Papers by Gabrielle Davie
Journal of Paediatrics and Child Health, 2003
Intestinal parasitic carriage is common in East African populations with a wide spectrum of clini... more Intestinal parasitic carriage is common in East African populations with a wide spectrum of clinical severity. There are scant data on the rates of carriage in East African immigrants to Australia. This study describes the prevalence of and risk factors for intestinal parasite carriage among children recently arrived from East African countries. Children aged 0-17 years, who attended an outpatient clinic, were born in East Africa and had immigrated since 1998 were eligible to participate. A single preserved stool specimen was collected for faecal microscopy, and blood tests were conducted for Strongyloides and Schistosoma serology, full blood examination and serum ferritin. One hundred and thirty-five children (median age 8.1 years, range 1.0-17.5) participated, of whom 133 (99%) provided a stool specimen. Parasites were detected in 50% of samples, and 18% of children carried a possibly pathogenic species. No child was symptomatic at diagnosis. Positive or equivocal serology occurred in 11% of children for Strongyloides and 2% for Schistosoma. Anaemia and iron deficiency were detected in 16% of all children. Those carrying an intestinal parasite were older (mean age 9.8 vs 7.4 years, P= 0.002) and less likely to be anaemic (odds ratio 0.37, 95% confidence interval 0.14-0.96) than those who were not carriers. Carriage of intestinal parasites is common among children from East Africa. Those carrying pathogenic organisms require treatment and follow up to ensure eradication. The results of this survey support the need for routine assessment of newly arrived immigrants from East Africa for intestinal parasites, anaemia and iron deficiency.
The Lancet Regional Health - Western Pacific
Background Previous research identified inequities in all-cause mortality between Maori and non-M... more Background Previous research identified inequities in all-cause mortality between Maori and non-Maori populations. Unlike comparable jurisdictions, mortality rates in rural areas have not been shown to be higher than those in urban areas for either population. This paper uses contemporary mortality data to examine Maori and non-Maori mortality rates in rural and urban areas. Methods A population-level observational study using deidentified routinely collected all-cause mortality, amenable mortality and census data. For each level of the Geographic Classification for Health (GCH), Maori and non-Maori age-sex standardised all-cause mortality and amenable mortality incident rates, Maori:Non-Maori standardised incident rate ratios and Maori rural:urban standardised incident rate ratios were calculated. Age and deprivation stratified rates and rate ratios were also calculated. Findings Compared to non-Maori, Maori experience excess all-cause (SIRR 1.87 urban; 1.95 rural) and amenable mortality (SIRR 2.45 urban; 2.34 rural) and in all five levels of the GCH. Rural Maori experience greater all-cause (SIRR 1.07) and amenable (SIRR 1.13) mortality than their urban peers. Maori and non-Maori all-cause and amenable mortality rates increased as rurality increased. Interpretation The excess Maori all-cause mortality across the rural: urban spectrum is consistent with existing literature documenting other Maori health inequities. A similar but more pronounced pattern of inequities is observed for amenable mortality that reflects ethnic differences in access to, and quality of, health care. The excess all-cause and amenable mortality experienced by rural Maori, compared to their urban counterparts, suggests that there are additional challenges associated with living rurally.
Injury Prevention, 2021
BackgroundKnowledge of fatal injuries is required to inform prevention activities. Where hospital... more BackgroundKnowledge of fatal injuries is required to inform prevention activities. Where hospital patients with an injury principal diagnosis (PDx) died and were certified to a medical underlying cause of death (UCoD), there is the potential to underestimate injury mortality. We sought to characterise injury/non-injury (NI) mismatches between PDx and UCoD by identifying which subgroups had small/large mismatches, and to understand why mismatches had occurred using informative examples.MethodHospital records (n=10 234) with a PDx of injury were linked to the mortality collection using a unique personal identifier. Percentages UCoD coded to a NI were tabulated, for three follow-up periods and by selected variables. Additionally, we reviewed a sample of 70 records for which there was a mismatch.Results%NIs were 39%, 66% and 77% for time from injury to death of <1 week, <90 days and <1 year, respectively. Variations in %NI were found for all variables. Illustrative examples of ...
