fig,12' d. Age - standardised sex, specific mortality rates. 1949 - 78. 100 (j OR= 2.10 5 «ORe 2.97 8 ~. 4 10 ~. a: 3 \I) ::;> Q.i a: 2 o*-~~__~~~~~__~~-.~ 0- 10- 20- 30- 40- 50- 60- 70- 85+ 30- 40- 50- 60- 70- 85+ Age Group Age Group Fig.12 a. Age - sex specific mortality rates, 1974-78 Fig.12 e. Age - sex specific' reiative risks of death, (NB: the use of' a semi-logarithmic grid). 1969 -78 compared with 1949- 58. 61 Females (Fig. 12c) Dominating this pattern is a high mortality band across the northern half of the North Island encompassing the districts of Northland (SMR 134, p Time trends (Figs. 12d &l2e) The male rate in 1969-1978 was more than twice (OR=2.10, p . During the 1974-1978 period 299 male and 237fema1e deaths were attributable to a malignant skin melanoma (Fig. 1), The mortality rate for males was 3.9 per 100 000 and for females 2.8 per 100,000 (Table 1). . . .' . Spatial patterns Mal~s (Fig. l3b) . - . , 'Th~ least favourable mortality experience is in Gisborne urban area (SMR 305, p<'O.Ol), and reg~onally, in Cook district (SMR 239, p<0.05). The remaining high risk areas have a rural distribution: Waikato County (SMR 247, p<0.10), Waipukurau County (SMR 411, p Females (Fig. l3c) The most unfavourable experience for females is in Taranaki district (SMR 215, p .' ,There is a favourable mortality in Wellington urban area (SMR 54; p Time trends (Figs. 13d &l3e) Both the male' (OR=2.29, p 63 64 Melanoma of the Skin .. ,MALES . ,0-05 obs)exp '0-10 '0-15 ,0·20 obs:a:exp r-t.-...... ,..j '0·20 '0·15 '0·10 ,0·05 p<0·01 Fig. 13b 65 Melanoma of the Skin - FEMALES Significance Level p'0'01 ,0·05 obs)exp '0·10 '0·15 ,0·20 obs.a:exp ..... h...... l ,0·20 '0·15 '0·10 ,0·05 p'O·01 Fig.13c •• Melanoma of the Skin --._-<===:::-===~'-:;':__~---=--:-::::--:'-""" ------v.' ----./ ------9--- o+-~r-~_,~-.~_r~._.-._~,_~~~~~~_r~._._~~ 194950 52 54 56 58 60 62 64 66 68 70 72 74 76 78 Years . Fig.13 d. Age - standardised sex specific mortality rates, 1949 - 78: 200 100 c .S! § :> d OR~ 2.29 0. 5 0 OR",2.10 Il. 9 I" , , I. , 0 0 I , 0 4 f \ 0 I \ 0 0"'/ / ,, - 10 ,...... / , lii 3 \, Il. I/ 9 \ , I \ Q> , , , m " , , 'I a: 2 \,,'/ 0 10- 20., 30- 40- 50- 60- 70- 85+ Age Group Age Group Fig. 13 a. Age - sex specific mortality rates, 1974 -78 Fig.13 e; Age sex specific relative risks of death, (NB: the use of a semi-logarithmic grid). 1969 -78 compared with 1949-58. CANCER· OF THE BREAST In the 1974-1978 period 18.9 percent of the total female cancer mortality was due to breast cancer (Fig. 1). The death rate from this cause was 24.5 per 100 000 (Table 1). Figure 14a shows the rapid rate of increase in the mortality rates for age groups 25-45 years. Spatial pattern (Fig. 14b) At the gross scale there is a high mortality gradient across the central North Island, extending from WanganlJi district (SMR 120, p<0.20) in the west, through Hawke's Bay district (SMR 114, p<0.20), to the highly unfavourable Cook district (SMR 148, p<0.05) in the east. Applying the spatial filter reveals that this distribution is due, primarily, to the high number of deaths in the respective urban areas of Wanganui (SMR130, p<0.10), Hastings (SMR 131, p Time trends (Figs. l4c &l4d) The mortality rate of 22.6 per 100 000 in 1949-1958 increased (OR=1.07, p 67 68 Breast - FEMALES ·0·05 , '0·10 '0·15 .0·20 .0:20 " '0·15 '0·10 ·0·05 p'0·01 Fig.14b •• . Breast 30 25 20 15 10 5 O;-~~~T-~r-r-~r-r-r-~r-~~~~~-'-'__~-T~-T~-?-' 1949 50 52 .54 56 58 60 62 64 66 66 70 72 74 76 78 Years Fig. 14 c. Age - standardised sex specific mortality rates. 1949-78. 500 ,,/ ,/' ~--" 100 ,/ ... ---' -' /.-- 9 ", i / ~ / 5 1? OR= 1.07 t I I § I I I 4 ~ ,I I ~ 10 I I I 3 ~ I a: I I i 2 I I I I I / I 0- 10- 20- 30- 40- 50- 60- 70- 85+ 30- 40- 50- 60- 70- 85+ A£8~ Age GrOlC) Fig.14 a. Age - sex specific mortality rates, 1974-78 Fig.14 d. Age - sex specific relative risks of death. (NB: t~,e use of a semi-logarithmic grid). 1969-78 compared with 1949-58. 'CANCER,'OF' THE' CERVIX UTERI Deaths from cancer of the:cervix, uteri (473) comprised 4 percent of the total female cancer mortalitY-in -1974-1978 (Fig. 1). The mortality . rate was 5,.5 per 100 000 (Table 1L ' Spatial pattern (Fig. 15b) There is a clear inter-island dichotomy in this pattern. The' South Island is characterised by non-significant deviations from the nationalaverag~, while high mortality is concentrated in four distinct, 'largely' rural, re~ions ,in the Nprth Island. The experience is severe in Wairarapa district (SMR'194, p<0.05), and particularly in Eketahuna (SMR 800, p " . . Wanganui district (SMR 184, p<0.05)is a further high risk area due to the excess number of deaths in Patea County (SMR 588, p<0.05) and Wanganui urban area (SMR 176, p .' ',' . Ohinemuri County'{SMR 244, p are the most propiti ous. . " . \, Time trends (Figs. lSc & l5d) 'The all-ages mortality rate declined significantly (OR=0.76, 'p 71 72 Cervix FEMALES ,0-05 '0-10 ',0-15 .0-20 ·.0·20 '0·15 '0'10 ·0-05 . p'0-01 / Fig.15b Cervix Uteri 30 26. J 20 § 16 8... I 10 I Yeara FIg. 15 c. Age - standardised sex specific mortality rates. 1949-78. 100 6 ~ 00-0.76 J 4 § 8 10 ... ~ 3 .0: G) > {l== -2 0: 1 1+-~r-~~~~-r~..,..~~~~~~ 0- 10- 20- 30- 40- 50- so- 70- ~ It{p Qtq) Fig. 15 a. Age - eex epeclflc mortality rates. 1974-78 Fig.15 d. Age - sex specific relative risks of death. (NB: the use of a semHogarlthmic grid). 