Background
Māori, the indigenous peoples of Aotearoa New Zealand (NZ) experience disproportionately
worse outcomes in cardiovascular health compared to non-Māori. Waikato Hospital provides
tertiary cardiothoracic services to the Midland region of NZ, and has instituted an
official policy to eliminate ethnic inequity in health. We aimed to audit the outcomes
of our cardiothoracic intensive care unit (ICU) against this standard.
Method
We analysed data from the prospectively-entered Australia and NZ Intensive Care Society
database for all planned cardiothoracic ICU admissions from 2014 to 2018 at Waikato
Hospital for patients aged 15-years and older (n=2,736). Outcomes measured were in-ICU,
in-hospital, and 1-year mortality.
Results
Māori were under-represented in this cohort (17.9%) compared to the general Midland
population. Māori patients were younger (median 60 vs 68-years old, p<0.001), were
more commonly female (34.8% vs 23.6%, p<0.001), domiciled in more deprived areas (2018
NZ Index of Deprivation of 9 vs 6, p<0.001), and more likely to have rheumatic heart
disease (35.6% vs 16.6%, p<0.001). More non-Māori required coronary vessel only surgery
(57.4% vs 45.2%), whilst more Māori required valvular only surgery (41.1% vs 31.2%)
(p<0.001 overall). Baseline Acute Physiology and Chronic Health Evaluation (APACHE)
III risk of death score was higher for Māori (1.53% vs 0.89%, p<0.001), as was the
European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (2.04% vs 1.55%,
p<0.001). Unadjusted mortality was higher for Māori in-ICU (3.1% vs 1.3%, p=0.005)
and at 1-year (7.1% vs 3.8%, p=0.002). Adjusted in-ICU mortality, however, was predicted
by combined coronary-valvular surgery (adjusted odds ratio, AOR 25.5 [95% confidence
interval (CI) 3.30–348.46], p=0.005), Australia and New Zealand Risk of Death (ANZROD)
score (AOR 1.11 [CI 1.05–1.19] p<0.001), and renal replacement therapy requirement
(AOR 154.56 [CI 30.86–1,107.17] p<0.001), but not by Māori ethnicity (AOR 0.27 [CI
0.03–1.43] p=0.156).
Conclusion
Our audit has identified significant inequity for Māori at our cardiothoracic ICU.
Māori are sicker on presentation for planned cardiac surgery, as evidenced by higher
admission severity scores, and experience higher unadjusted mortality up to 1-year
compared to non-Māori. Māori also appear under-represented despite a greater burden
of cardiovascular disease in the community. Further study is required to identify
if upstream risk factors, including failure of early detection and referral for disease,
contribute to these findings.
Keywords
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Article info
Publication history
Published online: March 03, 2022
Accepted:
November 28,
2021
Received in revised form:
July 22,
2021
Received:
March 29,
2021
Footnotes
Present Address for Corresponding Author: M. Atif Mohd Slim, Intensive Care Unit, Hawke’s Bay District Health Board, 398 Omahu Road, Hastings 4120, New Zealand.
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
