title: Ethnic disparities in infectious disease hospitalisations in the first year of life in New Zealand.
abstract: OBJECTIVE
  Infectious disease (ID) hospitalisation rates are increasing in New Zealand (NZ), especially in pre-school children, and Māori and Pacific people. We aimed to identify risk factors for ID hospitalisation in infancy within a birth cohort of NZ children, and to identify differences in risk factors between ethnic groups.
  
  
  METHODS
  We investigated an established cohort of 6846 NZ children, born in 2009-2010, with linkage to a national data set of hospitalisations. We used multivariable logistic regression to obtain odds ratios (OR) for factors associated with ID hospitalisation in the first year of life, firstly for all children, and then separately for Māori or Pacific children.
  
  
  RESULTS
  In the whole cohort, factors associated with ID hospitalisation were Māori (OR: 1.49, 95% CI: 1.17-1.89) or Pacific (2.51; 2.00-3.15) versus European maternal ethnicity, male gender (1.32; 1.13-1.55), low birthweight (1.94, 1.39-2.66), exclusive breastfeeding for <4 months (1.22, 1.04-1.43), maternal experience of health-care racism (1.60, 1.19-2.12), household deprivation (most vs. least deprived quintile of households (1.50, 1.12-2.02)), day-care attendance (1.43, 1.12-1.81) and maternal smoking (1.55, 1.26-1.91). Factors associated with ID hospitalisation for Māori infants were high household deprivation (2.16, 1.06-5.02) and maternal smoking (1.48, 1.02-2.14); and for Pacific infants were delayed immunisation (1.72, 1.23-2.38), maternal experience of health-care racism (2.20, 1.29-3.70) and maternal smoking (1.59, 1.10-2.29).
  
  
  CONCLUSIONS
  Māori and Pacific children in NZ experience a high burden of ID hospitalisation. Some risk factors, for example maternal smoking, are shared, while others are ethnic-specific. Interventions aimed at preventing ID hospitalisations should address both shared and ethnic-specific factors.
authors.affiliation: Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Hobbs
authors.affiliation: Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand.
authors.forename: Susan Mb
authors.initials: SM
authors.lastname: Morton
authors.affiliation: Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand.
authors.forename: Polly
authors.initials: P
authors.lastname: Atatoa-Carr
authors.affiliation: Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Ritchie
authors.affiliation: Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Thomas
authors.affiliation: Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand.
authors.forename: Rajneeta
authors.initials: R
authors.lastname: Saraf
authors.affiliation: Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
authors.forename: Carol
authors.initials: C
authors.lastname: Chelimo
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Harnden
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Department of Paediatrics, University of Auckland, Auckland, New Zealand.
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Grant
mesh_terms: D003141:Communicable Diseases / Q000453:epidemiology / Q000208:ethnology*; D016208:Databases, Factual; D005260:Female; D054624:Health Status Disparities; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D012307:Risk Factors; D044465:White People
keywords: Māori; Pacific Islanders; ethnic disparity; infant; infection