1969-78 compared with 1949-58. CANCER OF THE UTERUS This cause of death was responsible for 2.8 percent of the total female cancer mortality in the 1974-1978 period (Fig. 1). The death rate was 3.1 per 100 000 women (Table 1). Spatial pattern (Fig. 16b) The distinctive feature of the pattern is the rural distribution of the high mortality areas. There are two concentrations of unfavourable experience in the South Island. One centres on C1utha County (SMR 460, p<0.05) in the district of South Otago (SMR 336, p<0.05), and includes the contiguous counties of Tuapeka (SMR 377, p<0.20), Southland (SMR 189, p<0.20), and Wallace (SMR 392, p<0.05). In the north of the South Island, Nelson district (SMR 163, p<0.15), Kaikoura County (SMR 571, p<0.10), and Grey County (SMR 267, p<0.15) also have an excess number of deaths. Conversely, there is only a sporadic distribution of high risk areas "in the North Island: Franklin County (SMR 212, p<0.15), Cook district (SMR 192, p<0.15), Hawera County (SMR 263, p<0.15), Horowhenua County (SMR 187, p<0.15), and with the most unfavourable experience, Waipawa County (SMR 667, p<0.05). North Auckland urban area (SMR 47, p<0.05) has fewer deaths than the national average. Time trends (Figs. 16c &l6d) The mortality rate had declined (OR=0.73, p 75 76 Uterus - FEMAL~S " .. Significance Level p'O-.ol <.0-.05 ... '0-1.0 '.0-15 . ,0-2.0· <0-20 . '0··15 '0-1.0 . <0-05 p'O-.o1 o Fig.16b 71 uterus 30 25 5 ----_.•" ,_ 9 ""'...... - ''-''.,..''''...... --- ...... -''''...---- ... '---.. ~...------'''' .....,.-...... ,,;,,',...... , ...... ~'''''---,...-...... 04-~~~-r~~~~~~-T-r~~~~~~-r~~T_~~~ 1949 50 62 54 56 58 60 62 64 66 68 70 72 ·74 ~ 78 Years FIg.16 c. Age - standardised sex: specKlc mortality rates, 1949-78. 200 100 5 ~ 10 j 3 ~ CD ~ iD a: 2 ia: 9 / .. i---"-"-"-"-'-'~..--~ .,/ --- /'" o 1-' ---- 30- 60- 60- 70 Age GroI.p Fig. 16 a. Age - sex speci.fic mortality rates, .1974-78 Fig. 16 d. Age - sex: specific relative risks of death, (NB: the use of a semi-logarithmic grid). 1969-78 compared with 1949-58. CANCER OF THE OVARY, FALLOPIAN TUBE AND BROAD LIGAMENT This was the fourth leading female cancer site in the 1974-1978 period wi th 711 deaths (Fi g. n. The mortal; ty rate was 7.8 per 100 000 women (Table n. Spatial pattern (Fig. l7b) Dominating the regional distribution is the heterogeneous experience in the adjoining Waikato (SMR 129, p<0.05) and Tauranga (SMR 42, p Time trends (Figs. 17c &17d) The mortality rate increased (OR=1.13, p 79 80, Ovary - FEMAL,ES '0-05 '0·10 '0·15 .0·20 '0-20 -0-15' <0-10 <0-05 . p·0-01 ' Fig.17b .; .. : ' , .:," 81, ;" ; ", , ",0v~~y J .' , , " 30 ..\ " ,', .,... -. 25 , '"'# . -:, ';-: " :~~ o +'~+-T--..-'-;r--r"""",-r--'r-T-r-·',:_....;.,.... '-r-~-i-"7-' . .,....""'"'. r----"7"..;...... -:::-r..,..''+'-,-,";,-:;"7""""7'" " H~49: 50 52 54 56,58 ,:,~ '62' 64 ,:.' 66,. 68 7072\ 74' .,,76" 78 .;,' , ,.' ". ~ , .' ,.,,' '.~, -, "Fig:1i 'c; Age';.. standardised sex specific mortality··, '" , " -. rates. 1949-78. " ... . .~.: <~', 200 100. 5 I, ',' 4 "",, ,'. 14'~~-r-r~'-~~~~-.~-r~~ 0.' " .0-:- 10- 30- 40:-' "~- 60- lO-.. . ss+ 30-< 40-.'... 50- ,so..; ;>70-.' .Age GrOUJ) Age' Group' fig. ,1.7 a. 'Age,- sex specific' -mortality rates,1974'-78' d.A~~ ::"sexspe~ific relative':rilil! ~!, . ..,.' '.; , -~,. . ,-. • ~ '1,:. '" '.". 'I ~l. ' . '} .;, ',~.' ,,,~ :; I I'~" CANCER OF THE PROSTATE Prostate cancer, responsible for 1316 deaths in 1974-1978, was the second leading cause of cancer mortality in men:(Fig. 1). The mortality rate was 16.6 per 100 000 (Table 1). Figure 18a illustrates the rapid increase in the death rate after 45 years of age. Spatial pattern (Fig. lBb) The number of deaths from cancer of the prostate in Wairoa County (SMR 271, p Time trends (Figs. 18c &1Bd) The mortality rate in 1969-1978 was 16 per 100 000 compared (OR=1.14, p 83 84 . Prostate - MALES . Significance Leve' . p'0-01 ,0-05 obs )exp '0-10 -0-15 ,0·20 obs:!l:exp ,0·20 '0-15 '0-10 eO-05 p eO-01 Fig.18b Prostate ~ I 20 § 15 8..... 04-'-~~~r-r-'-'-r-~~~~~~-.~-.-r-r~.-~.-'-'-'-' 194950 52 54 74 76 78 Years Fig.18 c. Age - standardised sex specific mortality rates, 1949-78. 1000 c 100 ,g i § 5 d OR=1.14 4 ~ 10 ()- 1()- 20- ~- 40- 50- 60- 70- 85+ 30- 40- "50- 60- 85+ Age Group Age Gi'l:q) Fig. 18 a. Age - sex specific mortality rates, 1974-78 Fig.18 d. Age - sex specific relative risks of death. (NB: the use of a semi-logarithmiC grid). 1989-78 compared with 1949-58. CANCER OF THE BLADDER Deaths from bladder cancer in 1974-1978 comprised 3.3 percent of the' total male, and 1.S percent of the total female, cancer mortality (Fig. 1). The male rate was S.B per ]00 000 compared to the.female rate of 1. 6 per 100.000 (Table 1). . Spatial patterns Males (Fig. 19b) With the exception of Oroua County (SMR 25B, p Females (Fig. 19c) There is high mortality in Palmerston North (SMR 221, p Time trends (Figs 19d &1ge) The male rate increased (OR=1.26, p 87 88 Bladder - MALES' , . ~0'05 '0-10 '0,15 ~0·20 . ,0-20 "0-15 "0-10 ,0-05 p,O-Ol fig. 19b , 89 \ Bladder - FEMALES Significance Level p-O-01 -0-05 -0-10 -0-15 -0·20 -0-20 -0-15 -0-10 '0-05 p'O;Ol " Fig.19c •• Bladder 30 25 20 15 10 5 52 54 56 58 60 62 64 66 68 70 72 74 76 78 Years Fig. 19 d. Age - standardised sex specific mortality rates, 1949-78. 