Reducing ethnic inequities: Patterns of asthma medication use and hospital discharges in Māori in Aotearoa New Zealand

Background and objective: In Aotearoa New Zealand (NZ) widespread transition to budesonide/formoterol maintenance and/or reliever regimens in clinical practice is temporally associated with reduced rates of asthma hospitalization. It is unknown whether this association is observed in Māori, the indigenous population of NZ, who experience a disproportionate burden from asthma. We investigated patterns in asthma medication use and hospital admissions in Māori in NZ.

Methods: Review of NZ national dispensing data for asthma inhaler medications and asthma hospital discharge data from January 2013 to December 2023 in the 12+ age group, with calculation of the relative change in dispensed medication and asthma hospitalization rates for Māori and non-Māori. The most recent six-month period, July to December 2023, is compared with the corresponding six-month period 4 years earlier, July to December 2019.

Results: Budesonide/formoterol dispensing increased for both Māori and non-Māori for 2019-2023, with a relative 111% and 115% increase, respectively. Between the two periods, asthma hospital discharges reduced from 142.5 to 97.3 per 100,000, absolute difference 45.2 per 100,000, a 32% reduction for Māori; and 49.4-37.9 per 100,000, absolute difference 11.5 per 100,000; a 23% reduction for non-Māori.

Conclusion: The temporal association between a marked increase in dispensing of budesonide/formoterol maintenance and/or reliever regimens and reduced asthma hospitalization was observed for Māori and non-Māori, with a greater reduction in asthma hospitalization for Māori. Despite this reduction in health inequities, asthma hospitalization rates are two and a half times greater for Māori compared to non-Māori.