scholarly journals Defining Rural In Aotearoa New Zealand: A Novel Geographic Classification For Health Purposes

2021 ◽  
Author(s):  
Jesse Whitehead ◽  
Gabrielle Davie ◽  
Brandon de Graaf ◽  
Sue Crengle ◽  
David Fearnley ◽  
...  
Keyword(s):  
New Zealand ◽  
Urban Areas ◽  
Mortality Rates ◽  
Aotearoa New Zealand ◽  
Rural And Urban ◽  
Key Population ◽  
National Mortality ◽  
All Cause Mortality ◽  
Mortality Outcome ◽  
Rate Ratios

Abstract Objectives: To develop a valid rurality classification for health purposes in Aotearoa New Zealand (NZ) that is technically robust and incorporates heuristic understandings of rurality.Setting: Our Geographic Classification for Health (GCH) is developed for all of NZ.Participants: We examine the distribution of the entire NZ population across rurality classifications, and use the National Mortality Collection to examine previously masked rural-urban differences in mortality. Outcome measures: Unadjusted all-cause mortality rates and rural:urban incidence rate ratios (IRRs). Results: The GCH modifies key population and drive time thresholds in the generic rurality classifications, thereby identifying 19% of the NZ population as rural. Rural and urban all-cause mortality rates and associated rural:urban IRRs vary considerably depending on rurality classification. The GCH finds a rural mortality rate 21% higher than for urban areas.Conclusions: The GCH identifies a distinct rural population, and highlights rural-urban inequities that are masked by generic classifications.

Reclaiming the Past, Building a Future: Māori Identity in the Plays of Hone Kouka

2001 ◽  
Vol 26 (1) ◽  
pp. 15-24 ◽  
Author(s):  
William Peterson
Keyword(s):  
Twentieth Century ◽  
New Zealand ◽  
World War I ◽  
The Other ◽  
World War ◽  
The Past ◽  
Aotearoa New Zealand ◽  
Rural And Urban ◽  
The Future ◽  
The 1960S

Hone Kouka's historical plays Nga Tangata Toa and Waiora, created and produced in Aotearoa/New Zealand, one set in the immediate aftermath of World War I, and the other during the great Māori urban migrations of the 1960s, provide fresh insights into the way in which individual Māori responded to the tremendous social disruptions they experienced during the twentieth century. Much like the Māori orator who prefaces his formal interactions with a statement of his whakapapa (genealogy), Kouka reassembles the bones of both his ancestors, and those of other Māori, by demonstrating how the present is constructed by the past, offering a view of contemporary Māori identity that is traditional and modern, rural and urban, respectful of the past and open to the future.

scholarly journals Trends in the Incidence of New‐Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019

2022 ◽  
Author(s):  
Natalie A. Cameron ◽  
Ian Everitt ◽  
Laura E. Seegmiller ◽  
Lynn M. Yee ◽  
William A. Grobman ◽  
...  
Keyword(s):  
United States ◽  
Urban Areas ◽  
The United States ◽  
Hypertensive Disorders Of Pregnancy ◽  
Live Births ◽  
Rural And Urban Areas ◽  
Hypertensive Disorders ◽  
Rural And Urban ◽  
Rate Ratios ◽  
New Onset