200 100 / / / 5 OR= 1.26 c: / d' I ORQ 1.18 / Fig. 19 a. Age - sex specific mortality rates, 1974-78 Fig.19 e. Age - sex specific relative risks of death, (NB: the use of a semi-logarithmic grid). 1969-78 compared with 1949-58. CANCER OF THE BRAIN Our"jog 1974-1978 the deaths of 396 males and 277 females were attributable to brain cancer (Fig. 1). Persons under the age of 15 years comprised 11.S percent of this numerator population (Fig. 20a). The mortality rates were 5.1 per 100 000 for males and 3.4 per 100 000 for females (Table 1). . Spatial patterns Males (Fig. 20b) The outstanding feature of this pattern is that the mortality experience in all areas is not significantly different from the national average. Females (Fig. 20c) There is a cluster of high mortality, predominantly rural, counties in the west of the North Island: Taranaki (SMR 494, p Time trends (Figs. 20d &20e) The 1969-1978 male rate is 28 percent higher (OR=1.29, p 91 92 Brain - MALES . Significance Level p'0-01 / '0-05 '0·10 '0-15 ,0·20. ,0·20 '0·15 '0·10 ,0·05 p'0·01 Fig. 20b 93 Brain - FEMALES ·0·05 '0·10 '0·15 ·0·20 .0·20 '0·15 '0-10 ·0-05 p'0-01 Fig. 20c " Brain 30 25 20 15 10 5 -..._-----' ------...... ,-- ...... ,""';~9...... --'...------"' O+-~~~~~~~~~~~_r~~~~__~~~~~_.~_.~_, 194950 52 54 56 58 60 62 64 66 68 70 72 74 76 78 Years Fig. 20, d. Age standardised sex specific mortality rates, 1949-78. 200 100 5 ~ 5 d' 01'1= 1.29 a:s )' OR= 1.21 0 0 0 4 0 S? /""...... 10 / \ lii ., a c!' /'9 \ if"" a .2l / \ ., / \ .~ i2 I Iii "'--1 ., 2 ,I a: I I I I I /,__ 1 ..... -J/ 0- 10- 20- 30- 40 50 60 70 85+ 5- 10 40 50 70 Age Group Age Group Fig. 20 a. Age - sex specific mortality rates, 1974-78 Fig.' 20 e. Age.- sex specific relative risks of death, (NB: the use of a semi-logarithmic grid). 1969-78 compared with 1949-58. LYMPHOSARCOMA There were 238 male and 183 female deaths attributable to lymphosarcoma during 1974-1978 (Fig. 1). The mortality rate for males was 3 per 100 000 compared to 1.9 per 100 000 for females (Table 1). Spatial patterns Males (Fig. 21b) Central Auckland (SMR 150, p Females (Fig. 21c) The female pattern corroborates the male experience of high mortality in Central Auckland urban area (SMR 138, p Time trends (Figs. 21d &2le) Neither the male (OR=1.08, p>0.05) nor female (OR=1.15, p>0.05) rates in the 1969-1978 period were significantly different from the respective rates in 1949-1958 (Table 2). 95 96 Lymphosarcoma - MALES Significance level p-0'01 -0·05 -0·10 -0·15 -0·20 ·0·20 '0·15 '0-10 <0-05 p<0-01 Fig. 21b 97 Lymphosarcoma - FEMALES Significance Level p'O'Q1 '0-05 '0·10 '0·15 ,0·20 obs£l:exp ,0·20 '0'15 '0·10 ·0·05 p'0·01 Fig. 21c Lymphosarcoma 30 25 c: 0 20 ~ "5 0. a.0 0 15 8 ~ 10 Ii; a. a:1ii 5 .------~-~-...-',-- ---... ~------""'-""'''',...._------ O~~~~_T~~~r_~~~_r~~~~~~r_~~~~~_?__~~__~~ 1949 50 52 54 56 58 60 62 64 66 68 70 72 14 76 78 Years Fig, 21 d. Age - standardised sex specific mortality rates. 1949-78. 200 100 c: ,2 1ii "5 0. 0 a. 5 d' OR = 1.08 0 0 « OR-l.15 0 0 0 4 ~... Q) 10 .><: a. III i:i: 3 2 Q) tl > ~ 2 /' Q) ,I ,, a: I , I \ J \ \ --_ .... -' 0 10 20 30 40 50 60 70 85+ 30 40 50 60 70 85+ Age Group Age Group Fig. 21 a, Age - sex specific mortality rates. 1974-78 Fig. 21 e. Age - sex specific relative risks of death. (NB; the use' of a semi-logarithmic grid). 1969-78 compared with 1949-58. HODGKIN'S DISEASE A total of 84 male and 83 female deaths in 1974-1978 were attriDutable to'Hodgkin's disease (Fig. 1). The mortality rate for males was 1. 1 per 100 000 and for females 0.9 per 100 OOO'(T~ble 1). Spatial patterns Males (Fig. 22b) There is a higt) number of deaths from Hodgkin's disease in the 'urban areas of West Auckland (SMR 248, p<0.10), New Plymouth (SMR 320, . p Females (Fig. 22c) 'As in the male pattern there is minimal inter-district variation in mortality. West Auckland urban area (SMR 238, p<0.15) has an above average number of deaths for both sexes,while the excess mortality in Tauran9a County (SMR 513, p<0.15), Rotorua urban area (SMR 330, p<0.15), and Gisborne urban area (SMR 330, p<0.15) is limited to females only.' Amuri County (SMR 2000, p Time trends (Figs. 22d &22e) The 1969-1978 rate for males was the same (OR=0.98, p,>0.05) as the' rate ;n the 1949-1958 period (Table 2). ' . , Similarly, for females there was no significant change (OR=1.l9, ' p>0.05) in the mortality rate over time (Table 2). .. . However, for each sex the relative risk, generally, increased with age. 99 100 Hodgkins Disease - MALES '0-05 '0-10 '0-15 ,0-20 '0-20 '0·15 '0·10 ,0·05 p'O·Ol Fig. 22b 101 Hodgkins Disease - FEMALES D -0·05 -0·10 '0·15 -0·20 obs~exp r-h~ ,0·20 -0-15 -0-10 '0-05 p'0-01 Fig. 22c 10> Hodgkin's Disease 30 25 20 § 15 8... 10 5 cf o+-~~~'-~~-'~~~-'--~----T·--··~--,-----~-----.--~----r-----~-r-----~---.-~----~~-9 1949 50, 52 54 56 58 60 62 64 66 68 70 72 74 76 78 Years Fig. 22 d. Age - standardised sex specific mortality rates. 1949-78. 8 d' OR= 0.98 OR= 1.19 « , P 7 ,I 100 ," , , , I, 6 I I ,I I , I , I , I c: , I .2 5 , I ., I I , I ~0. I I I I I. I It. """ I I a:'" 4 I I 0 I (]) I 8 ,;:: I 10 9 ~ a:i 3 ~ 2 a:~ 1+-~'-~'-T-~~~+-~~~T-~~~ 0- 10- 20- 3D- 40- 50- 60- 70- 85+ 30- 40- so- 60- 70- 85+ Age Group Age Group Fig. 22 a. Age - sex specific mortality rates, 1974-78 Fig.22 e. Age sex specific relative risks of death. (NB: the use of a semi-logarithmiC grid). 