Introduction: Pathways aimed at increasing the medical workforce in regional and rural areas in Aotearoa New Zealand have been implemented in universities, such as the Regional and Rural Admission Scheme (RRAS) at Waipapa Taumata Rau | The University of Auckland, to address urban-rural variations in health outcomes. A recent review of the university's scheme suggested the program was not providing equitable opportunities for students from a rural background as originally intended. Therefore, an updated RRAS was required to be developed to address these inequities, creating a more genuine scheme that may more strongly contribute to developing the regional and rural workforce in New Zealand. Methods: We developed a methodological framework to identify and evaluate candidate rural definitions for the purposes of developing a new RRAS for the university. Following an extensive literature review, we utilised two sets of criteria to select candidate rural definitions, which were then evaluated using visual evaluation (mapping) and exploratory analysis. Candidate definitions were modified to use a three-group (rural-regional-urban) version to be suitable for use as an updated RRAS. We used a de-identified student dataset of applicants enrolled for the MBChB medical program at the University of Auckland from 2017 to 2023 (inclusive) and population counts from the New Zealand 2018 Census to investigate differences in potential admission numbers under each candidate definition. The New Zealand Index of Multiple Deprivation 2018 was used to assess the distribution of potential admission numbers by area-level socioeconomic status. We also examined the suitability of the candidate definitions by ethnicity, specifically for students of Māori ethnicity. Results: We selected two candidate definitions for exploratory analysis: Geographic Classification for Health (GCH) developed by the University of Otago, and the urban accessibility classification 2020 (UA 2020) by Stats NZ. We found that the three-group modified version of the UA 2020 definition consistently classified a higher proportion of students as regional and rural compared to the current RRAS and the alternative candidate definition, the three-group GCH. The modified UA 2020 was found to classify a higher number of Māori students and those living in less-deprived neighbourhoods as rural when compared to the other definitions. Therefore, our final recommendation is to update the existing RRAS using a three-group modified version of the UA 2020 by Stats NZ. Our proposed version will refocus attention to address the under-representation of rural students admitted to professional health programs at the University of Auckland, while not disadvantaging regional students. Conclusion: The updated RRAS will assist in supplementing the future professional rural medical workforce, and subsequently help to reduce health outcome variations between rural and urban areas in New Zealand. The modified UA 2020 is likely to be updated regularly by Stats NZ, and therefore the RRAS can be kept up to date in the future.

The last decade has seen increasing agreement on the measurement of wellbeing. Over this time two main approaches to measuring wellbeing nationally have emerged: multi-dimensional and subjective. Both approaches are widely used in national and international reporting. Progress on applying wellbeing measures in practice to inform policy and decision-making, however, has been less rapid. While there is a small, but growing, literature on the use of subjective wellbeing measures in public policy, there are fewer examples of applying multi-dimensional wellbeing measures in a public policy context. This paper describes wellbeing outcomes for social housing tenants from a multi-dimensional wellbeing survey drawing on the New Zealand Treasury’s Living Standards Framework. Building on the Alkire-Foster counting methodology, the paper proposes a novel metric for assessing the relative importance of different wellbeing outcomes within the context of a multi-dimensional wellbeing framework. This metric – fecundity – is defined as the number of additional dimensions of hardship that a person experiences conditional on being in hardship in one specific dimension. This fecundity metric to then compared to life satisfaction and the relationship between features of urban design and wellbeing is used as an illustrative case study to demonstrate the applicability of each approach in practice. Under both approaches neighbourhood characteristics and access to services are associated with tenant wellbeing compared to dwelling characteristics and length of connection to the neighbourhood, which have no significant association with life satisfaction and only a weak association with fecundity.

AIM:The B4 School Check includes hearing screening of four-year-old children in Aotearoa New Zealand. This study describes the prevalence and distribution of hearing loss, likely due to otitis media with effusion (OME), to determine if there is inequity in access to screening and primary healthcare, and to inform programme design and delivery. METHOD:Hearing data over a five-year period were linked with demographic data and interrogated using regression analyses for differences in disease burden, access to screening and to primary healthcare. RESULTS:Māori and Pacific children and those living with higher deprivation were less likely to be screened. When screened these children had higher rates of disease, were less likely to be referred immediately and had poorer access to primary healthcare to enable appropriate management. CONCLUSION:The current delivery of hearing screening is inequitable, missing those that need it most and exacerbating an uneven distribution of disease burden. A redeveloped programme to enable identification and screening of all eligible children, differential delivery according to need and a more holistic provision of care is required. This includes support for speech and language concerns, ear health promotion and linkage with primary care and healthy housing programmes.

