title: Geographic, ethnic and socioeconomic factors influencing access to implantable cardioverter defibrillators (ICDs) in New Zealand.
abstract: BACKGROUND
  We examined equity of access to implanted cardioverter defibrillators (ICDs) in New Zealand in 2010 by district health board (DHB), ethnicity and socioeconomic status.
  
  
  METHODS
  All new ICD recipients in 2010 were examined according to home district health board, ethnicity according to the national health database, and socioeconomic status using the NZDep index.
  
  
  RESULTS
  During 2010, 352 new ICDs were implanted nationwide, giving an overall implantation rate of 80.6/million. However, implant rates varied significantly across the 20 DHBs with the highest implant rate observed in Tairawhiti at 192.3/million, and the lowest at 22/million in the Nelson region. There was also significant variation in implant rate by ethnicity, with Maori ethnicity at an implant rate of 114/million, European patients at 83/million, Pacific Island patients at 47/million and Asian patients an implant rate of 32/million. There was no significant difference in number of implants by socioeconomic decile.
  
  
  CONCLUSIONS
  The variance in implantation rate by district health board and by ethnicity suggests that access to ICD therapy is not equitable in New Zealand. Investigation into causes of inequity of access is required.
authors.affiliation: Wellington Cardiovascular Research Group, Wellington Hospital, University of Otago, Wellington South, New Zealand.
authors.forename: David
authors.initials: D
authors.lastname: Wilson
authors.forename: Scott A
authors.initials: SA
authors.lastname: Harding
authors.forename: Iain
authors.initials: I
authors.lastname: Melton
authors.forename: Nigel A
authors.initials: NA
authors.lastname: Lever
authors.forename: Martin K
authors.initials: MK
authors.lastname: Stiles
authors.forename: Dean
authors.initials: D
authors.lastname: Boddington
authors.forename: Spencer
authors.initials: S
authors.lastname: Heald
authors.forename: Peter D
authors.initials: PD
authors.lastname: Larsen
mesh_terms: D016208:Databases, Factual; D017147:Defibrillators, Implantable; D005260:Female; D006297:Health Services Accessibility / Q000941:ethics*; D006801:Humans; D008297:Male; D009520:New Zealand; D044469:Racial Groups; D012189:Retrospective Studies; D012959:Socioeconomic Factors