Background Hypertensive disorders of pregnancy are growing public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. Given established rural‐urban differences in maternal cardiovascular health, we described contemporary trends in new‐onset hypertensive disorders of pregnancy in the United States. Methods and Results We conducted a serial, cross‐sectional analysis of 51 685 525 live births to individuals aged 15 to 44 years from 2007 to 2019 using the Centers for Disease Control and Prevention Natality Database. We included gestational hypertension and preeclampsia/eclampsia in individuals without chronic hypertension and calculated the age‐adjusted incidence (95% CI) per 1000 live births overall and by urbanization status (rural or urban). We used Joinpoint software to identify inflection points and calculate rate of change. We quantified rate ratios to compare the relative incidence in rural compared with urban areas. Incidence (95% CI) of new‐onset hypertensive disorders of pregnancy increased from 2007 to 2019 in both rural (48.6 [48.0–49.2] to 83.9 [83.1–84.7]) and urban (37.0 [36.8–37.2] to 77.2 [76.8–77.6]) areas. The rate of annual increase in new‐onset hypertensive disorders of pregnancy was more rapid after 2014 with greater acceleration in urban compared with rural areas. Rate ratios (95% CI) comparing incidence of new‐onset hypertensive disorders of pregnancy in rural and urban areas decreased from 1.31 (1.30–1.33) in 2007 to 1.09 (1.08–1.10) in 2019. Conclusions Incidence of new‐onset hypertensive disorders of pregnancy doubled from 2007 to 2019 with persistent rural‐urban differences highlighting the need for targeted interventions to improve the health of pregnant individuals and their offspring.

scholarly journals Excess Mortality Attributable to COVID-19 Among Assisted Living Residents

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 58-58
Author(s):  
Kali Thomas ◽  
Wenhan Zhang ◽  
David Dosa ◽  
Paula Carder ◽  
Philip Sloane ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Confidence Intervals ◽  
Assisted Living ◽  
Excess Mortality ◽  
Mortality Rates ◽  
All Cause Mortality ◽  
National Cohort ◽  
Adjusted Incidence Rate ◽  
Rate Ratios ◽  
Adjusted Incidence

Abstract This study examines the excess mortality attributable to COVID-19 among a national cohort of assisted living (AL) residents. To do this, we compare the weekly rate of all-cause mortality during 1/1/20-8/11/20 with the same weeks in 2019 and calculated adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs). All-cause mortality rates, nationally, were 14% higher in 2020 compared with 2019 (mean, 2.309 vs. 2.020, respectively, per 1000 residents per week; adjusted IRR, 1.169; 95% CI 1.165-1.173). Among the 10 states with the highest community spread, the excess mortality attributable to COVID-19 was 24% higher, with 2.388 deaths per 1000 residents per week in 2020 during January-August vs 1.928 in 2019 (adjusted IRR, 1.241; 95% CI 1.233-1.250). These results suggest that AL residents suffered excess mortality due to COVID-19.

scholarly journals Higher Hospitalization and Mortality Rates Among SARS-CoV-2 infected Persons in Rural America

2021 ◽  
Author(s):  
Alfred Jerrod Anzalone ◽  
Ronald Horswell ◽  
Brian Hendricks ◽  
San Chu ◽  
William Hillegass ◽  
...  
Keyword(s):  
Rural Communities ◽  
Urban Areas ◽  
The United States ◽  
Hospitalized Patients ◽  
Rural America ◽  
Inpatient Mortality ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
All Cause Mortality ◽  
Hospital Systems