1969-78 compared with 1949-58. MULTIPLE MYELOMA Multiple myeloma was the ascribed cause of death for 202 males and 180 females in the 1974-1978 period (Fig. 1). The respective mortality rates were 2.5 per 100 000 and 1.7 per 100 000 (Table 1). Spatial patterns Males (Fig. 23b) Toe unfavourable experience in Northland district (SMR 184, p<0.05) is especially marked in the contiguous counties of Whangarei (SMR 341, p<0.15) and Otamatea (SMR 465, p<0.15). The risk of death is also high in the urban areas of Hamilton (SMR 207, p Females (Fig. 23c) The northern Wairarapa county of Pahiatua (SMR 1111, p Time trends (Figs. 23d &23e) The male rate in 1969-1978 is more than twice (OR=2.27, p 103 104 Multiple Myeloma - MALES '0-05 '0-10 -0-15 ,0-20 obs:;Q;exp '0-20 -0-15 '0-10 '0-05 p'0·01 Fig. 23b 105 Multiple Myeloma - FEMALES Significance Level p'O'01 '0-05 '0-10 '0-15 ,0·20 ,0·20 '0-15 '0·10 -0·05 p·0·01 Fig. 2·3c 106 Multiple Myeloma 30 25 20 15 10 5 d - --'------;-..,,;:.9 o --- -_. _..... ""' ------_ ... --...... _---- :::::-----"'".... .. 194950 52 54 56 58 60 62 64 66 68 70 12 74 76 78 Years Fig. 23 d. Age - 'standardised sex specific mortality rates, 1949- 78. 8 (j OR= 2.27 '( OR= 2.13 ~ 1\ '\ 7 , I : I 100 , I , \ ~ 6 , \ , I t I I 0.. f I I 5 I § I . ~ \ ~ " II) I I ...... ',.." if I ,~ I 4 9:I I ~ I C1l I I . 2 0-1--+-._.-.---.--._.-.--.....,....-.--1 0 10 20 30 40 50 60 70 85+ 30 'l,0 50 60 70 85+ Age Group Age Group Fig.23 a. Age sex specific mortality rates, 1974-78 Fig.23 e. Age - sex specific relative risks of death,· (NB: the use of a semHogarithmic grid). 1969-78 compared with 1949-58. ·LEUKAEMIA 'In 1974-1978 a total of 542 male and 407, female' deaths were attributable to 1e.ukaemi a-( Fig. n. Of these persons 12 percent were tinder the age of 15 years (Fig. 24a). The mortality rate for males was 6.8 per . 100 OOO.and ;for females 4.2 per 100 000 (TableD.· Spatial patterns Males (Fig. 24b) .. This pattern is dominated by the high mortality in Auckland district· (SMR 115, p<0.10), and at the local scale, in Central Auckland urban area (SMR13l, p<0.05). Tauranga urban area (SMR 174, p<0.05) also has more observed deaths from leukaemia than expected. Kiwitea County (SMR 714, p<0.10) and Ashburton County (SMR 268, p There ts a low mortality in Cook district (Sr·1~ 28, p Females (Fig. 24c) The northernmost counties of Mangonui (SMR 31S, p<0.10) and Whangaroa (SMR 909, p Time trends (Figs. 24d &24e) The male mortality rate in 1969-1978 was 6.8 per 100 000 co~pared with (OR=1.11, p<0.05) a rat~ of 6.2 per 100 000 in the J949-1958 period. . .. In contrast, the female rate "in the second period isJittle different (OR=0.98, p>0.05) from that in the first. 107 108 Leukaemia - MALES () <0-05 <0-10 <0-15 ,0-20 obs!l:exp '0-20 '0-15 '0-10 '0-05 p'0-01 Fig. 24b 10.9 Leukaemia - FEMALES () ,0-05 '0-10 '0-15 ,0-20 obs!!:exp ,0-20 '0-15 -0-10 ,0-05 p,0-01 Fig. 24c 110 Leukaemia 30 25 is i:J. §- 20 ll. 0 8 15 ~ .f 10 ~ 5 Years Fig.24 d. Age standardised sex specific mortality rates. 1949-18. 200 100 8 "" /1" ! 0" /9 I 5 (j OR- 1.11 & I I 0 I )? OR- 0.96 8 I ,I 4 ~ / ,.--' 10 >£ I• .f I 3 I ~ 21 I to II> a: I. > __II i II> 2 a: I I I I I 1+-'-~~~~~~r-~r-r-r-~r-~~ 0- 10- 20- so- 40- 50- 60- 70- 80-85+ 0- 10- 30- 40- 50 Age Group Age C3rc:q) Fig. 24 a. Age sex specific mortality rates. 1974-78 Fig.24 e. Age - sex specific relative risks of death. (NB: the use of a semi-logarithmic grid). 1969-76 compared with 1949-58. APPENDIX Standardised mortality ratios, 1974-1978, for the following sites of cancer: 140-149 Buccal cavity and pharynx 150 Oesophagus 151 Stomach 153 Large intestine 154 Rectum 153-154 Large bowel 155-156 Liver, gallbladder and bile ducts 157 Pancreas 161 Larynx 162-163 Trachea, bronchus and lung, pleura and mediastinum 172 Melanoma of the skin 174 Breast 180 Cervi x uteri 182 Uterus, other 183 Ovary, fallopian tube and broad ligament 185 Prostate 188 Bladder 191 Brain 200 Lymphosarcoma 201 Hodgkin's disease 203 Multiple myeloma 204-207 Leukaemia 111 140':'149 . ·150 151 153 154 153-154 M F M F M F M F M F M F Count~/Urban Area (UA) Mangonul 171 250 59 88 154 116 59 73 43 Whangaroa 357 110 79 Hokianga 238 476 128 170 124 95 161 35 135 Bay of Islands 177 124 98 140 139 80 79 46 68 57 Whangarei 78 111 64 91 78 93 92 57 Whangarei UA 55 153 204 100 107 149 115 118 87 138 107 Hobson 208 145 154 214 47 64 80 111 59 77 Otamatea 168 404 148 39 101 94 56 Rodney 217 159 72 162 37 50 43 39 36 North Auckland UA 79 81 61 111 106 91 101 87 83 101 94 91 West Auckland UA 54 173 59 164 158 141 78 101 107 90 88 98 Central Auckland UA 108 106 97 138 115 95 94 100 91 101 93 100 South Auckland UA 87 84 90 68 118 94 90 101 98 97 93 100 ...... Franklin 70 171 25 92 51 56 96 69 70 60 89 w Waiheke Island 137 370 61 76 29 94 50 79 37 90 Great Barrier Island 2000 714 526 Haurak i Pl a"j ns 588 83 208 135 74 116 192 128 106 Coromandel-Thames 133 333 84 63 162 111 98 127 85 23 93 98 Oh"inemuri 143 96 93 87 65 94 40 27 169 70 76 Waikato 45 220 63 131 111 112 70 70 113 97 82 Raglan 71 53 69 93 52 134 59 75 Waipa 89 213 93 61 104 64 120 120 121 66 120 105 Hamilton UA 141 122 111 88 137 74 74 117 112 133 88 121 Piako 60 141 170 144 140 27 89 71 29 43 72 Matamata 41 94 141 50 96 89 106 102 70 94 96 Otorohan9a 137 98 73 161 93 61 54 79 79 66 Tauranga 113 120 122 92 54 23 35 67 49 Tauranga UA 74 100 101 137 91 98 71 75 83 91 Rotorua 588 130 155 41 43 143 111 78 62 Rotorua UA 62 227 90 178 86 108 79 107 111 108 86 107 140-149 150 151 153 154 153-154 M F M F M F M F M F M F Countx/UrbanArea (UA) Waitomo J 115 294 82 63 180 106 47 91 100 34 Taupo 41 106 142 74 131 80 68 70 108 77 Whakatane 83 30 106 100 68 101 133 48 92 87 Opotiki 149 769 228 236 100 62 79 64 67 Waiapu 638 82 185 138 100 Waikohu Cook 290 57 54 - 39 Gisborne UA 133 129 91 73 124 192 102 74 114 81 106 76 Wairoa 79 189 237 197 100 44 129 16 108 Hawke's Bay. 156 294 47 103 38 65 48 . Napier UA 86 82 179 70 77 82 101 108 75 95 91 104 Hastings UA 125 80 72 68 100 95 130 128 176 127 147 128 ...... Waipawa 152 115 50 43 222 32 94 ..... Waipukurau 211 192 81 203 103 81 118 139 109 97 ~ Dannevirke 95 392 65 156 126 114 73 167 106 128 Woody; 11 e ... 