This study describes and compares the utilisation rates of specialist mental health and addiction (MH) services between different refugee groups and the New Zealand (NZ) resident population. Using linked data in Statistics NZ’s Integrated Data Infrastructure, we identified 23,709 individuals with an asylum seeker or refugee visa who stayed in NZ for at least 6 months. Logistic regression models compared the use of MH services between different refugee groups (quota refugees, convention refugees, family reunification, and asylum seekers). We conducted cox regression hazard models to investigate the time to the first service use between refugee groups and a sample of NZ resident population, including NZ-born and overseas-born individuals. Adjusting for age, sex, ethnicity, neighbourhood deprivation, and time spent in NZ, we found that asylum seekers, family, and convention refugees were less likely to utilise MH services than quota refugees. The following groups had higher odds of utilising MH services: females compared with males (OR = 1.46, 95

Background:The healthcare needs of people living in areas of high deprivation are complicated by the cumulative effect of the sociodemographic factors known to impact on health outcomes, such as income, housing and education. Of note, for people living in more deprived areas, life expectancy is shorter and the onset of chronic disease and multimorbidity occurs much earlier. While the relationship between area deprivation and access to palliative care is becoming more widely researched, the vast majority of studies to date have focused on referrals to specialist palliative care services. This is problematic given the dominant model of generalist-specialist palliative care in high-income countries which assumes that most people will have a level of palliative care need that can be managed by non-specialist palliative care services. Objective:To identify associations between area deprivation and the use of generalist and specialist palliative care services in the last year of life. Design:A retrospective population-based cohort study. Methods:People aged over 18 years who died between January 2015 and December 2020 were identified within one geographical area of Aotearoa New Zealand. Using the National Health Identifier, deaths were matched to generalist and specialist palliative care service data. Results:A significant association was found between area deprivation and health service use in the last year of life. Of note, people living in rural areas of deprivation were significantly less likely to receive a hospital (p = <0.000) or inpatient hospice admission (p = <0.000). They were also less likely to have contact with their general practitioner (p = 0.007) or experience a specialist outpatient clinic appointment (p = 0.001). Conclusion:This study has revealed inequities in health service use across generalist and specialist palliative care services for people living in areas of deprivation. Of note, findings have highlighted how rurality amplifies inequities in access to appropriate palliative care. Further research is needed to better understand the consequences of these apparent inequities.

Summary: Background: Reliable data on trends of stroke incidence and outcomes over time are necessary for assessing the effectiveness of public health and clinical strategies, and for allocating healthcare resources. We assessed the levels and trends in incidence, mortality, early case fatality and disability for stroke in a defined, ethnically mixed population over 40 years. Methods: To analyse data from five population-based stroke incidence studies in adult residents (age ≥15 years) of the Greater Auckland Region of New Zealand (NZ) (1.35 million) over 12-month calendar periods for 1981–1982, 1991–1992, 2002–2003, 2011–2012, and 2021–2022. Fatal and non-fatal, hospitalised and non-hospitalised stroke events (first-ever and recurrent) were identified through multiple overlapping sources using clinical World Health Organization (WHO) diagnostic criteria and neuroimaging to define three major pathological types of stroke: ischaemic stroke (IS), primary intracerebral haemorrhage (PICH), subarachnoid haemorrhage (SAH), and stroke of undetermined type (SUT). Crude and age-standardised annual incidence, mortality, 28-day case fatality and disability level, and 40-year trends were calculated by age, sex, and ethnicity assuming a Poisson distribution. For comparison of our findings, we carried out a pooled analysis of methodologically comparable population-based stroke epidemiology estimates in high-income countries over the last two decades. Findings: Overall, there were 7462 first-ever strokes (9917 events) over the 40-year period (4,682,012 person-years). From 1981–1982 to 2021–2022, age-standardised stroke incidence rates decreased from 156/100,000 (95% confidence interval [CI] 143; 170) to 124/100,000 (119; 130) and mortality rates from 98/100,000 (88; 110) to 28/100,000 (26; 31) in nearly all age, sex, and ethnic groups. Moreover, from 2002–2003 to 2021–2022, there was an increase in stroke incidence of 1.28% per year (95% CI 0.38–2.17) in people aged 15–54 years, with the mean age of people with stroke decreasing from 73.0 (SD ± 13.8) in 2002–2003 to 71.6 (SD ± 14.9) in 2011–2012 and 70.7 (SD ± 15.2) years in 2021–2022 (p for trend <0.0001). The risk of stroke in Māori and Pacific people in 2021–2022 was almost 1.5 and 2.0 times greater than that in NZ Europeans. Ethnic disparities in the risk of stroke and age of stroke onset remained stable over the study period. From 1981–1982 to 2021–2022, 28-day stroke case fatality declined from 33.1% to 12.1% (p < 0.0001). There was a trend towards reducing 28-day case-fatality (from 31.6% [95% CI 27.6; 35.7] in 1981–1982 to 11.4% [10.0; 12.7] in 2021–2022) and an increasing proportion of stroke survivors with good functional outcome at discharge/28-days post-stroke (increased from 45.7% (95% CI 41.3; 50.0) in 1981–1982 to 60.2% (58.1; 62.3) in 2021–2022). Interpretation: Stroke incidence, 1-year mortality and 28-day case-fatality and disability have decreased in Auckland, NZ over the last 4 decades. However, over the last decade (2011–2022) there was a stagnation in the decline in the age-standardised stroke incidence rates. The absolute numbers of people with strokes, and those who have died or remained disabled from stroke, have significantly increased from 1981 to 2022. Ethnic disparities in the risk and burden of stroke persist. Effective prevention strategies for stroke must remain a high priority. Funding: Health Research Council of New Zealand.

