Lecture 20: Maori Injury Outcomes - inequities and determinants Flashcards
what is the context of injury in New Zealand?
- many people injured in New Zealand
- many are disabled as a result of injury
- New Zealand is unique because of ACC
- but ACC is costly
- there is little known about outcomes experienced by injured people, including for Maori
what is the context of injury for Maori?
- injury is the second leading cause of disability for Maori
- Maori aged 15-64 have 1.5x more mortality risk, 30% higher risk of hospitalisation and higher rates of disability post-injury due to unintentional injuries
- Maori have at least 2x the rate of injury compared to non-Maori
how do Maori experience ACC?
- injured Maori experience lower rates of access to ACC services, compared to non-Maori
- Maori make up 15% of the population, but 11.55% of total ACC claims (2010) and 12% of claims (2021)
- Maori are more likely to access ACC for more serious injuries
- Maori receive less social and vocational rehabilitation services
- therefore, more likely to have poorer long term outcomes
what is the name of the study that identified Maori injury inequities?
Development of the Prospective Outcomes of Injury Study (POIS)
what are the features of the Maori POIS cohort?
- majority living in Auckland or Manukau city
- 66% male
- mean age is 38.8 years
- 92% reported good overall health
- 25% hospitalised for injury
- 43% minor, 39% moderate, 15% severe
what were the most common injuries experienced by the POIS cohort?
- spinal strain or dislocation
- upper extremity fractures or sprain/dislocation
- lower extremity fractures or sprain/dislocation
- burns, crush injury
- some people experience multiple injuries
what factors were used to determine life satisfaction after injury?
componets of te whare tapa wha
taha wairua
- comfort in faith and spiritual beliefs
taha tinana
- general health
- chronic conditions
- injury severity
taha hinengaro
- overall happiness
- self-efficacy
- depressive-type episodes
tahua whanau
- satisfaction with social relationships
- family
- involvement
other factors
- paid employment
- education
- adequacy of household income
what was the life satisfaction of injured Maori 3 months after injury?
- 71% satisfied with life 3 months post-injury
- maori were less likely to be satisfied with life at 3 months if the injury is more severe, they were not satisfied were pre-injury social relationships, poor self-efficacy pre-injury
what was the injury severity and 3 month outcomes among Maori?
- prevalence of disability was 49%
- 50% experiencing difficulties walking 3 months post injury
- 66% reported pain or discomfort 3 months post-injury
- 50% experiencing a level of psychological distress
- adverse outcomes increased with severity but a high level of problems for those classified as a minor injury
- majority satisfied with life and considered themselves to have good to excellent overall health
what was the 12 month post injury outcomes for Maori and non-Maori?
- high levels of adverse outcomes in both groups
Maori were more likely than non-maori to have:
- risk of disability
- problems with mobility
- trouble performing usual activities
- psychological distress
- barely/not enough household income
what were the predictors of work participation for Maori 3 months after injury?
- at 3 months, 64% working
- a reasonable proportion not working (36%)
- people with financial security, less severe injuries, work-related injury, high job satisfaction and less repetitive hand movements in work were more likely to be working 3 months after injury
what is the prevalence and predictions of disability 24 months after injury?
- 25% were hospitalised
- maori have 70% greater risk of disability compared to non-Maori
- 9% experiencing disability 24 months post-injury
- 19% experiencing disability 24 months post-injury
- those who had inadequate household income, chronic conditions, hospitalisation and poor access to healthcare services were more likely to experience disability 24 months after injury
what were the long-term disability outcomes for Maori and non-Maori after hospitalisation?
- 105 Maori and 446 non-Maori were hospitalised for their injury
- 26% of Maori and 10% of non-Maori were experiencing profound disability 24 months post-injury
- Maori and non-Maori who were working for pay, had a pre-injury disability, chronic conditions, and a perceived threat to life or of long term disability were more likely to experience disability after hospitalisation
- non-Maori who had inadequate household income, low education, chronic conditions, high BMI were more likely to experience disability after hospitalisation
- Maori who had poor access to health services were more likely to experience disability after hospitalisation
how many Maori experience ACC subsequent injuries?
- 62% had more 1 or more ACC subsequent injuries in 24 months
- 755 ACC subsequent injuries in 24 months
- spine dislocations/sprain/strains were the most common ACC subsequent injury type
predictors of ACC-SI
- intracranial sentinel injury, 18-29 increases risk of ACC subsequent injuries
- lower extremity fracture and other sentinel injuries, living with family decreases risk of ACC subsequent injuries
what are the long term impacts of Maori injuries?
Maori reporting disability 24 months after injury resulting in hospitalization had impacts on:
- daily life
- relationships
- employment
- long term/ongoing employment