IMPORTANCE: Rural communities are among the most underserved and resource-scarce populations in the United States (US), yet there are limited data on COVID-19 mortality in rural America. Furthermore, rural data are rarely centralized, precluding comparability across urban and rural regions. OBJECTIVE: The purpose of this study is to assess hospitalization rates and all-cause inpatient mortality among persons with definitive COVID-19 diagnoses residing in rural and urban areas. DESIGN, SETTINGS, AND PARTICIPANTS: This retrospective cohort study from the National COVID Cohort Collaborative (N3C) examines a cohort of 573,018 patients from 27 US hospital systems presenting with SARS-CoV-2 infection between January 2020 and March 2021, of whom 117,897 were hospitalized. A sample of 450,725 hospitalized persons without COVID-19 diagnoses was identified for comparison. EXPOSURES: ZIP Codes provided by source hospital systems were classified by urban-rural gradient through a crosswalk to the US Department of Agriculture Rural-Urban Commuting Area Codes. MAIN OUTCOMES AND MEASURES: Primary outcomes were hospitalization and all-cause mortality among hospitalized patients. Kaplan-Meier analysis and mixed effects logistic regression were used to estimate 30-day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient mortality while controlling for major risk factors. RESULTS: Rural patients were more likely to be older, white, have higher body mass index, and diagnosed with SARS-CoV-2 later in the pandemic compared with their urban counterparts. Rural compared with urban inhabitants had higher rates of hospitalization (23% vs. 19%) and all-cause mortality among hospitalized patients (16% vs. 11%). After adjustment for demographic and baseline differences, rural residents (both urban adjacent and non-adjacent) with COVID-19 were more likely to be hospitalized (Adjusted Odds Ratio (AOR) 1.41, 95% Confidence Interval (CI), 1.37-1.45 and AOR 1.42, CI 1.35-1.50) and to die or be transferred to hospice (AOR 1.62, CI 1.30-1.49 and 1.38, CI 1.30-1.49), respectively. Similar differences in mortality were noted for hospitalized patients without SARS-CoV-2 infection. CONCLUSIONS: Hospitalization and inpatient mortality are higher among rural compared with urban persons with COVID-19, even after adjusting for several factors, including age and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.

scholarly journals Trends of Rural/Urban Homicide in Colombia, 1992-2015: Internal Armed Conflict and Hints for Postconflict

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Katherine Vallejo ◽  
Jose Tapias ◽  
Ivan Arroyave
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Armed Conflict ◽  
Homicide Rates ◽  
Internal Armed Conflict ◽  
Rural And Urban ◽  
Inflection Points ◽  
Younger Men ◽  
Urban Rural ◽  
Rate Ratios

Objective. To analyze the relationship between rural and urban homicide rates in Colombia between 1992 and 2015 and the fluctuations in these rates. Methods. Individual records of homicides and population aggregates in men and women aged 15-64 years were used. The adjusted rates of annual homicides were calculated for urban/rural areas and standardized by age. Rate Ratios (RRs) adjusted by region were calculated. A joinpoint analysis was performed to identify inflection points and the Annual Percentage Change (APC). Results. Four joinpoints were identified in rural and urban rates: after peaking in 1992, homicide rates fell until 1997, and then increased until 2002. From this point on there was a continuous reduction until 2015, although this reduction slowed down from 2005 onward. During almost the whole period, the rates of rural homicides were higher than those of urban homicides, although they equalized at the end of the period. Conclusions. Unlike in other countries, during the study period Colombian homicide rates, which coincided with the dynamics of the armed conflict, were higher in rural than in urban areas. In recent years, a predominance of urban homicides committed by younger men has been identified, which could pose a challenge to postconflict in Colombia.

scholarly journals Mortality in Norway and Sweden before and after the Covid-19 outbreak: a cohort study

2020 ◽  
Author(s):  
Frederik E Juul ◽  
Henriette C Jodal ◽  
Ishita Barua ◽  
Erle Refsum ◽  
Ørjan Olsvik ◽  
...  
Keyword(s):  
Excess Mortality ◽  
Mortality Rates ◽  
List Type ◽  
School Closures ◽  
Epidemic Period ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Before And After ◽  
Rate Ratios ◽  
Expected Mortality

