Ethnic inequality in non‐steroidal anti‐inflammatory drug‐associated harm in New Zealand: A national population‐based cohort study

Abstract

PurposeNon‐steroidal anti‐inflammatory drugs (NSAIDs) are associated with many serious complications and they are widely used in New Zealand (NZ). However, differences in NSAID‐associated risk for these complications between ethnic groups are largely unknown. We assessed ethnic disparities in risk of hospital admission for upper gastrointestinal bleeding (UGIB), heart failure, and acute kidney failure (AKF) in NZ's primary care population prescribed and dispensed NSAIDs.MethodsRetrospective cohort study utilising national pharmaceutical dispensing and hospital admissions data 2007 to 2015. Patient follow‐up included 90‐day periods following the dispensing of NSAIDs. Risk for each adverse outcome in Maori, Pacific, European, and Asian patients was estimated using multivariable Poisson regression adjusting for age, sex, deprivation, comorbidity and concurrent drug use.Results3 023 067 patients were dispensed NSAIDs between 2008 and 2015. Their total intended duration of NSAID treatment encompassed 2 353 140 patient‐years. Maori, Pacific and Asian patients were younger than European patients (all P < .001). After adjusting for other risk factors, Maori (rate ratio: 2.54, 95% confidence interval: 2.23‐2.90) and Pacific patients (3.17, 2.69‐3.74) were more likely to be hospitalised for UGIB than Europeans (reference), and heart failure (Maori: 2.48, 2.24‐2.74; Pacific: 1.97, 1.69‐2.30). Risk of AKF was higher in Maori (1.46, 1.23‐1.74). Higher risk for UGIB and HF in Maori and Pacific patients was most pronounced in males and patients aged <60 years.ConclusionsInequalities exist in the incidence of serious adverse outcomes experienced by different ethnic groups in NZ while using NSAIDs. Interventions to promote safer use of these medicines are required to reduce this inequity.

Restoration of the health system must not neglect medicines – but who has the power of reform?

“…22 Widespread access to NSAIDs has led to ethnic disparities in hospital admissions of Māori and Pacific peoples for serious adverse outcomesincluding upper gastrointestinal bleeding, heart failure, and acute kidney failure. 23 Māori and Pasifika are less often the recipients of medicines optimisation and are paying the price.…”

Māori, pharmacists, and medicines adherence – A mixed methods study exploring indigenous experiences of taking medicines ‘as prescribed’ and mechanisms of support

“…In Aotearoa New Zealand (NZ), inequities in health-related outcomes exist, driven by inequities in the access to determinants of health including quality healthcare. 3 Māori are the Indigenous people of NZ and experience earlier onset of chronic co-morbidity, 3 are prescribed higher numbers of medicines from a younger age, 4 experience higher rates of medicine-related harm, 5 and are less likely to be able to access medicines when disease burden is taken into account compared with non-Māori. 6 Access to appropriate medicine therapy for Māori is likely to improve health outcomes and support the achievement of health equity for Māori.…”

Safer Prescribing and Care for the Elderly (SPACE): a cluster randomised controlled trial in general practice

“…In New Zealand, Māori and Pasifika are more likely to be prescribed NSAIDs than other ethnic groups and have higher rates of associated ADEs and at younger age. 9,10 Trials of interventions to decrease high-risk prescribing in general practice have demonstrated improvements although the quality of evidence is mixed with many studies having short-term follow-up or interventions that are not readily scalable. [11][12][13][14][15][16] One cluster-randomised stepped-wedge trial of a pharmacist-led intervention plus financial incentives found decreased highrisk prescribing of and related ADE hospital admissions, but this trial did not have a true control group.…”

“…In New Zealand, Māori, and Pasifika people are more likely than other ethnic groups to be prescribed NSAIDs, and suffer associated ADEs at higher rates and younger ages. 9 , 10…”