Using Days Alive and Out of Hospital to measure inequities and explore pathways through which inequities emerge after coronary artery bypass grafting in Aotearoa New Zealand: a secondary data analysis using a retrospective cohort
Objectives To describe the use of days alive and out of hospital (DAOH) as a sensitive measure of equity of outcomes after surgery by comparing outcomes after a coronary artery bypass grafts (CABG) operation between Māori and non-Māori patients in Aotearoa New Zealand.Primary and secondary outcome m...
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/2/e093479.full |
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| author | Sarah-Jane Paine Luke Boyle Alan Forbes Merry Elana Curtis Thomas Lumley Jade Tamatea |
| author_facet | Sarah-Jane Paine Luke Boyle Alan Forbes Merry Elana Curtis Thomas Lumley Jade Tamatea |
| author_sort | Sarah-Jane Paine |
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| description | Objectives To describe the use of days alive and out of hospital (DAOH) as a sensitive measure of equity of outcomes after surgery by comparing outcomes after a coronary artery bypass grafts (CABG) operation between Māori and non-Māori patients in Aotearoa New Zealand.Primary and secondary outcome measures We calculated unadjusted and risk-adjusted DAOH scores at three time points (30, 90 and 365 days) and compare values between Māori and non-Māori using data from the New Zealand Ministry of Health (MoH) over a 9 year period. To assess the impact of different risk factors on differences in outcome, we risk-adjust for multiple factors individually and collectively, to begin to elucidate possible pathways for equity gaps.Results After our comparisons, Māori patients experienced fewer unadjusted DAOH90 at seven out of nine deciles. After risk-adjustment, the differences ranged from 8 days to 0 days when considering different risk factors. The equity gap was widest at the lower deciles and was most reduced after adjusting for the Measuring Multi Morbidity (M3) score. The equity gap widened as the time period extended from 30 to 90 to 365 days.Conclusion Māori patients who underwent a CABG operation experienced fewer DAOH than non-Māori patients even after adjusting for multiple possible explanatory variables, and this difference increased over time postoperatively. Importantly, our results illustrate the value of DAOH as a sophisticated outcome metric that can reflect the complex and accumulative impacts of disadvantage and discrimination faced by Indigenous peoples both here in New Zealand and worldwide. It has considerable potential to increase our understanding of how and where inequities arise on the entire patient journey. |
| format | Article |
| id | doaj-art-c2f796b8f74b4734a7b1fe8f252aa554 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-c2f796b8f74b4734a7b1fe8f252aa5542025-02-04T05:30:09ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115210.1136/bmjopen-2024-093479Using Days Alive and Out of Hospital to measure inequities and explore pathways through which inequities emerge after coronary artery bypass grafting in Aotearoa New Zealand: a secondary data analysis using a retrospective cohortSarah-Jane Paine0Luke Boyle1Alan Forbes Merry2Elana Curtis3Thomas Lumley4Jade Tamatea5Te Kupenga Hauora Māori, The University of Auckland, Auckland, New ZealandDepartment of Statistics, The University of Auckland, Auckland, New ZealandDepartment of Anaesthesiology, The University of Auckland, Auckland, New ZealandTe Kupenga Hauora Māori, The University of Auckland, Auckland, New ZealandDepartment of Statistics, The University of Auckland, Auckland, New ZealandFaculty of Medical and Health Sciences, The University of Auckland, Auckland, New ZealandObjectives To describe the use of days alive and out of hospital (DAOH) as a sensitive measure of equity of outcomes after surgery by comparing outcomes after a coronary artery bypass grafts (CABG) operation between Māori and non-Māori patients in Aotearoa New Zealand.Primary and secondary outcome measures We calculated unadjusted and risk-adjusted DAOH scores at three time points (30, 90 and 365 days) and compare values between Māori and non-Māori using data from the New Zealand Ministry of Health (MoH) over a 9 year period. To assess the impact of different risk factors on differences in outcome, we risk-adjust for multiple factors individually and collectively, to begin to elucidate possible pathways for equity gaps.Results After our comparisons, Māori patients experienced fewer unadjusted DAOH90 at seven out of nine deciles. After risk-adjustment, the differences ranged from 8 days to 0 days when considering different risk factors. The equity gap was widest at the lower deciles and was most reduced after adjusting for the Measuring Multi Morbidity (M3) score. The equity gap widened as the time period extended from 30 to 90 to 365 days.Conclusion Māori patients who underwent a CABG operation experienced fewer DAOH than non-Māori patients even after adjusting for multiple possible explanatory variables, and this difference increased over time postoperatively. Importantly, our results illustrate the value of DAOH as a sophisticated outcome metric that can reflect the complex and accumulative impacts of disadvantage and discrimination faced by Indigenous peoples both here in New Zealand and worldwide. It has considerable potential to increase our understanding of how and where inequities arise on the entire patient journey.https://bmjopen.bmj.com/content/15/2/e093479.full |
| spellingShingle | Sarah-Jane Paine Luke Boyle Alan Forbes Merry Elana Curtis Thomas Lumley Jade Tamatea Using Days Alive and Out of Hospital to measure inequities and explore pathways through which inequities emerge after coronary artery bypass grafting in Aotearoa New Zealand: a secondary data analysis using a retrospective cohort BMJ Open |
| title | Using Days Alive and Out of Hospital to measure inequities and explore pathways through which inequities emerge after coronary artery bypass grafting in Aotearoa New Zealand: a secondary data analysis using a retrospective cohort |
| title_full | Using Days Alive and Out of Hospital to measure inequities and explore pathways through which inequities emerge after coronary artery bypass grafting in Aotearoa New Zealand: a secondary data analysis using a retrospective cohort |
| title_fullStr | Using Days Alive and Out of Hospital to measure inequities and explore pathways through which inequities emerge after coronary artery bypass grafting in Aotearoa New Zealand: a secondary data analysis using a retrospective cohort |
| title_full_unstemmed | Using Days Alive and Out of Hospital to measure inequities and explore pathways through which inequities emerge after coronary artery bypass grafting in Aotearoa New Zealand: a secondary data analysis using a retrospective cohort |
| title_short | Using Days Alive and Out of Hospital to measure inequities and explore pathways through which inequities emerge after coronary artery bypass grafting in Aotearoa New Zealand: a secondary data analysis using a retrospective cohort |
| title_sort | using days alive and out of hospital to measure inequities and explore pathways through which inequities emerge after coronary artery bypass grafting in aotearoa new zealand a secondary data analysis using a retrospective cohort |
| url | https://bmjopen.bmj.com/content/15/2/e093479.full |
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