1. Deaths in New Zealand: Regional and Ethnic Projections 2014 to 2026 February 2014

2. Data supplied to Ministry of Health Prepared annually by Statistics New Zealand Using assumptions specified by the Ministry of Health Usually available from late October 2013 is first year that detailed data on deaths included Currently still using Base 2006 for projections Projections only to 2026 Last available census was in 2006 Projections based on 2013 census not available until 2015 Projections by DHB Have amalgamated to regions using DHB Shared Services regions Projections by prioritised ethnicity Māori, Pacific, Asian, Other

3. New Zealand Population 2014 The population has a relatively flat structure from childhood to age 55, with a steep decline in numbers thereafter. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

4. South Island has fewest children, large numbers of students, lower working age population and more older people. Northern has highest proportion in working age and lowest over age 55. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health Standardised Age Profiles by Region

5. Major differences between ethnic groups. Māori and Pacific have high proportion in childhood and young adult years. Asian very high in early working years. Other highest from age 45, with many more elderly. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health Standardised Age Profiles by Ethnicity

6. Ethnicity New Zealand 2014 The population has a relatively flat structure from childhood to age 55, with a steep decline in numbers thereafter. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

7. Ethnicity New Zealand 2014 Significant bulge in the Asian population in the early working years. High proportion of children for Māori and Pacific. At oldest ages, predominantly Other (non- Māori, non-Pacific, non-Asian). Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

8. Expected Population New Zealand FY 2014 Māori make up 15.3% of the population, with Other (non- Māori, non- Pacific, non-Asian) making up 65.8%. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

9. Expected Births in New Zealand FY 2014 Māori make up 28.4% of births. Māori, Pacific and Asian together make up more than half of births, 52.8%. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

10. Expected Deaths in New Zealand FY 2014 Māori make up 10.3% of deaths, with Other (non- Māori, non-Pacific, non- Asian) making up 82.9%. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

11. Expected Deaths in New Zealand FY 2026 By 2026, Māori are expected to make up 11.7% of deaths, up from 10.3% in 2014. Asian deaths show the greatest proportional increase from 2.9% in 2014 to 5.4% in 2026. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

12. Projected Deaths 2014 to 2026 An increase in deaths per annum from some 30,000 a year to some 35,000 a year is expected over the period. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

13. Projected Deaths 2014 to 2026 The proportion of deaths for Māori, Pacific and Asian increases steadily over the period. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

14. Regional Projections

15. Expected Births in New Zealand by DHB, financial year 2014 T Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

16. Expected Deaths in New Zealand by DHB, financial year 2014 T Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

17. Deaths Relative to Births by Region Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

18. Deaths Relative to Births by Ethnicity Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

19. Deaths Relative to Births 2014 Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

20. Deaths Relative to Births 2026 Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

21. Commentary Very different patterns of births and deaths by ethnicity in different DHBs and hence regions. Deaths are expected to exceed births in South Canterbury in 2014. Wairarapa may reach this mark by 2026 and most DHBs will see an increase in the proportion of deaths relative to births. By 2026, the ratio of deaths to births in the South Island region could be 0.774 (with 1.000 being when deaths equal births). For New Zealand as a whole, the ratio of deaths to births is expected to increase from 0.508 in 2014 to 0.556 by 2026.

22. Ageing of Deaths

23. Projected Deaths 2014 to 2026 All Deaths in New Zealand Over the period, the proportion of deaths over age 85 is expected to increase from 35.7% to 40.7%. Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health

24. Projected Deaths 2014 to 2026 Male Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health Male deaths tend to be at younger ages. The proportion of male deaths over age 85 is expected to increase from 28.2% to 34.8%.

25. Projected Deaths 2014 to 2026 Female Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health Female deaths tend to be at older ages. The proportion of female deaths over age 85 is expected to increase from 43.1% to 46.8%.

26. Projected Deaths 2014 to 2026 Māori Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health Māori deaths tend to be at much younger ages. Deaths below age 65 are expected to decline with those at older ages increasing.

27. Projected Deaths 2014 to 2026 Pacific Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health Pacific deaths are also at younger ages. Like Māori deaths, deaths below age 65 are expected to decline with those at older ages increasing.

28. Projected Deaths 2014 to 2026 Asian Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health Asian deaths are expected to show the most rapid ageing over the period, with deaths over age 85 increasing from 18.5% to 36.5%.

29. Projected Deaths 2014 to 2026 Other Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health Deaths of the Other group, including NZ European, already occur at much older ages and there are very few deaths under age 65. Deaths over age 85 are expected to increase from 40.7% to 46.1%.

30. Commentary The age structures of the population for the four ethnic groups are very different. This impacts the age structure of deaths and each ethnicity has a distinctive pattern. For all ethnic groups, the proportion of deaths at older ages is expected to increase over the period. The proportion of deaths at older ages is already high for the Other group, which includes NZ European. The proportion of deaths at older ages will rise rapidly for Māori and Pacific deaths, and most rapidly for Asian deaths.

31. Change in Numbers of Deaths Indexed 2014=100

32. New Zealand - Change in Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health All ethnic groups increase. Deaths for Pacific increase slightly faster than for Māori. Asian deaths increase very much faster.

33. Change in Deaths over Age 85 Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health Deaths over age 85 for Māori and Pacific increase faster than for Other. Asian deaths increase even faster.

34. Northern Region - Change in Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health All ethnic groups increase. Deaths for Māori and Pacific increase at a similar pace and a faster pace than Other. Asian deaths increase even faster.

35. Midland Region - Change in Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health All ethnic groups increase. Deaths for Pacific are at a low level but are expected to increase faster than for Māori by the end of the period. Asian deaths increase expected to increase even faster.

36. Central Region - Change in Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health All ethnic groups increase. Deaths for Māori increase faster than for Pacific. Asian deaths increase even faster.

37. South Island - Change in Deaths Source: Analysis of projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health All ethnic groups increase. Deaths for Pacific and Asian expected to increase faster than Māori although all are off a very low base.

38. Historic Deaths and Projections The period covered by this study is shown above, where deaths increase from some 30,000 to 35,000. The ageing of deaths in New Zealand is expected to be much more dramatic beyond this period. Source: Palliative Care Council, Working Paper No. 1, July 2013. Period of projections 2014 to 2026

39. Prof Heather McLeod Senior Analyst, Palliative Care Cancer Control New Zealand Office of the CMO Ministry of Health www.cancercontrolnz.govt.nz/palliative-care Email: Heather_McLeod@MOH.govt.nz Mobile: 0210 279 7425