Mäori asthma still worst
While asthma mortality and hospitalisation
rates have generally declined in the past 38 years, Mäori continue
to experience more severe asthma, and have a higher number of hospital
admissions for asthma, than non-Mäori, new research by the
Universitys Centre for Public Health Research has shown.
Mäori health research training fellow Lis Ellison-Loschmann
studied asthma deaths in Mäori and non-Mäori from 1962-98,
and asthma hospitalisations during 1976-98. Mäori had been
affected disproportionately by the asthma epidemics of the 60s and
70s, when peak mortality rates were twice that of non-Mäori.
Those rates declined following restriction on the use of inhaled
drugs isoprenaline forte and fenoterol, and are now similar to non-Mäori.
Ms Ellison-Loschmann says although Mäori and non-Mäori
mortality rates have now drawn even, Mäori hospitalisation
rates remained substantially higher than non-Mäori until 1987,
and still remain disproportionately high today.
A major reason for this imbalance is differential management of
asthma and inadequate access to primary health services.
Although urban and rural Mäori suffer equally from asthma,
those Mäori living in remote rural populations are likely to
have poorer access to primary health treatment. Theyre also
likely to have poorer access to the education programmes that could
enable them to effectively manage their asthma.
Ms Ellison-Loschmann says understanding the causes for the difference
in severity between Mäori and non-Mäori could be significant
in explaining asthma prevalence rates among adult Mäori.
Were finding asthma prevalence in Mäori and non-Mäori
children is often similar, but prevalence is greater in adult Mäori
and does not decrease with age as it does with non-Mäori. The
reasons for this are unclear but one possible explanation is that
asthma symptoms are being prolonged or exacerbated in Mäori
because of environmental exposures, such as tobacco smoke, or inappropriate
management, such as the under prescribing of preventive medications,
as well as problems in getting access to health care in the first
importance of issues relating to service access are consistent with
earlier findings from the Mäori Asthma Review undertaken in
1990. The Review recognised that problems of access to care might
be particularly acute in rural areas and Ms Ellison-Loschmann is
currently completing a project looking at regional differences in
asthma hospitalisation rates. She is also undertaking a Health Research
Council-funded study of factors that influence disease severity
and access to health care in Mäori teenagers with asthma.
Ms Ellison-Loschmann says the Ministry of Healths Asthma Working
Group asthma strategy for District Health Boards recommended an
integrated approach to asthma services and the need to address the
issue of access to treatment and improved education. The Mäori
Asthma Review also identified the need for a yet-to-be-implemented
national asthma strategy for Mäori asthma services and asthma
Ms Ellison-Loschmann says that the present move to District Health
Boards could be in conflict with that national approach because
most of the available evidence suggests no strong regional differences
in Mäori asthma prevalence and morbidity.
The economic burden of asthma to New Zealand has been conservatively
estimated as $800 million per annum. About 600,000 people are affected.