Nghiem Nhung, Leung William, Doan Tinh
Department of Public Health, University of Otago, 23A Mein Street, Newtown, Wellington, 6021, New Zealand.
College of Health and Medicine, Australian National University, 62 Mills Road, Canberra, ACT, 2601, Australia.
SSM Popul Health. 2022 Aug 15;19:101204. doi: 10.1016/j.ssmph.2022.101204. eCollection 2022 Sep.
Health demoting consumption of alcohol and tobacco are some of the most important risk factors for health loss worldwide, however there is limited information on these consumption risk factors in New Zealand (NZ) and whether inequities in the risk factors are ethnically patterned.
We used three nationally representative Household Economic Survey waves (2006/07, 2009/10, 2012/13) (n = 9030) in NZ to examine household expenditure for key health risk-related components of consumption by ethnicity, and its contributors to the differences using non-parametric, parametric and decomposition methods.
Māori households (NZ indigenous population) were significantly poorer (25% less) than non-Māori households in terms of household per capita expenditure. However, our various econometric estimations suggested that, in relative terms, Māori spent more on tobacco and alcohol, and less on healthcare. The gaps become larger at upper quantiles of the budget share distributions; the composition effect (the gap due to differences in individual and household characteristics between Māori and non-Māori) explains of the tobacco and alcohol budget share gap between the two groups, and less for healthcare. The structure effect (the gap due to returns to/or effect of individual and household characteristics) contributes to the budget share gap for tobacco and drink, but increasingly and predominantly when moving along the distribution of healthcare budget share.The differences between Māori and non-Māori in household ownership, education, and income negatively affect budget share on these health demoting consumption (tobacco and alcohol). The household head's age, education, and employment contributed most to the structure effect.
Our study suggested ethnic inequities in the health risk consumption behaviour are evidenced in NZ. Interventions targeting education and employment that significantly affect household budget shares on risk factors (i.e., harmful consumption) for health loss may help narrow the gaps.
有损健康的烟酒消费是全球健康损失的一些最重要风险因素，然而关于新西兰这些消费风险因素以及这些风险因素中的不平等现象是否存在种族差异的信息有限。
我们使用了新西兰三次具有全国代表性的家庭经济调查数据（2006/07年、2009/10年、2012/13年）（n = 9030），按种族来研究与关键健康风险相关的消费组成部分的家庭支出情况，并使用非参数、参数和分解方法来分析导致差异的因素。
就家庭人均支出而言，毛利家庭（新西兰原住民）比非毛利家庭明显更贫困（少25%）。然而，我们的各种计量经济学估计表明，相对而言，毛利人在烟草和酒精上的支出更多，而在医疗保健上的支出更少。在预算份额分布的较高百分位数处，差距变得更大；构成效应（由于毛利人和非毛利人在个人和家庭特征上的差异导致的差距）解释了两组之间烟草和酒精预算份额差距的 ，而对医疗保健差距的解释较少。结构效应（由于个人和家庭特征的回报/或影响导致的差距）对烟草和饮料的预算份额差距贡献了 ，但在医疗保健预算份额分布中，随着分布的推进，其贡献越来越大且占主导地位。毛利人和非毛利人在家庭所有权、教育和收入方面的差异对这些有损健康的消费（烟草和酒精）的预算份额产生负面影响。户主的年龄、教育和就业对结构效应的贡献最大。
我们的研究表明，新西兰存在健康风险消费行为方面的种族不平等现象。针对教育和就业的干预措施，这些措施会显著影响家庭在导致健康损失的风险因素（即有害消费）上的预算份额，可能有助于缩小差距。