833 238 175 167 267 98 Taumarunui 421 153 339 88 120 49 23 85 60 62 33 . Cl ifton 909 303 175 65 Taranaki· .. 110 . 303 114 185 50 120 124 31 . 121 New Plymouth UA 113 43 77 96 97 85 105 119 87 63 98 104 Inglewood 103 54 125 183 102 90 Stratford 563 . 140 146 218 79 169 102 200 85 Egmon'!: 256 216 120 110 103 143 114 119 'Eltham 227 161 313 62 44 114 63 Waimate West 417 303 769 121 278 202 175 263 190 73 Hawera 159 105 91 115 127 .34 182 118 100 65 159 Patea 111 226 240 119 88 197 Waimarino 76 208 48 58 Waitotara 244 204 - 130 Wanganui 556 149 127 80 140-149 150 151 153 154 153-154 M F M F M F M F M F M F Countt/Urban Area (UA) Wanganui UA 138 42 .78 24 140 108 131 103 87 98 115 103 Rangitikei 55 154 78 180 103 126 38 98 43 64 40 89 Kiwitea 200 145 Pohangina 400 Oroua 294 200 37 58 81 144 84 62 82 121 Manawatu 115 122 84 43 76 120 163 177 108 136 Kairanga 833 156 112 217 294 81 161 Palmerston North UA 94 70 66 80 107 105 110 112 80 96 99 108 Horowhenua 163 51 199 54 132 114 93 77 118 100 100 Pahiatua 217 500 303 221 241 103 202 Eketahuna 833 882 256 163 Masterton 556 385 133 141 84 101 ...... Masterton UA 99 56 41 59 132 122 124 63 129 105 0"1 Wairarapa South 156 217 208 120 140 88 61 76 111 85 Featherston 118 82 30 209 71 45 184 149 102 Hutt 56 225 152 65 82 89 123 37 106 95 117 53 Upper Hutt UA 214 98 160 57 75 59 91 152 104 59 95 126 Lower Hutt UA 116 167 140 110 85 92 126 91 88 115 112 97 Porirua UA 163 76 95 92 149 118 55 191 127 145 75 Wellington UA 164 78 154 186 114 102 103 100 107 118 105 105 Marlborough 128 73 66 126 98 73 121 142 49 182 95 153 Nelson UA 45 44 46 173 91 87 105 112 139 192 117 117 Waimea 152 163 89 138 100 94 61 69 63 84 61 Golden Bay 769 70 161 121 184 104 159 115 178 Buller 101 210 79 193 70 98 238 101 132 99 Inangahua 417 294 79 57 Grey 91 187 17 163 89 130 257 134 151 132 Westland 78 117 272 178 155 88 115 145 144 Kaikoura 278 196 148 143 281 111 145 41 243 Amuri 435 208 114 132 83 140-149 150 151 153 154, '153-154 M F M F M F M F M F M F Count~/Urban Area (UA) Cheviot 175 112 Waipara 303 233 97 303 62 221 Ashley 408 133 124 85 90 Rangiora . 95 213 195 244 24 85 84 103 37 175 67 123 Eyre 541 - ·400 Oxford 526 1429 270 119 204 278 150 . 78 Malvern' . 164 61 139 103 159 89 137 98 153 Paparua 278 179 180 112 131 . Chri stchurch UA· 103 127 94 121 101 105 118 99 '. 122 94 119 98 Mount Herbert 1667 1250 Akaroa 200 74 Wairewa - 2500 500 182 ..... Ellesmere 109 170 160 71 93 184 113 67 ..... Chatham Islands - 0\ Ashburton 153 133 20 90 77 100 118 129 92 109 Strathallan .. .64 88 50 96 73 152 100 228 83 173 Timaru UA 125 150 123 109 43 153 118 167 185 158 137 MacKenzie. 256 612 323 134 106 39 98 Waimate 101 69 228 113 76 39 86 55 Waitaki 236 111 44 60 140 126 65 109 184 119 99 Waihemo - 1000 192 189 79 161 179 57 Wai kouai ti 290 96 103 71 94 184 60 133 Taieri 167 196 130 167 124 140 Dunedin UA 171 81 87 64 92 119 123 112 153 110 134 112 Bruce 769 111 217 82 107 61 123 159 113 89 Clutha 167 159 32 108 110 233 57 154 95 Tuapeka 127 163 36 211 93 181 52 Maniototo 333 215 135 Vincent 152 149 112 260 74 83 42 54 62 75 Lake 164 63 122 279 185 362 68 302 140-149 150 151 ·153 154 153-154 M F M F M F M F M F M F Countl/Urban Area (UA) Southland 30 76 86 88 57 77 ··111 133 95 47 105 109 ...... Invercargill UA 88 165 201 117 93 99 130 118 190 183 152 136 '-I Wallace 67 172 92 144 121 107 Fiord Stewart Island 155-156 157 161 162':'163 '172 174 ' '180 182 183 M F M F M M F M F F F F F Hoseita1. Board Northland 137 158 114 89 137 99 134 49 136 91 55 65 117 Auckland 108 93 95 101 95 104 110 109 89 102 109 106 95 Waikato 142 144 83 112 78 101 137 127 85 ,86 106 69 129 Thames 122 87 102 136 112 102 154 81 112 103 181 51 70 Tauranga 54 76 121 96 31 100 111 48 56 90 101 53 42 Bay of Plenty 280 84 126 179 123 157 139 80 124 169 38 61 Waiapu 286 417 128 194 396 93 417 370 Cook' 130 108 113, 57 96 132 239 167 148 133 192 99 Hawke's Bay 71 104 122 105 28 90 110 108 108 114 114 92 75 Waipawa 171 388 37 153 204 75 ' 102, 328 110 97 112 345 Dannevirke 145 93 40 78 128 72 67 192 Taumarunui 267 182 71 168 137 91 274 63 286 244 101 ~ Taranaki 63 129 103 102 73 93 80 148 215 85 60 105 93 ,~ Wanganui 53 139 86 58 125 109 107 55 106 120 184 135 138 (Xl PalmerstonNorth 85 93 121 102 126 88 79 131 40 110 105 102 87 Wairarapa 162 145 101 76 163 108 100 93 11'9 92 194 43 129" Wellington 88 102 151 101 121 106 97 78 75 102 74 109 ' 112 Nelson ' 15 46 83 65 34 92 73 109 98 101 106 163 82 Marlborough 93 68 93 89 72 93 73 159 ' 84 93 62 30 165 ' West Coast 81 63 103 180 123 124 159 83 39 82 96 138 114 North Canterbury 83 82 104 108 146 102 76 89 115 108 102 87 90 Ashburton 84 32 132 115 67 113 202 107 25 148 100 South Canterbury 48 126 68 58 37 94 73 115 164 101 70 69 78 Waitaki 113 84 39 91 98 64 44 160 84 26 33 113 Otago 173 60 77 133 139 108 82 78 111 106 95 127 141 South Otago 75 29 40 77 40 126 85 75 87 336 119 Maniototo 200 101 ' 72 : 322 556 Vincent 106 120 46 84 126 290 92 71 105 47 Southland 152 130 62 125 121 98 78 39 127 101 90 125 108 155-156 157 161 162-163 172 174 180 182 183 M F M F M M F M F F F F F Countx/Urban Area (UA) Wai tOllio 220 148 146 116 182 204 68 76 250 161 Taupo· . 