AbstractObjectivesNorway and Sweden are similar countries regarding ethnicity, socioeconomics and health care. To combat Covid-19, Norway implemented extensive measures such as school closures and lock-downs, while Sweden has been criticised for relaxed measures against Covid-19. We compared the effect of the different national strategies on all-cause and Covid-19 associated mortality.DesignRetrospective cohort.SettingThe countries Norway and Sweden.ParticipantsAll inhabitants.Main outcome measuresWe calculated weekly mortality rates (MR) with 95% confidence intervals (CI) per 100,000 individuals as well as mortality rate ratios (MRR) comparing the epidemic year (29th July, 2019 to 26th July, 2020) to the four preceding years (July 2015 to July 2019). We also compared Covid-19 associated deaths and mortality rates for the weeks of the epidemic in Norway and Sweden (16th March to 26th July, 2020).ResultsIn Norway, mortality rates were stable during the first three 12-month periods of 2015/16; 2016/17 and 2017/18 (MR 14.8 to 15.1 per 100,000), and slightly lower in the two most recent periods including during epidemic period (2018/19 and 2019/20; 14.5 per 100,000). In Sweden, all-cause mortality was stable during the first three 12-month periods of 2015/16; 2016/17 and 2017/18 (MR 17.2 to 17.5 per 100,000), but lower in the year 2018/19 immediately preceding the epidemic (16.2 per 100,000). Covid-19 associated mortality rates were 0.2 per 100,000 (95%CI 0.1 to 0.4) in Norway and 2.9 (95%CI 1.9 to 3.9) in Sweden. The increase in mortality was confined to individuals in 70 years or older.ConclusionsAll-cause mortality remained unaltered in Norway. In Sweden, the observed increase in all-cause mortality during Covid-19 was partly due to a lower than expected mortality preceding the epidemic and the observed excess mortality, was followed by a lower than expected mortality after the first Covid-19 wave. This may suggest mortality displacement.Strengths and limitations of this studyCompares two similar contries in all aspects but the handling of the Covid-19 epidemicEvaluates the mortality for several years before and during the epidemicProvides a possible explanation of the observed mortality changesDiscusses the socioeconomic effects of the different strategies in the two countriesDoes not evaluate cause-specific mortality

scholarly journals Haumanu Ipukarea reviving tūrangawaewae, identity and place

2021 ◽  
Author(s):  
◽  
William Hatton
Keyword(s):  
New Zealand ◽  
Urban Environment ◽  
Cultural Values ◽  
Urban Areas ◽  
Natural Landscape ◽  
Cultural Expression ◽  
Aotearoa New Zealand ◽  
Beliefs And Values ◽  
Values And Beliefs ◽  
Sense Of Identity

<p>Landscapes are a fundamental component for the identity of people. This is evident through the eyes of the indigenous Māori people who express, like many indigenous cultures, that identity is formed from ones interconnected relationship to the land. For Māori, land is embodied as a part of their identity formed by the principle of whakapapa and importantly mātauranga. Mātauranga Māori is the comprehensive body of traditional indigenous knowledge built over centuries of both physical and metaphysical paradigms. Much of the knowledge obtained, originated from te taiao, where the importance of mountains, rivers, lakes, forests and place, established one’s sense of tūrangawaewae.  Since the first colonial migrations to Aotearoa/New Zealand, much of the traditional knowledge acquired and developed over generation’s are at great risk of western dominance. Western science and knowledge has altered the endemic Aotearoa/New Zealand landscape dramatically depleting many natural ecologies. Forests and waterways continue to be in jeopardy from commercialisation and urbanisation, where the current urban environment questions the way we appreciate and make sense of our endemic natural landscape. Alterations to the land has prompted changes in people’s beliefs and values, and sense of identity.  Mātauranga has slowly begun to be reintroduced into the urban environment as a progressive way forward. This research builds upon the concept to promote mātauranga, reconnecting people and place, and improving one’s sense of identity. With more than 88% of Māori now residing in urban areas, and many non-Māori unaware of indigenous cultural values and beliefs, the focus looks to provide a place of gathering, learning, engaging, reflecting, healing and belonging, preserving and appreciating Aotearoa/New Zealand’s cultural expression of the landscape. The research looks upon a regenerating valley system near the heart of Wellington City, reviving the Māori beliefsof ki uta ki tai and that of hīkoi. The research looks at opportunities to better express and understand bi-culturalism</p>

scholarly journals Disaggregating Proportional Multistate Lifetables by Population Heterogeneity to Estimate Intervention Impacts on Inequalities

