Mortality outcomes and inequities experienced by rural Maori in Aotearoa New Zealand

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.Copyright (c) 2022 The Authors. Published by Elsevier Ltd.