The vision of the 2019 Child and Youth Wellbeing Strategy is for Aotearoa New Zealand to be “the best place in the world for children and young people.” Ensuring good health outcomes for children and young people is crucial to realising this vision. While good physical health is intrinsically valuable, it also has knock-on effects for improved educational outcomes, mental wellbeing, and quality of life into adulthood. Moreover, hospitalisations and deaths from physical illness are a barometer of the wider wellbeing of children and young people in Aotearoa.
The following statistics present analyses of the deaths and hospitalisations of children in Aotearoa. These statistics are important, as they highlight the significance of socioeconomic and historical factors in shaping the extent to which babies, children, young people, current and future whānau are able to realise their potential.
All statistics and figures below are reproduced from the Child Poverty Monitor Dec 2019. If further interpretation of these statistics is required, please contact CPAG Health Spokesperson Innes Asher at firstname.lastname@example.org
Hospitalisation rates of under-15 year olds for medical causes have risen from 50.2 hospitalisations per 1,000 age-specific population in 1991 to 77.8 hospitalisations per 1,000 age-specific population in 2018. Hospitalisation rates for injury in this age group rose between 1991 and 1994 (from 14.1 to 18.6 hospitalisations per 1,000 age-specific population) and have since fallen to 10.3 hospitalisations per 1,000 age-specific population in 2017 (Figure 1).
There was a social gradient in all-cause hospitalisation rates (medical causes and injury) in under-15 year olds from 2000–2018, with hospitalisation rates increasing with increasing NZDep (NZ index of deprivation) scores (Figure 2).
Since 2000, the gap for medical condition hospitalisations has been widening between under-15 year olds living in areas with the highest deprivation scores (quintile 5) and those in areas lower deprivation scores (Figure 3). Children in all quintiles have seen an overall increase in medical condition hospitalisations since 2008.
There was an overall decline in injury hospitalisation rates for under-15 year olds and the gap between children in quintile 1 (least deprived) and those in quintiles 2–5 (more deprived) has been narrowing (Figure 3).
From 2000, Pacific children experienced consistently higher hospitalisation rates for medical conditions when compared to their peers of other ethnic groups (Figure 5) which is reflected in the higher rate of all-cause hospitalisation for this group of children (Figure 4). Since 2000, all-cause hospitalisation rates have widened overall, particularly when comparing hospitalisation rates for Māori and Pacific children with those of European/Other ethnicity (Figure 4).
In the five years from 2014–2018, there were 345,492 all-cause hospitalisations of under-15 year olds, of which 218,681 were in those aged 0–4 years at a rate of 135 per 1,000 population (Figure 6).
Children of Pacific and Middle Eastern, Latin American and African (MELAA) ethnic groups experienced significantly higher hospitalisation rates when compared to other ethnic groups, while European/Other children had the lowest of all groups.
All-cause hospitalisation rates were significantly different by deprivation score, with under-15 year olds living in areas with the highest deprivation scores (most deprived, quintile 5) experiencing twice the hospitalisation rate of those living in areas with the lowest deprivation score (quintile 1).
This univariate analysis is not able to quantify the independent effect of each demographic factor.
From the five years between 2014 and 2018, hospitalisation rates for selected respiratory and communicable diseases with a social gradient were highest for the youngest children (aged between 0 and 1 years) and declined steeply for children over the age of 1 before a gradual decline with increasing age (Figure 7). Respiratory infections had the highest hospitalisation rates in 0–1 year olds and asthma and wheeze contributed to the highest rates among children aged two years and older.
Respiratory system diseases saw the steepest social gradient by deprivation score of all medical conditions and injuries (Figure 8, Figure 9), with 13.6 hospitalisations per 100,000 for children in areas with the lowest deprivation scores (quintile 1) compared to 42.2 hospitalisations per 100,000 for children in areas with the highest deprivation scores (quintile 5). The hospitalisation rate for respiratory conditions was three times as high for children in areas with the highest deprivation scores compared with those living in areas with the lowest deprivation scores (quintile 5). There were also significant social gradients by deprivation score for infectious and parasitic diseases, falls, and inanimate mechanical forces, with hospitalisation rates higher for children in areas with the highest deprivation scores (quintiles 4 and 5) when compared to quintile 1. Higher injury rates for children living in areas with high deprivation scores may be associated with unsafe housing, poorly enforced tenant protection laws, less access to safe spaces to play, and poor maintenance of recreational facilities.
Of the respiratory system diseases, bronchiolitis had the largest equity gap between children in the most deprived areas (quintile 5) compared to children in the least deprived areas (quintile 1), with quintile 5 experiencing rates of hospitalisation nearly five times of those in quintile 1 in 2018, a difference which has been widening since 2000 (Figure 10).
Rates for asthma and wheeze have been increasing overall for each quintile from 2000–2018, with the gap between children in the most deprived area (quintile 5) and all other quintiles widening over time (Figure 11). Rates for asthma and wheeze in children living in the most deprived areas are over two times the rates seen in the least deprived areas.
The gap in hospitalisation rates for pneumonia between children in the most deprived areas (quintile 5) and all other quintiles narrowed marginally from 2000–2018; however children in quintiles 1–4 continue to experience much lower hospitalisation than those in quintile 5 (Figure 12). Hospitalisation rates for acute respiratory infections were overall stable from 2000 until 2008, when rates began increasing for children in every quintile while increasing most steeply for those in more deprived areas (quintiles 4–5) (Figure 13).