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What was already known from the asthma Atlas domain

Approximately 5000 children a year are admitted to hospital due to asthma or wheeze. There was a three-fold variation in admission between district health boards (DHBs). Māori (6.6/1000 population) and Pacific (12/1000 population) children had higher admission rates than the ethnic group ‘Other’ (3.6/1000 population). Younger children were more likely to be admitted than older children.

A higher proportion of Māori and Pacific peoples were dispensed relievers[1] than the ‘Other’ ethnic group (119/1000, 111/1000 and 99/1000 respectively). Younger (0–14-year-olds), older (over 65-year-olds) and female populations were also dispensed more relievers.

A lower proportion of Pacific peoples (68/1000) received preventer medicine[2] compared with the ‘Other’ ethnic group (81/1000) (despite higher admissions). Older adults (65+ years) and females were dispensed more preventer medicines.

What the equity indicators for asthma add

Māori, Pacific and socioeconomically deprived children are disproportionately more likely to be admitted to hospital for asthma

Asthma reliever inhalers were slightly more likely to be dispensed to Māori and Pacific peoples

There was wide variation in the dispensing of asthma preventer medicine between socioeconomic groups in some DHB areas

Māori, Pacific and socioeconomically deprived children are disproportionately more likely to be admitted to hospital for asthma

Variation in childhood hospital admissions was seen between DHBs, ethnic groups and socioeconomic groups.

Inequity between ethnic groups largely reflected that of the asthma Atlas domain. Rates for Māori ranged between 0.71 and 2.69 times that of European/Other ethnic group, depending on the DHB. In half of our DHBs, the rate ratio for Māori children was significantly higher (worse) than for European/Other children. For Pacific children, the rate ratio was 1.39–4.38. This means that Pacific children had higher admission rates than European/Other children in all DHBs where the Pacific rate could be reported, and the rate was over four times higher in one DHB. Asian children had less inequity compared with European/Other children, with admission ratios of 0.79–1.61 (2014 data)

At a national level, it is clear that childhood asthma admissions disproportionately affect children in more deprived quintiles. Deprivation analyses were more difficult to interpret at a DHB level: low numbers meant we were not able to report some quintile rates. In several DHBs, the less deprived quintiles did not have sufficient childhood asthma admissions to show the rate in the Explorer.

Asthma reliever inhalers were slightly more likely to be dispensed to Māori and Pacific peoples

In 13 DHBs, Pacific peoples were less likely to be dispensed reliever inhalers (2014 dispensing ratios compared with the European/Other ethnic group were 0.79–1.48). Overall, the national dispensing ratio for Pacific peoples was 1.05: Pacific peoples were slightly more likely to be dispensed reliever inhalers. However, Pacific peoples (and Māori) are noted to have higher asthma rates[3], so this is a notable inequity.

In all DHBs, Māori were more likely to be dispensed reliever inhalers than the European/Other ethnic group (2014 DHB ratios were 1.02–1.28). This is consistent with the asthma Atlas domain and the higher asthma prevalence for Māori. Asian people were less likely to be dispensed relievers, which is consistent with lower asthma prevalence[4]. There was little variation in ethnic group ratios over time; those DHBs with wide variation tended to have wide variation over the five years of analysis.

Analyses by socioeconomic deprivation showed there was very wide variation, with the DHB ratio of most/least deprived NZDep2013 quintile ranging between 0.89 and 8.94.

There was wide variation in the dispensing of asthma preventer medicine between socioeconomic groups in some DHB areas

In nearly every DHB, a significantly higher proportion of Māori were dispensed a preventer medicine, and a significantly lower proportion of Asian people were dispensed a preventer, compared with the European/Other population (ratios of 0.98–1.33, and 0.55–0.93 respectively). For Pacific peoples, the inequity in preventer dispensing varied by DHB (ratio 0.63–1.29) (2014 data).

There was minor fluctuation in the numbers over the five years of data. Few ethnic groups changed ‘position’ within their DHB over this time. This indicates that in those DHBs where ethnic inequities in asthma prescribing existed, they were generally persistent over time.

Deprivation analyses also showed very wide variation. The ratio of most/least deprived NZDep2013 quintile ranged between 0.83 and 8.02 across the 20 DHBs.

Limitations

Asthma reliever and preventer dispensing is a difficult indicator to interpret because the correct rate is not clear. It will vary by prevalence. The amount of dispensing will depend on the number of doses per inhaler, which is between 60 and 200 doses. There are also practical factors such as being dispensed inhalers for different settings – such as having one at school and one at home.

How to use the Equity Explorer

Below is a video about how to use the Equity Explorer, including a case study example from Northland DHB.


Notes

  1. Reliever medicines are inhalers that are taken when a person has asthma symptoms (like wheeze or breathlessness) and needs immediate effect. 
  2. Preventer medicines are inhalers or tablets that are taken regularly and long term, to help control asthma and avoid the need for reliever inhalers. 
  3. Ministry of Health. 2015. Annual Update of Key Results 2014/15: New Zealand Health Survey. Wellington: Ministry of Health.
  4. Ibid.

Last updated 11/10/2019