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Kia āta kōwhiri Choosing Wisely

The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

Published articles

What was already known from the gout Atlas domain

The gout Atlas domain showed that Māori (39 percent) and Pacific peoples (33 percent) were less likely to receive allopurinol[1] regularly, compared to the European/Other ethnic group (43 percent).

Non-steroidal anti-inflammatory drugs (NSAIDs)[2] were dispensed to more Māori and Pacific peoples, compared to European/Other people. An NSAID without any allopurinol was dispensed to 21 percent of people with gout, with no significant variation by ethnicity.

Uric acid testing[3] was performed in 60 percent of people who received allopurinol in the previous year. Variation in testing rates was greater between DHBs than between ethnic groups.

What the equity indicators for gout add

Inequity in allopurinol dispensing for Māori and Pacific peoples persists with age-standardised analyses

The Equity Explorer shows that ethnic inequities in allopurinol dispensing for people with gout persist with age-standardisation.

The national Māori to European/Other ratio was 0.88 (this was a significant difference). Due to smaller numbers within individual DHBs, the rate ratio was not significantly different for 15 DHBs. It was significantly lower for five DHBs, and Māori did not have a significantly higher rate of allopurinol dispensing in any DHB.

For Pacific peoples, the national Pacific peoples to European/Other ratio was 0.90: significantly fewer Pacific peoples with gout were dispensed allopurinol compared with European/Other people. Again, most individual DHBs did not show a significant difference.

For Asian people, the national rate ratio of 0.92 was not a significant difference, although four DHBs showed significantly lower allopurinol dispensing for Asian people compared with European/Other people.

At a national level, people in less deprived socioeconomic groups were dispensed more allopurinol than those in more deprived socioeconomic groups. Deprivation analyses also showed wide variation, with the ratio of most/least deprived NZDep quintiles within DHBs varying between 0.36 and 2.04.

For most DHBs, there was no significant inequity in the rate of NSAID dispensing without allopurinol

At a national level, ethnic inequity in those dispensed NSAIDs without allopurinol was not significant: national rate ratios compared with European/Other were 1.01 for Māori, 1.00 for Pacific peoples and 0.87 for Asian people. At a DHB level, the ratio of Māori to European/Other dispensing ranged from 0.5 to 3.39 (with the 3.39 rate a clear outlier). This ratio lacked statistical significance for 16 of 20 DHBs. Pacific (ratio range 0.62–1.76) and Asian (ratio range 0.61–1.25) populations showed less variation in inequity between DHBs (2014 data).

Socioeconomic inequity in NSAID dispensing without allopurinol was not apparent. Ratios of the most/least deprived NZDep quintiles were between 0.47 and 2.87, although only statistically significant for two DHBs. There was no clear relationship between increasing deprivation and dispensing pattern.

Māori, Pacific and Asian people with gout received disproportionately more uric acid testing

At a national level, uric acid testing was significantly more likely to be completed for Māori (ratio 1.17), Pacific (ratio 1.26) and Asian (ratio 1.38) people taking allopurinol. There was a significant positive difference (ratio greater than 1.0) evident in five DHBs for Māori, five DHBs for Pacific peoples and eight DHBs for Asian people, compared with the European/Other ethnic group.

For socioeconomic deprivation, the picture was mixed, with two DHBs showing that people from more deprived areas were more likely to have a uric acid test, and one DHB showing this to be less likely (ratio range 0.72–1.98).

How to use the Equity Explorer

Download the Equity Explorer

Below is a video about how to use the Equity Explorer, including a case study example from Northland DHB.

Notes

  1. Reliever medicines are inhalers that are taken when a person has asthma symptoms (like wheeze or breathlessness) and needs immediate effect. 
  2. Preventer medicines are inhalers or tablets that are taken regularly and long term, to help control asthma and avoid the need for reliever inhalers. 
  3. Ministry of Health. 2015. Annual Update of Key Results 2014/15: New Zealand Health Survey. Wellington: Ministry of Health.
  4. Ibid.
  5. Allopurinol is a medicine that is taken over the long term, to prevent flares (or attacks) of gout. It is usually beneficial for people having more than one flare of gout per year. 
  6. NSAIDs are anti-inflammatory medicines that can control the pain of a gout flare (attack). However, they are not recommended for frequent use because they have many adverse effects. Taking NSAIDs without allopurinol suggests that gout is not controlled. 
  7. A blood test to measure uric acid can show whether medication is working to control gout. High uric acid levels lead to gout. In someone taking allopurinol, uric acid should be measured at least yearly.
Published: 29 Oct 2021 Modified: 2 Dec 2021