Covid 19: New model shows Māori, Pasifika at higher risk of hospitalisation

Māori and Pacific people are more than twice as likely to be hospitalised for Covid-19, finds new research that’s prompted a call to officials currently prioritising vaccine shots.

Experts have previously warned Māori and Pacific people are at higher risk – partly because of healthcare inequity – but fresh modelling by Te Punaha Matatini researchers has put that danger into numbers.

Using a mix of data covering age, deprivation, pre-existing health conditions and the clinical outcomes of more than 1800 Covid-19 cases reported in New Zealand, the researchers were able to break down risk of hospitalisation by ethnicity.

After controlling for age and pre-existing conditions, they showed Māori were two and a half times more likely to need hospital care than non-Māori – while the risk for Pacific people was even greater, at three times higher.

Last May, modelling by the group showed unequal access to healthcare could pose a major risk to poorer communities if Covid-19 surged in New Zealand.

That suggested that, among people with good access, three quarters of cases would be detected.

But for those with poor access, as little as five per cent of cases – or only the most severe ones – would be picked up.

Professor Michael Plank, a co-author of the new paper, said hospitalisation rates by ethnicity couldn’t be modelled at that time because there wasn’t enough data.

“However, the Auckland August outbreak gave us a whole lot of additional data that allowed us to compare.”

While overseas outbreaks had offered plenty of insight into how hospitalisation risk increased rapidly with age, how those impacts related to ethnicities here hadn’t been well understood to date.

The new modelling, led by the University of Canterbury’s Nic Steyn, didn’t apply a catch-all risk to every Māori or Pacific person.

The researchers noted they didn’t have a large enough sample sized to estimate the effect of individual health conditions, or combinations of conditions.

A healthy Māori person, for instance, had the same Covid-19 hospitalisation risk as a NZ European person aged over 21, while a healthy Pacific person was just as vulnerable to others aged over 25.

But there were broad factors to consider.

Māori and Pacific people were more likely to have underlying health conditions, which put them at even higher risk of hospitalisation.

“Māori are more likely to experience multiple health conditions and this could exacerbate the risk of clinically severe outcomes from Covid-19,” the researchers said in the report, which has been published online ahead of peer review.

The virus could also spread quickly in communities with higher levels of workplace or community interaction, crowded housing, insecure employment – and poorer access to healthcare or testing.

Those were frequently the same communities at higher risk of hospitalisation and fatality if infected – meaning there was an extra potential burden.

The researchers added that, because testing rates were much higher in the second August outbreak than in the first outbreak in March and April 2020, more mild cases of Covid-19 would have been identified.

“As this second outbreak disproportionately affected Pacific and Māori people, the model may underestimate their relative risk of hospitalisation.”

They further noted the model was fitted to data from a period in New Zealand, in which Covid-19 was at low levels and there was enough capacity in the health system.

“Structural biases and systemic racism within the healthcare system could further exacerbate inequities in outcomes if Covid-19 prevalence increased and healthcare capacity was overstretched.”

They concluded that New Zealand’s Covid-19 response should include measures to protect high-risk groups, and prevent “large-scale inequities” that would be seen if the virus was able to run rampant.

“Our results also have clear implications for identifying priority groups for vaccination against Covid-19, for which planning is currently underway,” they said.

“They demonstrate that it will be essential to account for ethnicity when targeting vaccination to age groups based on their risk of clinically severe infection.”

The Government has outlined its first priority for the roll-out will be border workers and essential workers, who are expected to get the vaccine in the second quarter of this year.

Those workers include the border and MIQ workforce, the Covid-19 frontline healthcare workers and their household contacts.

The plan is to then vaccinate the rest of the general public throughout the second half of next year, dependent on speed of manufacture and sign-off from Medsafe which is developing an expedited approval process.

New study into support workers underway

Meanwhile, a new Health Research Council-funded project is investigating how – and why – community support workers have faced systemic inequality throughout the pandemic.

“Support workers and their unions raised several issues related to support worker wellbeing during Covid-19,” said AUT’s Associate Professor Katherine Ravenswood, who is leading the study, in partnership with E tu and PSA union members.

Many workers had been negatively affected during the response due to a lack of understanding of the sector – and more specifically – a lack of personal protective equipment and poorly-fitted wage and sick leave policies.

“Community support workers have had to take action themselves to protect their own wellbeing at work,” Ravenswood said.

“These wellbeing issues are underscored by ongoing systemic gender discrimination, and a failure to protect and promote Māori wellbeing in employment.”

The pandemic had compounded such problems by placing more risk, workload and responsibility on the workers – and often with little or no more resourcing than during usual.

The research team – also including Drs Fiona Hurd and Amber Nicholson, along with Kirsty McCully of E Tu and Melissa Woolley of the Public Service Association/Te Pukenga Here Tikanga Mahi union – planned to carry out a range of interviews across the sector.

“This project works with community support workers to find out what ‘wellbeing’ means to them, what extra challenges Covid-19 has brought to their wellbeing at work, and how they’ve got through,” Ravenswood said.

“Specifically, we’ll also find out how Māori community support workers think of wellbeing, and what challenges they face.

“Once we’ve finished all the interviews, then the AUT team and the community support worker researchers, will analyse the interview information to work out what the key themes and issues are that arise from the interviews.

“We’ll work together to co-construct a definition of wellbeing that specifically addresses the needs and context of community support workers themselves.

“This puts their voices at the fore of the research, and, we hope, at the fore of policy recommendations developed from this research.”

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