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Massey Magazine Issue 13 November 2002

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Lis Ellison-Loschmann

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 University’s 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. They’re 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.

“We’re 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 place.”

The 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 Health’s 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 education.

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.

 

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