International Journal of Population Data Science, 2020
IntroductionContact with child protection systems are a key site of the expression of social ineq... more IntroductionContact with child protection systems are a key site of the expression of social inequalities. ‘Child welfare inequalities’ by deprivation have been documented in a number of countries including the United Kingdom. The size and nature of this relationship is sparse in the New Zealand system context. Objectives and ApproachThe integration of data routinely collected by NZ’s Ministry for Children into Statistics NZ’s Integrated Data Infrastructure (IDI) provided the opportunity to examine how child protection data relates to deprivation and location. Anonymised person-level data in the IDI was used to obtain a population-based retrospective sample of children estimated to be resident in NZ in 2013/2014 and less than 17 years of age. Using pre-linked data in the IDI, all children with at least one of three child protection outcomes in 2013/2014 were ascertained. Deprivation was assessed using a small-area level national index derived from census data. The most recent reside...
BMJ Open, 2018
Objective The study aims to quantify the impact of injury on the financial well-being of older wo... more Objective The study aims to quantify the impact of injury on the financial well-being of older workers. The hypothesis was that injured older workers have substantially reduced income from work following injury, but that New Zealand’s (NZ) universal injury compensation scheme mitigates the difference for total income. Design, setting and participants An e-cohort of 617 722 workers aged 45–64 years old was created using de-identified linked administrative data in NZ’s Integrated Data Infrastructure. Person-level data from numerous government agencies were used to compare 21 639 with an injury-related entitlement claim in 2009 with the remaining 596 133. Event date was the date of injury, or for the comparison group, a randomly selected date in 2009. Primary and secondary outcome measures Geometric mean ratios (GMRs) were used to compare income from work and total income from all taxable sources between those injured and the comparison group. Adjusted GMRs estimated income differences...
International Journal for Population Data Science, 2020
IntroductionNew Zealand’s (NZ) workplace fatality record is very poor compared to similar OECD co... more IntroductionNew Zealand’s (NZ) workplace fatality record is very poor compared to similar OECD countries. The reasons for NZ’s poor performance are highly debated yet inadequately informed due to a lack of high quality fatality data. Due to incomplete official data on work fatalities in NZ, it is not currently possible to use routine official data collections to reliably report: i) who is fatally injured due to work activities, and ii) what groups should be prioritised for action. Objectives and ApproachThis study uses coronial records to overcome the limitations of existing official data collections to provide the most complete and detailed evidence platform for occupational safety policy and action in NZ. A work-related fatal injury dataset spanning the period 2005-2014 was created by: 1) identifying possible cases aged 0-84 years from the Mortality Collection using selected external cause of injury codes, 2) linking these to Coronial records and 3) identifying and coding work-rel...
'S0085' Superficial injury of other parts of head 'S010' Open wound of scalp 'S022' Fracture of n... more 'S0085' Superficial injury of other parts of head 'S010' Open wound of scalp 'S022' Fracture of nasal bones 'S023' Fracture of orbital floor 'S024' Fracture of malar and maxillary bones 'S0260' Fracture of the mandible, part unspecified 'S028' Fracture of other skull and facial bones 'S065' Traumatic subdural haemorrhage
Australian Journal of Rural Health, 2021
INTRODUCTION Rural-urban health inequities, exacerbated by deprivation and ethnicity, have been c... more INTRODUCTION Rural-urban health inequities, exacerbated by deprivation and ethnicity, have been clearly described in the international literature. To date, the same inequities have not been as clearly demonstrated in Aotearoa New Zealand despite the lower socioeconomic status and higher proportion of Māori living in rural towns. This is ascribed by many health practitioners, academics and other informed stakeholders to be the result of the definitions of 'rural' used to produce statistics. AIMS To outline a protocol to produce a 'fit-for-health purpose' rural-urban classification for analysing national health data. The classification will be designed to determine the magnitude of health inequities that have been obscured by use of inappropriate rural-urban taxonomies. METHODS This protocol paper outlines our proposed mixed-methods approach to developing a novel Geographic Classification for Health. In phase 1, an agreed set of community attributes will be used to modify the new Statistics New Zealand Urban Accessibility Classification into a more appropriate classification of rurality for health contexts. The Geographic Classification for Health will then be further developed in an iterative process with stakeholders including rural health researchers and members of the National Rural Health Advisory Group, who have a comprehensive 'on the ground' understanding of Aotearoa New Zealand's rural communities and their attendant health services. This protocol also proposes validating the Geographic Classification for Health using general practice enrolment data. In phase 2, the resulting Geographic Classification for Health will be applied to routinely collected data from the Ministry of Health. This will enable current levels of rural-urban inequity in health service access and outcomes to be accurately assessed and give an indication of the extent to which older classifications were masking inequities.
