Abstract
This report from the New Zealand Child and Youth Epidemiology Service (NZCYES) presents data and information to assist health services to plan and fund services that can contribute to improved health and wellbeing of children and young people in each locality. This 2021 report focuses on selected indicators of child and youth health status. The first section of the report presents data from the National Mortality Collection for deaths of under-25-year-olds, subdivided into deaths of infants aged under one year, children aged 1–14 years, and young people aged 15–24 years. Mortality rates are highest in the first year of life (463.8 deaths per 100,000 infants aged 0–11 months), and after infancy are highest for 20–24-year-olds followed by young people aged 15–19 years, children aged 1–4 years, and 5–14-year-olds. Overall mortality rates are higher for males than they are for females. Mortality rates for Māori children and young people, and also for Pacific children and young people, are significantly higher than they are for other ethnic groups. There is a strong social gradient in all-cause mortality with the highest rates observed for children and young people living in areas with the highest scores on the New Zealand Index of Deprivation (NZDep). Despite an overall decline in mortality rates from 1990 to 2018, inequity has persisted and will require sustained and committed structural change to remove the barriers to survival for so many children and young people in Aotearoa. For the first time the NZCYES has reported on the Child and Youth Wellbeing indicator of ‘potentially avoidable hospitalisations.’ This indicator was developed by the Ministry of Health and Department of the Prime Minister and Cabinet for the New Zealand Child and Youth Wellbeing Strategy and is broader in scope than the previous indicator of ‘ambulatory sensitive hospitalisations.’ Hospitalisations for the included conditions have been assessed to be potentially avoidable through primary care interventions, population-level public health initiatives (such as vaccination programmes), and social policy interventions (such as access to healthy housing and adequate income). Potentially avoidable hospitalisation (PAH) rates for medical conditions were highest in under-five-year-olds with little difference between males and females. Persistent inequity was observed over time with PAH rates for medical conditions consistently highest for Pacific children and young people. Potentially avoidable hospitalisation rates for Māori children and young people have been consistently higher than have the rates for European/Other and Asian children and young people. Children and young people of Middle Eastern, Latin American, and African (MELAA) ethnicity also had high PAH rates for medical conditions (similar in magnitude to rates for Māori). Children and young people living in areas with the highest deprivation scores (NZDep quintile 5) have consistently experienced the highest observed PAH rates for medical conditions since 2000. Rates for these children and young people increased to even higher levels between 2008 and 2009, before returning close to the previous rates in 2016. Within this section, additional analysis is presented for respiratory conditions, vaccine preventable conditions, and injuries. In the case of PAH for injuries, the highest rates were observed in the 15–24-year-old age group, and rates for males were significantly higher than were rates for females. Rates of PAH for injury declined overall in all ethnic groups between 2000 and 2020, and in all quintiles of social and material deprivation over the same time period. An overview of immunisation coverage is presented to inform interpretation of the hospitalisation rates for vaccine preventable disease. Vaccine delivery was negatively impacted by the COVID-19 pandemic and response, with Māori children missing out on vaccine delivery to a greater extent than children in other ethnic groups. Immunisation coverage also fell for Pacific children and for those of NZ European ethnicity, and stayed fairly stable for Asian/Indian children. The commentary for this section includes a rapid literature review, which summarises evidence for good practice to improve children’s access to vaccines and increase parental confidence in vaccines and in the health system. The COVID-19 pandemic protections enacted in 2020 were associated with a marked reduction in PAH rates for medical conditions. In discussion with child health experts, the NZCYES became aware that there was, at the same time, concern about increasing hospitalisation rates for intentional self-harm and for eating disorders. The final two sections of this report present data for these conditions. Although hospitalisation rates for intentional self-harm are about ten-fold as high in 15–24-year-olds compared with under-14-year-olds, a parallel increase in rates can be seen in both age groups. Hospitalisation rates for eating disorders increased from 2006 to 2020 among 10–14-year-olds and 15–19-year-olds, with a particularly marked increase in the younger age group between 2019 and 2020. The report appendices describe the processes used in compiling information for these reports, including the clinical codes relevant to each indicator, information about data sources and their limitations, classification of ethnicity and social and material deprivation, and statistical methods used in data analyses. In summary, the 2021 report from the NZCYES presents data and interpretation on selected indicators of child and youth health status. The most recent data available at the time of writing were extracted in 2021 from a range of administrative datasets. This report cannot address questions that require outpatient data, as these are not yet available at a national level. Developing systems that can provide a fuller picture of outpatient and primary health care data is important to inform child health service planning at national and regional levels.