Inequalities in mortality during and after restructuring of the New 
Zealand economy: repeated cohort studies

Tony Blakely, Martin Tobias, June Atkinson. BMJ. Published online Jan 24, 2008.

Abstract

Objectives To determine whether disparities between income and 
mortality changed during a period of major structural and 
macroeconomic reform and to estimate the changing contribution of 
different diseases to these disparities.

Design Repeated cohort studies.

Data sources 1981, 1986, 1991, 1996, and 2001 censuses linked to 
mortality data.

Population Total New Zealand population, ages 1-74 years.

Methods Mortality rates standardised for age and ethnicity were 
calculated for each census cohort by level of household income. 
Standardised rate differences and rate ratios, and slope and relative 
indices of inequality (SII and RII), were calculated to measure 
disparities on both absolute and relative scales.

Results All cause mortality rates declined over the 25 year study 
period in all groups stratified by sex, age, and income, except for 
25-44 year olds of both sexes on low incomes among whom there was 
little change. In all age groups pooled, relative inequalities 
increased from 1981-4 to 1996-9 (RIIs increased from 1.85 (95% 
confidence interval 1.67 to 2.04) to 2.54 (2.29 to 2.82) for males 
and from 1.54 (1.35 to 1.76) to 2.12 (1.88 to 2.39) for females), 
then stabilised in 2001-4 (RIIs of 2.60 (2.34 to 2.89) and 2.18 (1.93 
to 2.45), respectively). Absolute inequalities were stable over time, 
with a possible fall from 1996-9 to 2001-4. Cardiovascular disease 
was the major contributor to the observed disparities between income 
and mortality but decreased in importance from 45% in 1981-4 to 33% 
in 2001-4 for males and from 50% to 29% for females. The 
corresponding contribution of cancer increased from 16% to 22% for 
males and from 12% to 25% for females.

Conclusions During and after restructuring of the economy disparities 
in mortality between income groups in New Zealand increased in 
relative terms (but not in absolute terms), but it is difficult to 
confidently draw a causal link with structural reforms. The 
contribution of different causes of death to this inequality changed 
over time, indicating a need to re-prioritise health policy accordingly.

http://www.bmj.com/cgi/content/full/bmj.39455.596181.25v1

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