OBJECTIVES:This study aimed to investigate the proximity of existing specialist vape retailers to schools in New Zealand. METHODS:Specialist vape retailers were mapped, and accessibility to them from schools was calculated across New Zealand. RESULTS:Thirteen percent of New Zealand's schools have at least one specialist vape retailer within 300 m. Forty-four percent of New Zealand's schools have at least one specialist vape retailer within 1 km. This means that almost half of schools had a specialist vape retailer within a 10-minute walking distance. CONCLUSIONS:There is a high density of specialist vape retailers around New Zealand schools, where children are likely to see the stores and window displays on their journey to and from school. IMPLICATIONS FOR PUBLIC HEALTH:Vaping products have a wide accessibility to many school students in New Zealand. The high exposure to specialist vape retailers on the way to and from school needs to be regulated to minimise youth uptake of vaping.

There is growing interest in using outcome-based measures in sub-national level health system performance management, particularly in high-income countries. Increasingly, population health indicators used for making international comparisons are being applied at a sub-national level. This study aims to understand whether and under what circumstances population health outcome-based measures can be used for performance measurement and management at the sub-national level health systems. We have integrated empirical population-based data with key health system expert perspectives to evaluate the appropriateness of two population health indicators - amenable mortality and ambulatory-sensitive hospitalization of young children. Our assessment focused on two key aspects: (i) the technical validity of these indicators, ensuring they accurately measure these outcomes, and (ii) the functionality and legitimacy of performance information, determining whether it meets stakeholders' program or policy needs and supports strategic decision-making. Overall, we found that the 'intermediate' outcome measure, childhood ambulatory sensitive hospitalization, was more useful for identifying district-level health system performance variation than the 'end' outcome measure, amenable mortality. Performance information based on childhood ambulatory-sensitive hospitalization is more appropriate for improving decisionmaking, and it is more likely to be accepted by a wide range of stakeholders involved in health system performance improvement.

The physical (spatial) and temporal availability of alcohol is a key determinant of alcohol use and harm. Community input into local alcohol licensing decisions is vital and may be supported by online tools that provide information on alcohol harm risk for local areas. We developed an online tool to provide data on area-level factors (deprivation and ethnic composition) shown to increase a community's risk of alcohol-related harm from the surrounding density and proximity of licensed premises. Data were derived using the Index of Multiple Deprivation (IMD18), the New Zealand Index of Deprivation (NZDep18), and the New Zealand Census 2018. In addition, we mapped proximity to sensitive sites (schools, hospitals and Marae [M & amacr;ori meeting grounds]) and existing licensed alcohol premises. In this paper, we demonstrate the development and use of our automated alcohol reporting tool that integrates numerous secondary data sources related to alchohol-related risks in the community within a 1 and 2 km radius (buffer) of an address seeking an alcohol off-license. Online tools leveraging geospatial data may assist community-based organisations to actively participate in local alcohol licensing decision processes using a robust evidence-base and support efforts to ensure that the impact of licensing decisions on equity is explicitly considered.

Human mobility typically exhibits temporal and spatial predictability. However, during hazardous events, roadways, footpaths and public transport networks can be disrupted by detours, closures and congestion. Urban fires, exemplified by the October 2019 New Zealand International Convention Centre (NZICC) fire in Auckland, New Zealand, are on the rise, posing threats to life, property and mobility. In this study, we employ geospatial analyses to investigate the impact of the NZICC fire on human mobility, encompassing both driving and walking. We generate predicted surfaces of particulate matter (PM2.5 and PM10) from seven local fixed air monitoring stations to estimate network-based exposure and inhalation dosage during travel. High levels of air pollution during the fire exceeded baseline concentrations, surpassing National Environmental Standards for Air Quality (NESAQ) and World Health Organization (WHO) limits for both PM2.5 and PM10. Private car commuters faced delays and congestion due to road closures, prolonging smoke exposure. Pedestrians, including those accessing essential public transportation infrastructure, experienced unavoidable exposure to smoke along the fastest routes from NZICC to places like Britomart train station and the Downtown Ferry. We recommend increasing the availability and dissemination of air pollutant monitoring data to enhance public awareness of the health risks associated with smoke exposure.

Long COVID is expected to be the most significant and enduring impact of the COVID-19 pandemic. This study provides evidence of the impact of long COVID symptoms on EQ-5D-5L, change in this impact and explores any mediators of the impact.