Applying the polio model to New Zealand: The contingent role of socioeconomic status in infectious disease mortality

Objectives

The traditional polio model depicts a positive relationship between the disease and socioeconomic status (SES), with higher SES associated with exposure to the poliovirus beyond infancy/early childhood and a higher mortality rate. This study uses occupation data from non-Māori New Zealand death registrations and the Census to assess evidence for differential mortality by SES during the polio epidemics of 1916, 1924–25, and 1936–37.

Materials and Methods

Polio deaths were classified by father's occupation using the Caversham Project scheme, which includes nine collapsible urban occupational strata and codes rural occupations separately. Evidence for differential mortality and differences in age at death between rural and urban areas and among urban occupational strata was assessed using nonparametric Mann–Whitney U, Kruskal–Wallis, Jonckheere-Terpstra, and chi-square tests.

Results

There was limited evidence of either differential mortality or differences in age at death among collapsed urban strata, mainly in 1924/25, only partially meeting the expectations of the traditional polio model. For 1916 only, the rural group had a higher proportion of deaths (χ² (1, n = 95) = 8.341, p = 0.0039, φ = 0.30)) and higher age at death (U = 828.00, p = 0.026, r = −0.23).

Discussion

These results suggest that rural New Zealand was more isolated from poliovirus infection prior to 1916, but thereafter rural and urban groups faced more similar exposure patterns and mortality—at least among non-Māori. The degree to which occupational categories reflect conditions of exposure requires further research.