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New Respiratory Disease Report Highlights Back-to-school Asthma Risk And Inequity For Pasifika And Māori

A new report on New Zealand’s respiratory health shows that huge inequity persists in terms of asthma and other respiratory disease. 'The Impact of Respiratory Disease in New Zealand: 2020 update', commissioned by the Asthma and Respiratory Foundation (ARFNZ) and authored by Dr Lucy Telfar-Barnard and Jane Zhang, finds:

- Hospitalisation for bronchiectasis, childhood bronchiolitis and total respiratory disease on the rise

- Pacific hospitalisation rates highest across all respiratory disease except for asthma and COPD, where Māori rates are higher

- Māori have the highest respiratory disease mortality

- Economic deprivation is a major factor in respiratory disease

- Return-to-school period greatly increases risk of respiratory hospitalisation for children

- 2020 COVID-19 pandemic measures substantially reduced respiratory disease rates.

Letitia Harding, ARFNZ Chief Executive says, "Chronic and serious respiratory illness continues to be a massive health burden to New Zealand, costing an estimated $6.68bn and accounting for 1 in 10 of all 2019 overnight hospitalisations, with Pacific peoples and Māori sharing the highest burden."

Pacific hospitalisation rates were highest across all indicators except for asthma and COPD, where Māori rates were higher. Māori had the highest mortality rates for total respiratory disease, asthma and COPD; bronchiectasis and childhood pneumonia mortality rates were highest in Pacific peoples.

"It is clear that the Pacific and Māori populations are suffering disproportionately," says Joanna Turner, ARFNZ Research and Education Manager. "It’s vital that we have targeted information and resources for these groups, and we have been working hard to produce our key respiratory resources in Te Reo and Samoan. We are also in the process of getting them translated into Tongan."

Socio-economic deprivation was also a major risk factor. Differences between the most and least deprived quintiles ranged from a rate ratio of 2.0 for childhood pneumonia, to 4.9 for adult COPD. While differences across the first four quintiles were not always significant, all categories showed major differences between the fourth and fifth (most deprived) quintile.

The report also found a surprising ‘back-to-school' effect in children’s asthma. In weeks 3 and 4 of term 1, the risk of hospitalisation from respiratory disease greatly increased, peaking during week 3 at three times the risk of the first day of term.

"We will be investigating what measures might reduce the impact of the return to school on children’s asthma exacerbations," says Letitia. "But what we do know is this is an important issue to address, and that the report shows that the back-to-school effect is even more dramatic than the winter effect when it comes to children’s respiratory disease. Investing funding into educating children on asthma at school is a huge focus for the Foundation, and shows that the delivery of the Sailor Asthma Shows, both in te reo Māori and in English, is more important than ever.

"It’s important to note that three of the report’s recommendations are unchanged from when the last report was published two years ago," adds Letitia. "Urgent programmes to reduce severe ethnic and socio-economic inequality; targeted programmes for at-risk communities, and research into the prevalence of obstructive sleep apnoea are all vital, and the fact these recommendations have to be reiterated two years down the line indicates that more urgent action is required."

New recommendations in the report include initiatives to improve housing quality and warmth, and further research to identify elements of the COVID-19 pandemic response that could reduce respiratory illness on an ongoing basis.

"COVID-19 pandemic management measures greatly reduced overall respiratory infection, which made the 2020 figures unrepresentative of usual trends," says ARFNZ Medical Director Dr James Fingleton. "We must learn lessons from this to reduce the burden of infectious respiratory diseases long term.

"Most importantly, the massive and persistent inequity of outcomes for Māori and Pacific peoples highlights the failure of our current systems. This report includes concrete recommendations that would reduce death and suffering in Aotearoa New Zealand. We hope the new Māori Health Authority will be able to commission services that will target these inequities and look forward to working with them and Health NZ to improve this in the future."

'The Impact of Respiratory Disease in New Zealand: 2020 update' is launched today and is available on the ARFNZ website at asthmafoundation.org.nz/research. Read the one-page summary here.

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