Injury, 2021
INTRODUCTION This paper identifies predictors of subsequent injury (SI) in a cohort of injured Mā... more INTRODUCTION This paper identifies predictors of subsequent injury (SI) in a cohort of injured Māori. Interventions to reduce SI among indigenous populations would help overcome the disproportionate burden of subsequent injury experienced, thereby reducing inequities in injury outcomes and the overall burden of injury. METHODS Interview data from the Prospective Outcomes of Injury Study (POIS) were combined with Accident Compensation Corporation (ACC; New Zealand's universal no-fault injury insurer) and hospital discharge datasets. Any injury event resulting in an ACC claim and occurring within 24 months of the injury for which participants were recruited to POIS was considered an SI. This was regardless of whether it was the same type, region or cause as the original injury or not. Predictors of SI were identified using modified Poisson regression. RESULTS Of 566 participants, 62% (n=349) experienced ≥1 SI in the 24 months following their sentinel injury. Māori whose sentinel injury was an intracranial injury were more likely to sustain an SI compared to those whose sentinel injury was another type. SI was less likely to occur for participants whose sentinel injury was a lower extremity fracture or classified as "Other" (e.g. crush, burn, poisoning). SI were more common among those aged 18-29 years compared to those aged 30-49 years, and less common among those living with family compared to those who were living alone. CONCLUSIONS More research into the circumstances of intracranial injury and SI among Māori is warranted. This would help inform the nature of interventions to prevent SI and the points at which these should be implemented.
Objectives: To develop a valid rurality classification for health purposes in Aotearoa New Zealan... more Objectives: To develop a valid rurality classification for health purposes in Aotearoa New Zealand (NZ) that is technically robust and incorporates heuristic understandings of rurality.Setting: Our Geographic Classification for Health (GCH) is developed for all of NZ.Participants: We examine the distribution of the entire NZ population across rurality classifications, and use the National Mortality Collection to examine previously masked rural-urban differences in mortality. Outcome measures: Unadjusted all-cause mortality rates and rural:urban incidence rate ratios (IRRs). Results: The GCH modifies key population and drive time thresholds in the generic rurality classifications, thereby identifying 19% of the NZ population as rural. Rural and urban all-cause mortality rates and associated rural:urban IRRs vary considerably depending on rurality classification. The GCH finds a rural mortality rate 21% higher than for urban areas.Conclusions: The GCH identifies a distinct rural popul...
Spatial and Spatio-temporal Epidemiology, 2021
Helicopter Emergency Medical Services (HEMS) in New Zealand (NZ) are located at hospitals or airp... more Helicopter Emergency Medical Services (HEMS) in New Zealand (NZ) are located at hospitals or airports near the communities they serve. This may result in suboptimal response times. Timely access to advanced hospital care improves critically injured patients' chances of survival. This study optimised the location of HEMS bases in NZ and compared current versus optimal placement on timely access for surrounding populations. Optimal placement of HEMS bases could result in 113,886 additional people (3% of the population) benefiting from access to advanced hospital care within one hour. Optimal placement would especially benefit indigenous Māori as well as deprived and rural communities.
Occupational and Environmental Medicine, 2019
BackgroundNZ’s workplace fatality record is high compared to similar countries, with a rate twice... more BackgroundNZ’s workplace fatality record is high compared to similar countries, with a rate twice that of Australia and four times that of the UK. The reasons for NZ’s substandard performance are highly debated, and in-depth analysis to inform this debate is limited by a dearth of detailed fatality data. This study aims to inform work-related injury prevention efforts for NZ by: i) enumerating the fatal injury burden; and ii) identifying high risk groups and circumstances to prioritise and target preventive action.MethodsA dataset spanning forty-years of Coronial records was created by collecting data for the period 1995–2014 and appending this to existing data for 1975–1994. Data collection involved: 1) identifying possible cases aged 0–84 years from mortality records using injury external cause codes, 2) linking these to Coronial records 3) retrieving and reviewing records for work-relatedness, and 4) coding work-related cases. Work-related cases were classified as workers, bystan...
Injury Prevention, 2019
IntroductionIt has been commonplace internationally, when using hospital data, to use the princip... more IntroductionIt has been commonplace internationally, when using hospital data, to use the principal diagnosis to identify injury cases and the first external cause of injury code (E-code) to identify the main cause. Our purpose was to investigate alternative operational definitions of serious non-fatal injury to identify cases of interest for injury surveillance, both overall and for four common causes of injury.MethodsSerious non-fatal injury cases were identified from New Zealand (NZ) hospital discharge data using an alternative definition: that is, case selection using principal and additional diagnoses. Separately, identification of cause used all E-codes on the discharge record. Numbers of cases identified were contrasted with those captured using the usual definition. Views of NZ government stakeholders were sought regarding the acceptability of the additional cases found using these alternative definitions. Views of international experts were also canvassed.ResultsWhen using ...