217 79 122 131 168 97 52 74 164 Whakatane 356 127 235 144 135 172 50 122 133 51 58 Opotiki 364 125 52 231 208 133 . 313 69 Waiapu 286 417 128 194 396 93 417 370 Waikohu 222 37 213 Cook 192 313 88 169 59 34 303 294 220 Gisborne UA 128 92 96 48 104 135 305 199 168 118 51 89 . Wairoa - 147 48 88 144 149 85 154 130 53 Hawkels·Bay 140 119 47 ... 24 14 76 Napier UA 84 39 135 133 98 88 130 108 101 112 112 103 89 Hastings UA 81 171 122 90 188 97 96 148 124 131 111 84 64 ..... Waipawa 213 250 267 N 91 200 278 156 143 667 0 Waipukurau 145 476 64 83 345 64 169 411 60 93 141 - Dannevirke 185 118 49 79 132 89 83 159 Woodville .. - 72 109 - 328 . Taumarunui 267 182 71 168 137 91 274 63 286 244 50 Clifton 189 125 172 455 714 250 Taranaki 282 231 67 116 105 68 155 127 ·53 . New Plymouth UA 44 142 84 127 101 91 80 137 163 85 66 88 111 Inglewood. 222 198 326 67 204 556 61 217 97 Stratford 105 61 76 63 206 135 103 47 Egmont 323 225 172 . 625 76 165. 222 Eltham 256 98 207 571 32 299 104 Waimate West 323 122 143 . - 1111 Hawera 149 75 127 95 82 157 194 ISO 263 93 Patea 88 176 214 278 161 588 Waimarino 96 233 . 294 435 106 233 Waitotara 189 ~ 417 Wanganui .·238 417 80 200 500 91 714 294 155-156 162.;.163 157 161 172 174 180 -----.182 183 M F M F M M F M F F F F F Count~/Urban Area {UA} Wanganui UA 45 140 75 63 206 110 102 50 113 130 176 157 162 Rangitikei 106 216 117 38 87 75 87 118 65 83 Kiwitea 667 127 Pohangina Oroua 213 146 96 19. 74 92 94 45 61 234 Manawatu 100 245 155 93 105 187 92 185 87 40 Kairanga 233 39 77 Palmerston North UA 36 83 95 114 256 91 70 107 42 124 106 59 62 Horowhenua 136 145 158 50 52 87 113 189 34 101 113 187 91 Pahiatua 208 92 123 500 124 63 30 143 190 Eketahuna - 1429 244 370 169 800 Masterton 88 ..... Masterton UA 104 142 112 122 128 80 53 248 96 42 100 .....N Wairarapa South 303 120 91 469 88 102 204 Featherston 227 139 148 73 263 91 145 104 320 123 162 HlJtt 217 183 56 127 88 75 116 70 102 47 68 Upper Hutt UA 41 13 228 144 202 143 106 34 90 95 95 164 119 Lower Hutt UA 45 101 148 136 106 117 105 96 80 95 60 120 103 Porirua UA 62 182 134 157 89 82 99 127 103 69 169 116 Wellington UA 113 96 139 66 143 98 97 65 54 109 91 91 121 Marlborough 93 68 93 89 72 93 73 159 84 93 62 30 165 Nelson UA 22 42 103 65 51 92 81 140 84 112 109 165 87 Waimea 70 25 74 82 55 161 70 121 188 82 Golden Bay 112 131 90 256 86 Buller 300 114 42 237 133 244 89 71 138 Inangahua 357 266 123 Grey 76 55 159 299 114 139 131 78 136 267 150 Westland 187 203 93 106 109 161 103 81 114 53 Kaikoura 278 333 118 136 385 83 571 385 Amuri 385 97 75 155-156 157 161 162-163 172 '174· ' '180 '182. 183 M F M F M M F M F F F F F Countx/Urban Area (UA) Cheviot 56 385 Waipara 182 323 205 Ashley' 247 192 667 103 94 89 Rangiora 93 99 79 52 85 53 98 123 104 61 86 40 Eyre 78 Oxford 36 385 - Malvern 97 33 80 36 Paparua 303 . 455 244 500 185 Christchurch UA 82 85 104 110 160 106 78 93 118 110 101 86 , 90 Mount Herbert 5000 Akaroa 500 426 333 69 81 247 Wairewa ' - 1000 82 Ellesmere 96 66 233 135 44 99 138 '""" N Chatham Islands 263 N Ashburton 84 32 132 115 67 11'3, 202 107 25 148 100 Strathallan 126 74 53 38 120 57 260 268 112 88 116 Timaru UA 30 104 78 54 70 91 74 98 185 90 88 45 78 MacKenzie 400 83 202 ' 172 Waimate 220 84 115 70 59 101 - 288 45 Waitaki 113 84 39 91 98 64 44 ' 160 84 ' 26 33 113 Waihemo 417 58 185 400 189 Waikouaiti 175 107 106 270 77 128 308 240 Taieri 62 400 92 145 Dunedin UA 175 69 75 145 162 111 83 90 104 108 101 108 132 Bruce 179 94 70 48 308 91 211 159 213 Clutha 50 51 34 145 64 460 51 Tuapeka 351 76 1111 101 111 ' 53 377 246 Maniototo 200 101 72 323 556 Vincent 106 120 46 84 126 290 92 71 105 47 Lake 270 286 99 203 33 204 155-156 157 161 162-163 172 174 180 182 183 M F M F M M F M F F F F F Countl/Urban Area (UA) Southland 173 106 64 93 69 91 37 155 95 98 189 81 ..,;.. N Invercargi 11 UA 171 117 46 123 152 109 103 83 124 118 87 52 114 W Wallace 81 217 108 173 196 79 28 114 66 119 392 125 Fiord Stewart Island 1111 185 188 191 200 '201 203 204-207 M M F M F M F M F M F M F Hoseita1 .Board Northland 123 81 21 80 79 97 75 . 105 40 184 137 101 124 ' Auckland 99 95 86 109 95 117 99 100 112 93 103 115 100 Waikato 105 100 110 106 112 64 73 68 i07 143 125 105 95 Thames 120 72 97 62 125 93 46 93 100 91 111 65 Tauranga 103 92 130 66 125 103 144 152 159 77 24 146 56 Bay of Pl enty 96 44 155 139 128 112 125 97 125 75 Waiapu 769 189 625 290 Cook 128 113 45 119 28 i 129 43 187 283 187 43 28 132 Hawke's Bay, 85 144 130 74 120 153 123 63 92 115 28 81 86 Waipawa 84 58 180 211 - 156 183 130 Dannevirke 89 43 57 268 120 - 120 39 108 Taumarunui 184 71 67 111 ' 53 .84 ..... Taranaki 129 92 90 127 149 169 203 185 114 91 155 91 76 I'll Wanganui 101 123 186 104 105 66 66 97 148 95 88 80 79 ~ Palmerston North 102 134 141 112 138 38 49 28 111 54 49 76 73 . Wairarapa 120 ' 73 203 35 128 86 76 165 85 134 193 62 118 Wellington . , ", 96 108 116 102 82 88 138 69 69 88 99 96 96 Marlborough 87 58 .;. 