Access to Preventative Gout Medicine Inequitable for Pasifika

According to a report released today by Pharmac, Pacific peoples health – Gout data insights, data shows that while the prevalence of gout in Pacific people continues to climb, access to preventive gout medicine remains inequitable.

The latest insights show that Pacific people aged 20 years and older are about three times more likely to live with gout when compared to non-Māori, non-Pacific people.

Pharmac’s Chief Medical Officer Dr David Hughes says, “we’ve found that Pacific peoples start being dispensed preventive gout medicine approximately 13 years earlier than non-Māori, non-Pacific peoples.”

He says while Pacific people are approximately three times as likely to be dispensed medicine for gout compared to non-Māori, non-Pacific peoples, it is still not enough. “About 8,700 more Pacific peoples need preventive gout medicine each year to achieve equity of access to medicines.”

Gout is a form of arthritis that sets in when high levels of uric acid build up in the blood and solidify as painful crystals in joints. It is a life-long condition that can reduce someone’s life expectancy and quality of life.

Dr. Hughes explains that for Pacific people, biological factors such as kidney disease, genetic variants, and some medicines contribute to a higher prevalence of gout when compared to non-Māori, non-Pacific people.

Dr Apisalome Talemaitoga, GP and Chair of the Pacific GP Network, understands the impact of gout for Pacific people from a first-hand perspective, “there are many barriers that make it harder for Pacific peoples to access medicines for gout,” he says.

Arthritis New Zealand Chief Executive Phillip Kearney hopes the findings challenge stigmas around what causes gout.

Mr Kearney, Dr Talemaitoga, and Dr Hughes all agree that Pacific people’s realities, worldviews, and aspirations of health and wellbeing must be central when driving interventions and developing solutions.

Key findings demonstrate inequities between Pacific people and non-Māori, non-Pacific people:

  • While Pacific people are approximately three times as likely to be dispensed medicine for gout compared to non-Māori, non-Pacific people, this is still not enough to meet health needs for Pacific people.
  • Pacific people start being dispensed preventive gout medicine 13 years earlier than non-Māori, non-Pacific people. Given the much higher gout disease burden, Pacific people may need to start even earlier.
  • For both Pacific people and non-Māori, non-Pacific people, the younger the person, the less likely they are to be regularly dispensed preventive gout medicine.
  • Pacific people are more likely to live with both gout and other long-term conditions, such as Type 2 diabetes, than non-Māori, non-Pacific people.
  • Pacific people are 13.8 times more likely to be hospitalised with a primary diagnosis of gout compared with non-Māori, non-Pacific people.

Recommendations include :

  • If young Pacific people, particularly those aged between 20 and 44, present with joint pain, practitioners should consider gout as a cause.
  • Practitioners should be aware of the harms of long-term use of NSAIDs for Pacific people with gout.
  • Practitioners should consider other medicines for gout treatment and prevention.
  • Practitioners should follow up with young Pacific men aged between 20 and 44 years and repeat prescribe preventive gout medicine as needed.
    People who work with patients and whānau should create a care-plan for gout (for example encompassing health promotion, talanoa, and support) and regularly review.
  • People and organisations that work with whānau can work together to raise awareness of the biological factors that contribute to gout in Pacific people.
  • Studies have found that what people eat and drink only makes a small contribution to high uric acid levels (6).
  • Understanding this can reduce stigma and embarrassment associated with gout and encourage better access to preventive gout treatment.
  • Programmes and quality improvement initiatives should be co-designed with Pacific people to improve outcomes for Pacific people living with gout.

Pacific people’s health – Gout data insights is the second report into medicine access inequities for gout as part of Pharmac’s monitoring and outcomes framework. It follows the release of Gout insights – Impact on Māori in December 2021.

Find the full report: Pacific peoples health – Gout data insights

Image credit: Karolina Grabowska/pexels