Injury, 2019
Objectives: To describe: 1) settings, activities and types of injuries for an 'initial' (sentinel... more Objectives: To describe: 1) settings, activities and types of injuries for an 'initial' (sentinel) injury and subsequent injuries over 24 months, and 2) concordance between sentinel and subsequent injury events. Methods: Participants (n = 2856) were recruited to the Prospective Outcomes of Injury Study (POIS) following their sentinel injury event, an injury event resulting in an Accident Compensation Corporation (ACC) entitlement claim. Subsequent injuries were those from additional ACC claims in the following 24 months. Injury settings, activities and types were from electronic ACC claims data. The risks of having a subsequent injury of the same type as the sentinel injury were estimated. Results: Overall, 1653 (58%) participants had 3444 subsequent injury events in 24 months, resulting in 4470 injury diagnoses. Twenty one percent had at least one subsequent injury event of the same type as their sentinel injury; 33% with a spine sprain/strain had at least one subsequent spine sprain/strain. Many participants had at least one subsequent injury event at same setting (26%) as their sentinel injury; of note, 36% of participants whose sentinel injury occurred at home had at least one subsequent injury at home. Seventeen percent of participants had at least one subsequent injury involving the same activity as their sentinel injury; 28% of those whose sentinel injury was a result of contact in sport had at least one subsequent injury also involving sport. Conclusions: Subsequent injuries among people presenting to healthcare providers are common. Greater emphasis should be placed on maximising such healthcare provider contact as an injury prevention opportunity.
Injury Prevention, 2016
surveillance. These. The status of the data sources with respect to these data elements was recor... more surveillance. These. The status of the data sources with respect to these data elements was recorded and compared to reporting standards of the ILO, OSHA and ICD10. Results 8 data sources were included. 4 from the Hamad Medical Corporation [HMC], the national health service provider: trauma registry, ambulance service, emergency department [3 hospitals] and mortuary. Other data sources were: Qatar Red Crescent Clinics, Public Works Authority, the Ministry of Labour and Ministry of Interior. The following data elements were collected by all sources: age, sex and nationality. External causes of injury, circumstances and nature of injury were collected by 6 or more sources, occupation by 4 sources, while the documentation of work-relatedness, and injury severity score calculation was only done by 1, the HMC Trauma registry. Conclusions Data collection for the estimation of WRIs in Qatar is not systematic and thus important aspects of injury prevention and safety promotion are overlooked. A mechanism to generate data in compliance with international standards is needed. In the interim, linking these data sources, through ongoing multi-sectoral collaboration will improve the quality of WRI data and inform occupational injury prevention efforts.
PLOS ONE, 2018
Understanding the role of comorbidity in recovery following injury is an important challenge give... more Understanding the role of comorbidity in recovery following injury is an important challenge given the increasing prevalence of multimorbidity (2 or more comorbidities) in many countries. The Prospective Outcomes of Injury Study recruited 2856 injured 18-64 year olds that had registered for entitlements with New Zealand's universal no-fault injury insurer. Recovery, or lack of, in this longitudinal cohort was measured using the World Health Organization Disability Assessment Schedule at 3, 12 and 24 months post-injury. Twenty-one pre-existing chronic conditions were used to identify comorbidity. To investigate whether rates of recovery differed by pre-injury comorbidity, the interaction between time and comorbidity was modelled using Generalised Estimating Equations. Of 1,862 participants with complete data, the distribution reporting none, one comorbidity, or multimorbidity pre-injury was 51%, 27%, and 21% respectively. Longitudinal analysis estimated no difference (log odds per year 0.05, 95% Confidence Interval-0.17 to 0.27) between the rate of change of disability for those with one pre-injury comorbidity compared to those with none. Those with pre-injury multimorbidity had significantly slower reduction in disability over time than those with no pre-injury comorbidity (log odds per year 0.27, 95% Confidence Interval 0.05 to 0.48). In a working age cohort, the rate of recovery in the 24 months following injury was similar for those with none or one pre-existing comorbidity and significantly slower for those with multimorbidity. It is important that further research explores mechanisms driving this, and that researchers and health providers identify and implement better supports for injured people with multimorbidity.
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Papers by Gabrielle Davie