97 106 154 108 133 217 123 Nelson 102 28 129 107 101 113 220 55 64 146 67 90 West Coast' 91 120 159 42 66 136 99 196 220 116 199 153 68 North Canterbury 104 104 57 82 75 97 99 63 90 131 126 102 107 Ashburton 72 58 43 47 197 135 290 267 268 180 South Canterbury 85 98 104 99 122 . 119 100 172 112 68 . 74 79 138 Waitaki 152 164 61 134 46 SO 61 299 110 S9 45 85 Otago 77 143 136 126 87 104 110 215 150 64 54 109 148, South Otago 137 43 385 187 145 161 233 227 256 194 244 35 152 Maniototo 112 Vincent 70 199 83 189 192 118 86 Southland 101 114 166 115 183 75 118 104 74 76 52 98 111 185 188 191 200 <<201 <<203 204-207 M M F M F M F M F M F M F Countx/Urban Area (UA) Mangonui 109 52 128 103 238 185 92 315 Whangaroa 97 370 909 Hokianga 272 667 286 556 345 256 Bay of Islands 132 75 83 66 70 119 127 61 152 Whangarei 130 102 56 341 43 Whangarei UA 101 85 81 116 200 88 288 97 116 179 102 78 Hobson 130 63 78 290 200 165 85 Otamatea 140 200 196 465 172 154 Rodney 74 173 162 131 67 112 238 60 North Auckland UA 110 107 103 108 102 85 60 54 52 45 97 105 136 West Auckland UA 73 101 57 115 113 124 47 248 238 82 183 85 116 Central Auckland UA 104 96 87 121 83 150 138 100 119 102 105 131 102 South Auckland UA 90 78 95 88 91 74 70 90 73 141 76 111 76 N Franklin 109 44 50 154 126 61 135 -U'l 101 128 147 54 Waiheke Island 68 69 286 152 175 Great Barrier IS'land Hauraki Plains 155 244 Coromandel-Thames 104 101 87 40 238 83 169 117 103 40 Ohinemuri 139 41 125 119 263 94 238 156 57 Waikato 112 86 91 93 105 157 147 167 129 248 90 237 Raglan 45 76 128 221 303 Waipa 151 54 97 244 53 78 125 160 23 Hamilton UA 123 109 149 104 106 66 88 91 207 46 128 85 Piako 124 115 222 204 63 71 200 174 211 154 44 Matamata 124 96 99 156 112 46 308 134 57 88 Otorohanga 32 89 147 203 Tauranga 94 111 294 41 131 208 122 513 62 107 Tauranga UA 105 87 95 75 123 68 150 204 67 101 30 174 42 Rotorua 105 132 192 Rotorua UA 45 145 124 99 146 109 158 330 140 171 123 88 185 188 191 ,200 ' '201 203 '204-207 M M F. M F M F M F M F M F Count~/Urban Area (UA) Waitomo 82 75 244 148 455 169 227 114 85 Taupo 102 156 149 34 56 175 - 85 395 55 139 Whakatane 108 58 206 145 158 93 80 ...;' 127 136 ' 62 Opotiki 62 114 182 ' 278 79 125 Waiapu 769 189 625 290 Waikohu Cook 150 '. "" 130 189 Gisborne UA 131 135 51 127 34 159 49 235 330 225 48 35 131 Wairoa 271 14·1 119 132 217 ~ 238 93 Hawke's Bay 46 435 182 182 250 154 125 Napier UA 76 117 96, 81 152 182 123 139 150 68 70 Hastings UA 64 186 156 63 107 126 120 147 , 68 86 30 99 , 95 ..... Waipawa 52 147 513 400 222 172 N Waipukurau 106 97 202 155 105 0\ Dannevirke ' 93 74 345 149 149 - 134 Woodville 72 208 Taumarunui 184 71 67 111 .,.. 53 84 Clifton - - - 1000 667 244 Taranaki 196 494 370,' 227 New Plymouth UA 133 174 133 141 24 275 194 320, ' 1~7 93 159 98 105 Inglewood 58 156 149 370 119 317 Stratford 144 152 116 357 156 185 56 Egmont 65 476 244 Eltham 166 455 154 488 400 417 167 Waimate West 270 455 500 625 435 Hawera 125 175 328 185 270 119 40 Patea 95 ' 133 476 667 455 Waimarino 149 ' 213 213 690 Waitotara 222 Wanganui 253 357 370 625 667 185 188 191 200 . "201 203 204-207 M M F M F M F M F M F M F County/Urban Area (UA) Wanganui UA 105 130 195 115 98 283 64 85 "224 92 63 112 91 Rangitikei 62 70 127 74 129 109 160 118 55 91 Kiwitea 455 714 Pohangina 250 Oroua 59 258 56 79 100 39 Manawatu 168 148 167 144 106 224 Kairanga Palmerston North UA 89 139 221 148 200 45 53 63 118 53 80 68 81 Horowhenua 118 99 78 63 86 57 77 89 59 37 100 56 Pahiatua 43 238 1111 112 Eketahuna - Masterton 313 - ..... MastertonUA 122 65 308 40 54 129 150 370 172 75 75 56 202 N Wairarapa South 130 189 175 435 270 84 """" Featherston 194 70 238 267 141 164 61 95 Hutt 111 32 175 87 61 170 200 76 84 30 198 Upper Hutt UA 103 154 80 51 154 100 68 75 147 113 Lower Hutt UA 99 152 154 89 103 70 124 78 77 85 180 100 64 Porirua UA . 61 26 68 138 37 53 95 46 185 Wellington UA 96 99 98 113 80 123 174 52 102 124 70 106 79 Marlborough 87 58 97 106 154 108 133 217 123 Nelson UA 95 27 34 108 73 111 328 76 31 197 74 124 Waimea 105 37 494 87 134 143 167 Golden Bay 175 196 313 282 Bull er 45 63 192 345 370 143 357 117 Inangahua 206 714 Grey 99 202 260 155 238 238 263 92 121 181 110 Westland 101 70 165 135 455 159 183 90 Kai koura 65 179 345 Amuri 119 - 2000 233 185 . ·188 ·191 200 ..201 . ·203 ·204~207 M M F M F M F M F M F M F Countt/Urban Area (UA) Cheviot Waipara 104 625 . . Ashley 133 185 417 159 250 Rangiora 39 112 313 313 102 73 Eyre 526 Oxford 110 417 667 Malvern 250 102 Paparua 109 909 Christchurch. UA 109 106 63 87 82 100 100 73 90 140 125 103 111 Mount Herbert Akaroa 323 417 667 500 Wairewa 270 ...... Ellesmere 115 104 100· 159 121 N Chatham Islands 00 Ashburton 72 58 43 47 197 135 290 . 267· 268 180 Stratha11 an . 140 119 125 147 75 79 682 256. 90 118 71 54 Timaru. UA 68 109 84 76 160 i54 84 97 43 81 120 138 MacKenzie Waimate 83 60 185 161 119 125 . 351 - 139 325 Waitaki 152 164 61 1.34 46 . 50 61 299 110 59 45 85 Waihemo· 244 370 556 244 357 Wai kouaiti 27 385 86 135 Taieri 182 408 299 250 Dunedin UA 86 135 152 125 98 110 98 218 167 63 61 102 143 Bruce 101 97 303 115 175 192 278 556 222 247 Clutha 166 444 236 123 139 200 - 435 172 417 61 86 Tuapeka 41 345 645 588 263 94 143 Maniototo 112 .;. Vincent 70 199 83 189 192 118 86 Lake 56 317 238 ..,; 124 182 .'