Identifying health inequalities between Māori and non‐Māori using mortality tables

Abstract While there is a need for more detailed information on health inequality to guide public health policy, the most complete and easily available data remain those in mortality tables. We investigate, via a comparative analysis of data from New Zealand on Māori and non‐Māori mortality, whether more detailed information than raw life expectancy may be extracted from the mortality tables. Given a parametric distribution for the mortality capable of fitting irregularities in mortality table data, the curvature of the survival and hazard rates can identify changes in mortality rates, such as infant and late‐life adult mortality, which allows for straightforward comparisons between the two sub‐populations. Our results identify an exogenous effect in earlier mortality among Maori, which correlates well with many published observations of health and health‐care inequalities between Māori and non‐Māori. This “proof of concept” for our method of analysis indicates that examination of bulk data such as those in mortality tables has a potential role in the design of more detailed studies involving causes of mortality.

[1]  H. Seal Early uses of Graunt's life table , 1980 .

[2]  Mixed trends in population health among older adults. , 1996, The journals of gerontology. Series B, Psychological sciences and social sciences.

[3]  T. Blakely,et al.  Measuring Ethnicity in New Zealand: Developing Tools for Health Outcomes Analysis , 2007, Ethnicity & health.

[4]  J. Dolejs The extension of Gompertz law's validity , 1997, Mechanisms of Ageing and Development.

[5]  T. Blakely,et al.  Ethnic inequalities in mortality among the elderly in New Zealand , 2008, Australian and New Zealand journal of public health.

[6]  J. Anson,et al.  The parameters of death: a consideration of the quantity of information in a life table using a polynomial representation of the survivorship curve. , 1988, Statistics in medicine.

[7]  P. Graham,et al.  Health expectancy in New Zealand, 1981-1991: social variations and trends in a period of rapid social and economic change. , 1999, Journal of epidemiology and community health.

[8]  Adriana Hornikova,et al.  Stochastic Ageing and Dependence for Reliability , 2007, Technometrics.

[9]  K. McPherson,et al.  Ethnicity, equity, and quality: lessons from New Zealand , 2003, BMJ : British Medical Journal.

[10]  E. Mitchell,et al.  Ethnic differences in mortality from sudden infant death syndrome in New Zealand. , 1993, BMJ.

[11]  T. Blakely,et al.  What is the contribution of smoking and socioeconomic position to ethnic inequalities in mortality in New Zealand? , 2006, The Lancet.

[12]  Mason Durie,et al.  Mauri Ora: The Dynamics Of Māori Health , 2001 .

[13]  T. Blakely,et al.  Widening ethnic mortality disparities in New Zealand 1981-99. , 2005, Social science & medicine.

[14]  J. Atkinson,et al.  Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies , 2008, BMJ : British Medical Journal.

[15]  Chin-Diew Lai,et al.  Useful periods for lifetime distributions with bathtub shaped hazard rate functions , 2006, IEEE Transactions on Reliability.

[16]  J. Abernethy Gompertzian mortality originates in the winding-down of the mitotic clock. , 1998, Journal of theoretical biology.

[17]  J. Graunt,et al.  Natural and political observations made upon the bills of mortality , 1939 .

[18]  Chin-Diew Lai,et al.  Reduction in mean residual life in the presence of a constant competing risk , 2008 .

[19]  T. Witten,et al.  Multiphasic models of survival: Analysis of mortality rate change regions and the issue of finite species lifespan , 1997, Experimental Gerontology.

[20]  J. Atkinson,et al.  Ethnic counts on mortality and census data (mostly) agree for 2001-2004: New Zealand Census-Mortality Study update. , 2008, The New Zealand medical journal.

[21]  M. McGee,et al.  Onset and lifetime use of drugs in New Zealand: results from Te Rau Hinengaro: the New Zealand Mental Health Survey 2003-2004. , 2009, Drug and alcohol review.

[22]  T. Blakely,et al.  Ethnic inequalities in cancer survival in New Zealand: linkage study. , 2005, American journal of public health.

[23]  Min Xie,et al.  Reliability analysis using an additive Weibull model with bathtub-shaped failure rate function , 1996 .

[24]  Benjamin Gompertz,et al.  On the Nature of the Function Expressive of the Law of Human Mortality , 1815 .

[25]  Chin-Diew Lai,et al.  A flexible Weibull extension , 2007, Reliab. Eng. Syst. Saf..

[26]  P. Metcalf,et al.  Dietary intakes of European, Māori, Pacific and Asian adults living in Auckland: the Diabetes, Heart and Health Study , 2008, Australian and New Zealand journal of public health.

[27]  N. Pearce,et al.  Improving access to health care among New Zealand's Maori population. , 2006, American journal of public health.

[28]  A. Sporle,et al.  Social class mortality differences in Maori and non-Maori men aged 15-64 during the last two decades. , 2002, The New Zealand medical journal.

[29]  P. Cox,et al.  The Analysis of Mortality and Other Actuarial Statistics , 1971 .

[30]  B. Charlesworth,et al.  Ageing: Levelling of the grim reaper , 1997, Current Biology.

[31]  Chin-Diew Lai,et al.  MEAN RESIDUAL LIFE AND OTHER PROPERTIES OF WEIBULL RELATED BATHTUB SHAPE FAILURE RATE DISTRIBUTIONS , 2004 .

[32]  James W. Hollingsworth,et al.  Time, Cells, and Aging , 1963, The Yale Journal of Biology and Medicine.

[33]  H. Luder Onset of human aging estimated from hazard functions associated with various causes of death , 1993, Mechanisms of Ageing and Development.

[34]  M. Witten A return to time, cells, systems, and aging: IV. Further thoughts on Gompertzian survival dynamics — the neonatal years , 1986, Mechanisms of Ageing and Development.

[35]  J. H. Pollard,et al.  The age pattern of mortality , 1979 .

[36]  V. Kannisto,et al.  The Biology of Life Span: A Quantitative Approach , 1992 .

[37]  L. Gavrilov,et al.  The reliability theory of aging and longevity. , 2001, Journal of theoretical biology.

[38]  R. H. Daw Smallpox and the double decrement table: a piece of actuarial pre-history , 1979 .

[39]  M. Ardagh,et al.  Emergency department overcrowding--can we fix it? , 2004, The New Zealand medical journal.

[40]  Chin-Diew Lai,et al.  Modeling human mortality using mixtures of bathtub shaped failure distributions. , 2007, Journal of theoretical biology.

[41]  E. Halley,et al.  An Estimate of the Degrees of the Mortality of Mankind, drawn from curious Tables of the Births and Funerals at the City of Breslaw; with an Attempt to ascertain the Price of Annuities upon Lives , 1874 .

[42]  P Howden-Chapman,et al.  Retrofitting houses with insulation to reduce health inequalities: aims and methods of a clustered, randomised community-based trial. , 2005, Social science & medicine.

[43]  Guest Editorial: Mixed Trends in Population Health among Older Adults , 1996 .

[44]  T. Blakely,et al.  Mortality among lifelong nonsmokers exposed to secondhand smoke at home: cohort data and sensitivity analyses. , 2006, American journal of epidemiology.