ETHNIC-DIFFERENCES IN CORONARY HEART-DISEASE CASE-FATALITY RATES IN AUCKLAND

Data from the Auckland Coronary or Stroke (ARCOS) study for the years 1983 to 1992 were analysed to describe 28-day case fatality fates from coronary heart disease among Europeans, Maori and Pacific Islands peo ple in Auckland, New Zealand. The case fatality rate was consistently higher in each age group and for both sexes among Maori and Pacific Is lands people than in Europeans. Age-standardised case fatalities for M aori and Pacific Islands people were similar at around 65 per cent, co mpared with around 45 per cent among Europeans, and these differences were not explained by ethnic differences in possible underreporting of nonfatal myocardial infarction, in socioeconomic status, smoking, sym ptoms or past myocardial infarction. There was evidence of a more rapi d progression of acute coronary events to a fatal outcome among Maori and Pacific Islands people. partly explained by delays in access to li fe support and coronary care: greater proportions of Pacific Islands p eople than Maori or Europeans who died did so within an hour of onset of symptoms (56 per cent of Pacific Islands people, 47 per cent of Mao ri, 45 per cent of Europeans). Pacific Islands and Maori people with a cute coronary events took longer to reach a coronary care unit (mean t imes: Pacific Islands people 8.6 hours, Maori 7.4 hours, Europeans 6.7 hours, P < 0.05), although the median times were not significantly di fferent; life-support units were used by a majority of Pacific Islands people and Europeans (57 per cent and 55 per cent, respectively), com pared with only 46 per cent of Maori, but hospital care was similar fo r the three groups. Further qualitative and quantitative research is n eeded to investigate the reasons for these ethnic disparities in case fatality rates.