About Counties Manukau District Health Board

Hospital care

Admission to hospital is usually a negative indicator of health for communities – the lower the rate (assuming adequate access) the likely healthier the population is. In 2007 in public hospitals there were 101,600 hospitalisations of CMDHB residents, just on 71,000 of which were medical-surgical (the rest being maternity, mental health, and health of older people).  Manurewa had the most medical-surgical hospitalisations (Figure ‎1.12), followed by Mangere.  Indeed Manurewa had the highest number in every age group apart from the 75+ where its 1500 hospitalisations were eclipsed by the 2400 from Howick Pakuranga.

Each ward has distinctive patterns of hospitalisations by ethnicity, as seen in Figure ‎1.13.  Manurewa had the highest number of Maori medical-surgical hospitalisations in 2007 (4050), while Mangere had the most Pacific (6530), Papatoetoe the most Asian (1540) and Howick/Pakuranga the most European/Other (7420).

On average for the years 2005 to 2007 there were 59,000 medical-surgical hospitalisations in public hospitals for CMDHB residents aged  0-74 years, making up 87% of all hospitalisations.  Hospitalisations can be divided into those thought to be potentially avoidable (PAH) by medical or public health interventions and those less avoidable.  Of the 59,000 0-74 year old hospitalisations, 19,000 would be classified as PAH – that is 32% of all hospitalisations.  

Figure ‎1.14 shows hospitalisation rates for children (ages 0-14) for CMDHB for the 3 years 2005-2007.  The hospitalisations have been divided into those considered potentially avoidable and those not (with 95% confidence intervals for the combined total).  The line, based on the right-hand axis, shows the percentage of all 0-14 year old hospitalisations in each area that would be considered PAH, with the CMDHB average being 45%.  The relatively less deprived suburbs of Howick/Pakuranga and Botany/Clevedon have significantly lower rates of child hospitalisations than all the other areas.  The proportion of hospitalisations that are PAH is also the lowest in those two areas.  Mangere and Papatoetoe have significantly higher hospitalisation rates than all other areas including Otara, even though Otara has the equal highest PAH proportion (with Mangere) at 51%.  Overall the equivalent of 12% of all children in CMDHB are hospitalised in any one year, ranging from 7.5% in Howick/Pakuranga to 15.6% in Mangere[6].  In any one year in CMDHB there are over 6000 child hospitalisations that could be considered potentially avoidable – approaching 18 per day.  If all areas had the same rate as Howick/Pakuranga this rate would more than halve to around 8 per day – 3,500 less hospitalisations.

The area pattern is similar for adults (Figure ‎1.15), with Howick/Pakuranga and Botany/Clevedon having significantly lower rates of hospitalisation than all the other areas.  Franklin also has lower rates than the others.  The overall rate of PAH at 29% is lower than seen for children, but the pattern is the same across the wards.  Overall the equivalent of 14.5% of all adults aged 15-74 in CMDHB are hospitalised in any one year, ranging from 8.8% in Botany/Clevedon to 19.4% in Mangere[6].  In any one year in CMDHB there are over 12,000 adult hospitalisations that could be considered potentially avoidable – around 35 per day.  If all areas had the same rate as Howick/Pakuranga this rate would halve to around 18 per day – 6,000 less hospitalisations.

Ischaemic heart disease

The single largest cause of PAH is that relating to lack of oxygen to the heart muscle – angina through to heart attacks, collectively described here as ischaemic heart disease (IHD).  The same broad pattern as all PAH is shown in Figure ‎1.16, but Papatoetoe stands out more with a significantly higher rate than any other ward.  It is likely that this is due the large Indian community in Papatoetoe.  Indians have a high rate of diabetes and IHD, and seem to have good access to services.[7]

Housing-related PAH

For the evaluation of the Healthy Housing programme in CMDHB an indicator for hospitalisations that might be potentiated by bad housing conditions was developed.  It consists of various respiratory and infectious disease causes from the potentially avoidable hospitalisations (PAH) list, and is labelled HrPAH for housing-related PAH.  A similar pattern to that of overall PAH is shown, but it is more exaggerated, with a nearly 5-fold difference between the least deprived and most deprived areas.  Franklin shows up relatively well.