The Health of Pacific Children and Young People What can New Zealand and the Islands learn from each other? Dr Liz Craig, NZ Child and Youth Epidemiology Service

Overview of NZCYES Pacific Reports Annual Pacific Child and Youth Health Report Ministry of Health Funded since 2007 Three Year Reporting Cycle Year 1 Health Status Year 2 Health Determinants Year 3 Chronic Conditions and Disability Oversight by TAHA Well Pacific Mother and Infant Service Advisory Group Graphs and Tables (Trends, Demography) Viewpoints by Pacific Academics/Health Professionals

Ethnicity Classifications

Breakdown of Pacific Births by Ethnic Group, New Zealand Source: Birth Registration Dataset; Includes all births where a Pacific ethnicity was recorded in the first three ethnic groups

Proportion of Pacific Births Using Three Different Ethnicity Classifications, New Zealand Year Prioritised PacificAny PacificSole PacificNZ Total Number % of Births Number % of Births Number % of Births Number 20006, , , , , , , , , , , , , , , , , , , , , , , , , , , ,666 Source: Birth Registration Dataset

Number of Pacific Births by Ethnic Group, New Zealand Year SamoanTonganCook Island Māori AnySole% SoleAnySole% SoleAnySole% Sole 20004,2152, ,8781, , ,2551, ,9231, , ,1751, ,8341, , ,2181, ,8771, , ,5472, ,9911, , ,4631, , , ,6832, , , Year NiueFijianTokelauan AnySole% SoleAnySole% SoleAnySole% Sole

Teenage Births

New Zealand’s Teenage Pregnancy Rates, Source: Numerators-Birth Registration Dataset and Abortion Supervisory Committee; Denominator Census

Live Birth Rates by Maternal Age and Ethnicity, New Zealand 2006−2010 Source: Numerator: Birth Registration Dataset (Live births only); Denominator: Statistics NZ Census Population Counts; Note: Ethnicity is Level 1 Prioritised

Birth and Termination of Pregnancy Rates by Age and Ethnicity, New Zealand 2007 Source: Numerator-Abortion Supervisory Committee (via Statistics NZ) and Birth Registration Dataset; Denominator- Census. Note: Each abortion has been included in every ethnic group specified, thus some abortions are counted more than once. Similarly those identifying with >1 ethnic group have been included in each of the ethnic groups of the denominator.

Teenage Birth Rates by Ethnicity and NZ Deprivation Index Decile, New Zealand

Teenage Birth Rates by Ethnicity, New Zealand 2000–2010 Source: Numerator: Birth Registration Dataset (Live births only); Denominator: Statistics NZ Estimated Resident Population; Note: Ethnicity is Level 1 Prioritised

Teenage Birth Rates in Pacific Women by Pacific Group, New Zealand 2006−2010 Ethnicity Number: Total 2006−2010 Number: Annual Average Rate per 1,000Rate Ratio95% CI Teenage Births Any Pacific Any Samoan1, – 3.16 Any Tongan – 3.65 Any Cook Island Māori1, – 5.34 Any Niue – 5.19 Any Fijian – 2.40 Any Tokelauan – 4.13 Any Other Pacific – 4.59 Any Pacific4, – 3.81 non-Māori non-Pacific8,3071, Sole Pacific Sole Samoan – 2.84 Sole Tongan – 3.19 Sole Cook Island Māori – 6.08 Sole Niue – 5.72 Sole Fijian – 1.46 Sole Tokelauan – 5.03 Sole Other Pacific – 6.76 Sole Pacific2, – 3.53 non-Māori non-Pacific8,3071, Source: Numerator: Birth Registration Dataset (Live births only); Denominator: Statistics NZ Census Population Counts; Note: Ethnicity assigned using Any/Sole Classification. Rate ratios are compared to the non-Māori non- Pacific group and are unadjusted

Teenage Birth Rates in Pacific Women by Pacific Group, New Zealand 2000−2010 Source: Numerator: Birth Registration Dataset (Live births only); Denominator: Statistics NZ Census Population Counts; Note: Ethnicity assigned using Any/Sole Classification

Smoking in Pregnancy

Babies Born to Mothers who Smoked, at First Registration with a Lead Maternity Carer, by Maternal Age, Baby’s Ethnicity and NZ Deprivation Index Decile, New Zealand 2009−2010

Babies Born to Mothers who Smoked at First Registration with a LMC by Maternal Age, Baby’s Ethnicity and NZ Deprivation Index Quintile, New Zealand 2009–2010 Variable RateRate Ratio95% CI Maternal Smoking at LMC Registration (Unknown Smoking Status Excluded) Maternal Age <20 Years – –24 Years – –29 Years – –34 Years – Years Baby’s Ethnicity Asian/Indian –0.12 European Māori –3.95 Pacific –1.21 NZ Deprivation Index Decile Deciles 1– Deciles 3– –1.82 Deciles 5– –2.48 Deciles 7– –3.40 Deciles 9– –4.81

Proportion of Babies Born to Mothers who Smoked at First Registration with a Lead Maternity Carer by Baby's Ethnicity and Maternal Age, New Zealand 2009–2010

Sudden Unexpected Death in Infancy (SUDI)

Sudden Unexpected Death in Infancy by Type, New Zealand 1996–2008 Source: Numerator: National Mortality Collection; Denominator: Birth Registration Dataset

Sudden Unexpected Death in Infancy by Type and Age in Weeks, New Zealand 2004–2008 Source: Numerator: National Mortality Collection; Denominator: Birth Registration Dataset

Sudden Unexpected Death in Infancy by Ethnicity, New Zealand 1996–2008

Risk Factors for Sudden Unexpected Death in Infancy, New Zealand 2004–2008 Source: Numerator: National Mortality Collection; Denominator: Birth Registration Dataset. Note: Rates are per 100,000; Rate Ratios are unadjusted; Ethnicity is Level 1 Prioritised

Risk Factors for Sudden Unexpected Death in Infancy, New Zealand 2004–2008 New Zealand Sudden Unexpected Death in Infancy VariableRateRate Ratio95% CIVariableRateRate Ratio95% CI NZ Deprivation Index DecileEthnicity Decile 1– Asian/Indian –0.82 Decile 3– –4.15European Decile 5– –4.58Māori –6.53 Decile 7– –6.16Pacific –3.60 Decile 9– –13.01Gender Maternal Age GroupFemale <20 Years –7.17Male – –24 Years –4.62Gestation at Birth 25–29 Years –2.2020–36 Weeks – –34 Years Weeks Years –1.32 Source: Numerator: National Mortality Collection; Denominator: Birth Registration Dataset. Note: Rates are per 100,000; Rate Ratios are unadjusted; Ethnicity is Level 1 Prioritised.

Babies Born to Mothers who Smoked, at First Registration with a LMC, by Maternal Age, Baby’s Ethnicity and NZ Deprivation Index Decile, New Zealand 2009−2010

In Summary Monitoring the health of Pacific children and young people in New Zealand allows consideration of where health resources may best be spent Higher proportion of both Pacific births and teenage births in NZ occur in most deprived areas Teenage pregnancy in NZ associated with higher rates of both smoking in pregnancy and SUDI Need to address the economic environments in which teenage mothers and their children live, as well as providing resources to assist with smoking cessation and SUDI prevention

Questions for Discussion Is comparable monitoring of child and youth health occurring in other Pacific nations? If so, is there potential for a greater sharing of expertise / monitoring methods / approaches to data collection? Is the current information on child and youth health in the Pacific sufficient? If not, what types of information would be required to assist policy development and the evidence based planning of services? Any other issues for discussion?