Ethnic disparities in asthma treatment and outcomes in children aged under 15 years in New Zealand: analysis of national databases.
BACKGROUND
Mãori and Pacific children experience poorer outcomes relating to asthma management than other ethnicities.


OBJECTIVE
To measure recommended treatment and outcomes for asthma in all New Zealand children by age, sex, and ethnic group.


METHODS
Children aged <15 years dispensed >2 asthma medicines (N=80,514) were identified from the national pharmaceutical claims database. We measured the number of children dispensed oral steroids >2 times and hospital admissions with a primary diagnosis of asthma and compared asthma treatment steps and hospitalisation by age and ethnicity.


RESULTS
16.0% of children were dispensed asthma medicines, 9.2% were dispensed medicine >2 times, 3.6% of children were hospitalised at least once for asthma and 98.9% of admissions were acute. Mãori (OR 1.46, 95% CI 1.41 to 1.51) and Pacific children (OR 2.38, 95% CI 2.28 to 2.47) were more likely to remain on the lowest step of treatment. At all steps of treatment, Mãori and Pacific children had higher rates of oral steroid use. In all age groups, more Mãori children (5.1%, OR 1.88, 95% CI 1.73 to 2.04) and Pacific children (5.6%, OR 2.05, 95% CI 1.84 to 2.29) were hospitalised for asthma than children of other ethnicities (2.8%).


CONCLUSIONS
Mãori and Pacific children are less likely to have their treatment escalated to a higher step than other children. They are also more likely to use oral steroids to control asthma exacerbations and be admitted to hospital for severe asthma episodes. New Zealand databases can be used to monitor these outcomes.
Best Practice Advocacy Centre, Dunedin, New Zealand.
Todd D
TD
Gillies
Andrew M
AM
Tomlin
Susan M
SM
Dovey
Murray W
MW
Tilyard
D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D044382:Population Groups / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*
D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D020024:Leukotriene Antagonists