~ . -',< ,<. , f_ <,'",. "-, '., -: 188 191 -200 201 203 ,'~ , M F ,M F M F M F M '<'::159 185 100 96 107 162 116 88 97 195 108 256 79 93 74 69 94 94 :.54. 114.. 95 167 556 ,'{ "'! ",; '" ~. .- . . .' ~:., . ;'0.,' .' "':-, J ~', !, '; .. ,.: .~ . "-.-'~;;:---)~ - -~, " • ' QZ"17 [QJ BOR: · Borman I Barry · A cancer mortality New Zealand. of QZ 17 [Q1 96369 BOR 1982 Information Centte MinistIy of H~~ Wellington DEPARTMENT OF HEALTH Special Report Series Obtainable from the Government Publications Bookshops-' . . A UCKLAND: Hannaford Buildings; Rutland Street , .. . (Private Bag)' " ,; HAMILTON" Alexandra Street' (P.o.' Box 857) . CHRISTCHURCH: 130 Oxford Terrace (Private Bag) DUNEDIN.~ T'& G Bllilding, Princes'1Street . , (P.o. Box 1104) .[ ; WELLINGTON: Mulgrave Street ,(Private Bag) . . '. . .. World Trade C~ntr~, CUbacade, . Cuba Street .. TITLE DATE OF ISSUE *No.. 1MAOR~~EUROPEAN S!,ANDARDS"OF HEALTH, . April 1960 *No. 2; .. DOMEStIC ACCIDENTS (Public Hospital Admissions) July 1960 *No. 'J ,THE GREY VALLEY SURVEY (Lung Function iI} Coal Miners) February 1961 *No; 4 ',ELDERLY PATIENTS IN PUBLIC HOSPITALS, :1958 March 1961 *No. : 5 SMOKING HABITS OF SCHOOL CHILDREN, May 1961 *No. ~ 6 SURVEY OF WORK IN COMPRESSED AIR-AUCKLAND HARBOUR BRIDGE April 1962 *No.. 7 TUBERCULOSIS IN CANTERBURY July 1962 *No. 8 MAORI PATIENTS IN MENTAL HOSPITALS', October 1962 *No.,9 CENSUS OF MENTAL HOSPItAL PATIENTS, 1961 April 1963 *No.IO ELDERHY PERSONS ACCOryIMODATION NEEDS IN NEW ZEALAN D, 1962 . April 1963 *No.11 PATIENT-NURSE DEPENDENCY: EXPLORATORY STUDY December 1963 " . *No.12 PATIENT-NURSE DEPENDENCY: GENERAL SURVEY DATA January 1965 No. 13 PATIENT-NURSE DEPENDENCY: GYNAECOLOGY' March 1964 *No.14 PATIENT-NURSE DEPENDENCY: GERIATRICS; Decem ber 1964 No. i5 PATIENT-NURSE DEPENDENCY IN CHRISTCHURCH: PAEDIATRICS, ' Septem ber 1963 *No.16 SMOKING HABITS OF NEW ZEALAND DOCTORS July 1964 *No. 17 INFANT AND FOETAL LOSS IN NEW ZEALAND . October 1964 *No.18 TRENDS IN NOTIFIABLE DISEA~E: ( ,I,' , Decem ber 1964 *No: 19 SURVEY OF FACTORY FIRST AID 1963-64 Decem ber 1964 *No.20 PATIENT-NURSE DEPENDENCY: GENERAL SURGERY Decem ber 1964 *No.21 PATIENT-NURSE DEPENDENCY: ORTHOPAEDIC'SURGERY January 1965 No. 22 PATIENT-NURSE DEPENDENty: GENE~AL M'EDICINE ' April 1965 No. 23 PATIENT-NURSE DEPENDENCY G.U. EYE, E.N.T. May 1965 *No.24 DISEASES OF THE EAR, NOSE AND THROAT IN MAORI CHILDREN July 1965 No. 25 MAORI PATIENTS IN PUBLIC HOSPITALS October 1965 No. 26 THE HEALTH OF TWO GROUPS OF COOK ISLAND MAORIS November 1966 *No.27 MENTAL HOSPITALS ADMISSION AND RELEASE DATA COHORT STUDY OF FIRST ADMISSIONS, 1962 November 1967 *No.28 OCCUPATIONAL MORTALITY AMONG MALE POPULATION, OTHER THAN MAORIS, 20 to 64 YEARS OF AGE November 1967 *No.29 DENTAL HEALTH STATUS OF THE NEW ZEALAND POPULA TION IN LATE ADOLESCENCE AND YOUNG ADULTHOOD May 1968 *No.30 CENSUS OF MENTAL HOSPITAL PATIENTS, 1966 May 1968 No.31 SURVEY OF THE PUBLIC DENTAL HEALTH SERVICE IN NIUE AND PLAN FOR DEVELOPMENT May 1968 No. 32 HOSPITAL FOOD SERVICES March 1969 No. 33 BIBLIOGRAPHY OF THE EPIDEMIOLOGY OF NEW ZEALAND AND ITS ISLAND TERRITORIES April 1969 *No.34 CENSUS OF PUBLIC AND PRIVATE HOSPITAL PATIENTS, AND OLD PEOPLE'S HOMES, 1966 Decem ber 1969 *No.35 DOMESTIC ACCIDENTS September 1970 *Out of print. - -- ..::::r ------.,--;- ,I ,I TITLE DATE OF ISSUE (I *No.36 AN EVALUATION OF A REGIONAL MASS MINIATURE RADIOGRAPHY PROGRAMME 1956-67 November 1970 *No.37 MAORI EUROPEAN COMPARISONS IN MORTALITY 0 o'l9 November 1972 No. 38 PHYSICAL DEVELOPMENT OF NEW ZEALAND SCHOOL CHILDREN 1969 ", September 1971 *No.39 PSYCHIA TRIC ILLNESS CAUSING HOSPITALIZATION OR DEATH 1967 January 1973 *No.40 CENSUS OF MENTAL HOSPITAL PATIE'NTS,1971 October 1973 *No.41 CENSUS OF PUBLIC, PRIVATE AND MATERNITY HOSPITAL PATIENTS, AND OLD PEOPLE'S HOMES, 1971 October 1973 *No.42 CANCER OF THE LUNG IN NEW ZEALAND October 1973 No. 43 ORGANISATION OF THE WORK OF HOSPITAL HOUSE SURGEONS October 1975 No. 44 GROWTH OF NEW ZEALAND PRE-SCHOOL CHILDREN October 1975 No. 45 MATERNAL AND INFANT CARE IN WELLINGTON-A HEALTH r; CARE CONSUMER STUDY October 1975 No. 46 ACCOMMODATION AND SERVICE NEEDS OF THE ELDERLY October 1976 No. 47 SURVEY OF PATIENTS IN PSYCHIATRIC HOSPITALS October 1974 No. 48 FAMILY GROWTH STUDY 1976 No. 49 A PATIENT OPINION SURVEY, WELLINGTON HOSPITAL 1977 *No.50 PERINATAL MORTALITY IN NEW ZEALAND 1972-73 1977 No.51 HOME HELP SERVICES IN NEW ZEALAND 1978 1978 No. 52 LUNG FUNCTION AND CHRONIC BRONCHITIS 0 IN NEW ZEALAND 1978 No. 53 HEALTH EXPENDITURE IN NEW ZEALAND-TRENDS AND GROWTH PATTERNS ' 1979 No. 54 BED OCCUPATION SURVEY 1976 1979 No. 55 SURVEY OF OCCUPIED PSYCHIATRIC HOSPITAL BEDS AND PSYCHIATRIC DAY AND OUTPATIENTS, 1976 1979 No. 56 COMMUNITY ATTITUDES TO SICKNESS AND HEALTH (!) VOLUMES I, 2 and 3. 1979 ~ No. 57 THE WORK LIFE OF QUALIFIED NURSES IN ONE METROPOLITAN HOSPITAL: A PILOT PROJECT 1980 I\ No. 58 NOT PUBLISHED . \ No. 59 PHYSICAL DISABILITY: RESULTS OF A SURVEY IN THE . WELLINGTON HOSPITAL BOARD AREA 1981 '\ No. 60 MANAWATU FAMILY GROWTH STUDY 1981 ~ No.61 POST-NEONATAL MORTALITY' 1982 No. 62 POST-BASIC NURSING EDUCATION IN NEW ZEALAND , . 1982 J .'" *Out of print. o •• P" D. HASSELBERG. GOVERNMENT PRINTER. WELLINGTON. NEW ZEALAND-I 982 90IS7J-8S0/11/82PT