The epidemiology of cardiovascular disease among Pacific peoples in Aotearoa New Zealand

In Aotearoa New Zealand (NZ), health outcomes are usually reported for Pacific peoples as a collective group. This results in variability between Pacific-specific ethnic groups remaining hidden, which may be further compounded by differences in country of birth. The aim of this thesis was to determine whether there are differences in the epidemiology of cardiovascular disease (CVD) among Pacific peoples in NZ by Pacific-specific ethnicity and country of birth. The five objectives were: i) to conduct a systematic review of the epidemiology and management of CVD by Pacific-specific ethnicity and country of birth, and; to describe Pacific peoples in NZ aged 30 to 74 years old according to ii) ethnicity and country of birth, iii) selected sociodemographic and clinical characteristics, iv) prevalence of CVD (total, and by subtype), and v) 5-year CVD (total) mortality. The systematic review demonstrated differences in the mortality, incidence, prevalence and management of CVD by Pacific country and/or Pacific ethnic group. Anonymised individual-level linkage using the Statistics NZ Integrated Data Infrastructure identified a cohort of 2,409,861 people aged 30-74 years and resident in NZ on 31 March 2013 (of whom 56,781 were Samoan, 21,654 Tongan, 21,780 Cook Islands Māori, 8,346 Tagata Niue, 2,502 Tokelauan, 6,138 Fijian and 4,347 Other Pacific). Almost two thirds of Pacific peoples (65.7%) in the study cohort were born overseas, ranging from 45.3% (Cook Islands Māori) to 82.7% (Fijian). Significant differences were identified in the prevalence of CVD between at least two Pacific ethnic groups for all CVD types reported, other than peripheral vascular disease. For example, total CVD prevalence was 1.3 times higher for Cook Islands Māori and Tokelauans compared to Other Pacific peoples. By country of birth, total CVD prevalence was higher for Cook Islands Māori born overseas compared to those born in NZ. CVD mortality was similar between Pacific groups other than Cook Islands Māori, who had at least 1.5 times higher mortality than all other Pacific groups. OS-born Tagata Niue and Cook Islands Māori CVD mortality was 1.6 times that compared to those born in NZ, though only significantly different for the latter. The results highlight substantial heterogeneity in CVD prevalence and mortality among Pacific peoples, challenging assumptions of homogeneity in their CVD needs. Researchers, clinicians and decision makers should disaggregate Pacific peoples according to Pacific-specific ethnicity and country of birth whenever possible.

Name thesis:degree_name

PhD

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Population Health

Grantor dc:publisher

ResearchSpace@Auckland

Year dc:date.issued

2023

Author dc:creator

• Winter-Smith, Julie Lynnette

Advisors dc:contributor.advisor

• Selak, Vanessa
• Grey, Corina
• Harwood, Matire
• Paynter, Janine

Statement dc:rights

• Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Licence dc:rights.uri

• https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm

Handle dc:identifier.uri

https://hdl.handle.net/2292/70322

OAI identifier oai:identifier

oai:researchspace.auckland.ac.nz:2292/70322