New research shows the survival rates of babies with a rare but potentially fatal heart defect is lower for Pacific and Māori compared to European babies.
Researchers say it is another example of inequity in health outcomes that raises the question of whether methods of healthcare provision contribute to these different outcomes.
The study also showed that babies of European ethnicity were more likely than other ethnicities to have the condition, called congenital critical left heart obstruction (LHO), in which the left side of babies’ hearts does not form properly.
Liggins Institute researcher, neonatologist and PhD student Dr Elza Cloete will present the new findings on Tuesday at a major gathering of international mother and baby researchers and health professionals in Auckland, the Perinatal Society of Australia and New Zealand (PSANZ) Annual Scientific Congress 2018.
Dr Cloete analysed New Zealand health statistics on the condition over a nine-year period as part of her PhD, working with her supervisors Professor Frank Bloomfield, Liggins Institute Director and neonatologist at Starship Hospital, and Dr Tom Gentles, Director of the national paediatric cardiac service at Starship Hospital. They found that:
- The incidence of LHO was highest in European fetuses and babies (0.59 per 1,000), followed by Māori (0.31 per 1,000) and then Pacific (0.27 per 1,000). Across all ethnicities, it was 0.43 per 1,000.
- Management options taken during pregnancy and shortly after birth varied among ethnic groups. Higher pregnancy termination rates were found in Europeans, but more stillbirths and higher palliative care rates were recorded for Māori and Pacific.
- Survival to one year was highest in European babies at 58 percent, compared to 44 percent for Māori and 41 percent for Pacific.
Says Dr Cloete, “Ministry of Health figures clearly show that Māori and Pacific families experience inequities across maternal health and access to care – true across the broader health care sector. Despite that, I don’t think we were anticipating these results. The differences in perinatal outcomes in particular is quite striking.”
Dr Cloete says there is probably a combination of reasons for these differences.
“We know that Pacific families seek out antenatal care later in pregnancy compared to other ethnic groups. In addition how a particular mother and baby are cared for at each step will be influenced by the cultural and religious beliefs of the family, as well as by their health literacy,” she says.
Where families live and their ability to travel to the country’s paediatric cardiac intervention centre at Starship Hospital could also influence outcomes, as could differences in socioeconomic status, health literacy and disease severity.
“We also have to consider the possibility of healthcare provider bias,” says Dr Cloete. “Much has been written about unconscious bias in medicine. When health professional counsel families, we may guide them towards the decision that we think is appropriate for them based on our own bias, rather than present them with all the options that will allow them to make the best decision for their family. Those biases may be shaped by our own religious beliefs, cultural awareness, and societal influences – how ethnic groups are portrayed – or perhaps previous experiences.”