2021 ◽  
Author(s):  
Patrick Andersen ◽  
Anja Mizdrak ◽  
Nick Wilson ◽  
Anna Davies ◽  
Laxman Bablani ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Total Population ◽  
Case Fatality ◽  
Mortality Rates ◽  
Time Step ◽  
Life Years ◽  
All Cause Mortality ◽  
Population Mortality ◽  
Rate Ratios

Abstract BackgroundSimulation models can be used to quantify the projected health impact of interventions. Quantifying heterogeneity in these impacts, for example by socioeconomic status, is important to understand impacts on health inequalities.We aim to disaggregate one type of Markov macro-simulation model, the proportional multistate lifetable, ensuring that under business-as-usual (BAU) the sum of deaths across disaggregated strata in each time step returns the same as the initial non-disaggregated model. We then demonstrate the application by deprivation quintiles for New Zealand (NZ), for: hypothetical interventions (50% lower all-cause mortality, 50% lower coronary heart disease mortality) and a dietary intervention to substitute 59% of sodium with potassium chloride in the food supply. MethodsWe developed a disaggregation algorithm that iteratively rescales mortality, incidence and case fatality rates by time-step of the model to ensure correct total population counts were retained at each step.To demonstrate the algorithm on deprivation quintiles in NZ, we used the following inputs: overall (non-disaggregated) all-cause mortality & morbidity rates, coronary heart disease incidence & case fatality rates; stroke incidence & case fatality rates. We also obtained rate ratios by deprivation for these same measures. Given all-cause and cause-specific mortality rates by deprivation quintile, we derived values for the incidence, case fatality and mortality rates for each quintile, ensuring rate ratios across quintiles and the total population mortality and morbidity rates were returned when averaged across groups.The three interventions were then run on top of these scaled BAU scenarios. ResultsThe algorithm exactly disaggregated populations by strata in BAU. The intervention scenario life years and health adjusted life years (HALYs) gained differed slightly when summed over the deprivation quintile compared to the aggregated model, due to the stratified model (appropriately) allowing for differential background mortality rates by strata. Modest differences in health gains (health adjusted life years) resulted from rescaling of sub-population mortality and incidence rates to ensure consistency with the aggregate population.ConclusionPolicy makers ideally need to know the effect of population interventions estimated both overall, and by socioeconomic and other strata. We demonstrate a method and provide code to do this routinely within proportional multistate lifetable simulation models and similar Markov models.

A COMPARISON OF PARAMETRIC MORTALITY MODELS TO GRADUATE URBAN AND RURAL MORTALITY

2021 ◽  
Vol 37 (04) ◽  
pp. 485-497
Author(s):  
Mushtaq Ahmad Khan Barakzai ◽  
Aqil Burney
Keyword(s):  
Loss Function ◽  
Life Insurance ◽  
Rural Areas ◽  
Rural Population ◽  
Urban Areas ◽  
Mortality Rates ◽  
Mortality Data ◽  
Rural And Urban ◽  
Mortality Models ◽  
Urban And Rural Areas

This study examine twenty-nine parametric mortality models and assess their suitability for graduating mortality rates of urban and rural areas in Pakistan. Grouped age specific mortality rates of rural and urban populations for the year 2019 are used. The data is collected from the website of National Institute of Population Studies which conduct Maternal Mortality Survey in Pakistan on regular basis. The parametric mortality models were applied to rural and urban mortality data. We used R software to estimate the model’s parameters and assess their suitability for urban and rural populations. The suitability of these models was assessed by using 3 different loss functions. Our analyses found that the fourth type of Heligman-Polard’s model with loss function 3 provides reliable results for graduating the mortality of rural population while second type of Carriere model with loss function 3 produce best results for graduating the urban mortality of Pakistan. Based on two models, mortality rates of urban and rural population have been graduated over age range 0-85. We suggest the use the graduated mortality rates of urban and rural areas for pricing life insurance products in rural and urban areas respectively. In addition, graduated mortality rates are also suggested for use in calculation of life insurance liabilities.

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