Tupu Ola Moui Volume 5: Health System – Part Two

Introduction

This report is part of the Tupu Ola Moui Chart Book series, which provides the most comprehensive and up-to-date data on the health of Pacific peoples in New Zealand.

Designed as a clear and accessible resource, this series offers straightforward descriptions of key health data to enable users to further analyse and interpret their implications. The Tupu Ola Moui series serves as a foundational reference point for understanding the current state of Pacific health.

This volume of the Chart Book series relates to Te Mana Ola: The Pacific Health Strategy:

• priority area 2: Te pāruru‘anga, te apii‘anga, e te akateretere‘anga no te ora‘anga meitaki – Disease prevention, health promotion and management for good health, and
• priority area 4: Haitiaaga moui malolo – Access.

These priority areas focus on ‘… population health, by working with communities to build, maintain and enable strong foundations for Pacific health and wellbeing’.

The other reports in this series are:

• Tupu Ola Moui Volume 1: Pacific Population in New Zealand
• Tupu Ola Moui Volume 2: Pacific Health Workforce
• Tupu Ola Moui Volume 3: Healthier Environments
• Tupu Ola Moui Volume 4: Health System – Part One

Glossary

Cardiovascular interventions

A range of cardiac procedures and surgery that help to reduce symptoms, improve quality of life, minimise the risk of a cardiac event and prolong life. These include angiography, angioplasty and stent placement, catheter ablation, coronary artery bypass graft, heart valve replacement or repair, revascularisation and heart transplants.

Confidence interval (CI)

A range that likely contains the true population value, with a given level of confidence, such as 95%.

Chronic obstructive pulmonary disease

A progressive lung disease that causes airflow obstruction, making breathing difficult due to conditions such as emphysema and chronic bronchitis.

Pacific peoples

People who identify with one or more of the following ethnic groups: Samoan, Cook Islands Māori (Cook Islanders), Tongan, Niuean, Tokelauan, Fijian and other within the statistical definitions of ‘Other Pacific peoples’ and ‘Pacific peoples not further defined (nfd)’.

Defined comprehensively by Stats NZ within the ‘Aria’ classification tool.

Other Pacific peoples

The ethnic groups of Indigenous Australian, Hawaiian, i-Kiribati, Nauruan, Papua New Guinean, Pitcairn Islander, Rotuman, Tahitian, Solomon Islander, Tuvaluan, Ni Vanuatu and Pacific peoples not elsewhere classified.

Summary

This report provides an overview of the performance of the health system for Pacific peoples, covering respiratory disease, kidney disease, gout, cardiovascular disease, cancer and diabetes.

Respiratory disease

The age-standardised mortality rate from respiratory diseases fell by about a third among Pacific peoples over the two decades from 2001 to 2020, from 42.0 per 100,00 people to 37.8 per 100,000 people. Pacific peoples had relatively high rates of hospitalisation due to chronic obstructive pulmonary disease, at 694 per 100,000 people in 2022, but the rate declined by almost half (47.5%) between 2010 and 2022.

Kidney disease

Kidney disease mortality among Pacific peoples was 3.1 per 100,000 people in 2020, which was almost twice the rate among non-Māori, non-Pacific people (1.6). The age-standardised rate of kidney disease mortality among Pacific peoples fell by 38.0% between 2000 and 2020.

Gout

Around one in 16 (6.1%) Pacific adults had gout in 2023/24. Pacific adults were almost four times (3.98) as likely to have gout as non-Pacific adults.

Cardiovascular disease

Cardiovascular disease age-standardised mortality among Pacific peoples was 143.0 per 100,000 people in 2020, which was 1.7 times the rate for non-Māori, non-Pacific people.

Pacific peoples were more likely than other ethnic groups to receive cardiovascular interventions in 2022, even as the rate at which these interventions were used declined since 2010.

Pacific adults between 30 and 74 years enrolled in a primary health organisation who were eligible for cardiovascular risk assessment had the highest rate of cardiovascular disease risk assessment in 2024, at 77.0%, compared to 74.1% for Māori and 73.6% for non-Māori, non-Pacific peoples.

Cancer

There were 5,715 Pacific peoples diagnosed with cancer between 2015 and 2019. This number is forecast to increase to 14,464 by 2040–2044. The age-standardised cancer incidence rate among Pacific women is forecast to increase from 406.0 per 100,000 to 460.0 per 100,000 over that time period. The comparable rate for Pacific men is expected to fall from 380.0 to 368.0 per 100,000.

Screening rates of Pacific peoples for breast cancer (37.6%), cervical cancer (56.0%) and bowel cancer (63.8%) were lower than those reported for non-Māori, non-Pacific peoples in 2024.

Pacific peoples in New Zealand experienced higher cancer incidence and a lower survival rate for several cancers between 2007 and 2019, including lung, liver and stomach cancers, when compared to the European population.

Diabetes

There were 46,515 Pacific peoples with diabetes in 2023. Pacific peoples are diagnosed with diabetes more often than other ethnic groups, and at a younger age on average.

The age-standardised rate of diabetes per 1,000 people was 127.1 for Pacific women and 124.0 for Pacific men in 2023, an increase from 2013, when rates were 105.6 and 106.7 per 1,000 people respectively. The increase in the prevalence of diabetes between 2013 and 2023 was 20.4% and 16.2% respectively.

Use of hypoglycemic medication by Pacific peoples with diabetes grew between 2018 and 2022, but research suggests marked disparities in the prescribing of modern classes of diabetes medications.

One in three hospital bed days used by Pacific peoples in 2019 was for a person with diabetes.

Data: Respiratory disease

Respiratory disease mortality

The age-standardised mortality rate from respiratory diseases among Pacific peoples decrease by 34% between 2001 and 2020.

The respiratory disease mortality rate among Pacific peoples was 37.8 per 100,000 people in 2019, down from 42.0 per 100,000 people in 2001.

There was a further decline to 27.6 per 100,000 people in 2020, but this result may have been affected by the public health measures introduced as part of the COVID-19 pandemic response.

The rate among Pacific peoples was 1.4 times as high as the rate for non-Māori, non-Pacific peoples in 2020.

Chronic obstructive pulmonary disease hospitalisations

The age-standardised chronic obstructive pulmonary disease hospitalisation rate for Pacific peoples was 694 per 100,000 people in 2022.

The hospitalisation rate for Pacific peoples declined by almost half (47.5%) between 2010 and 2022.

This decline was higher than that recorded for the Māori (down 29.6%) and European/Other (down 38.7%) populations.

The relative difference in the mortality rate of Pacific peoples and European/Other reduced from 2.7 times higher to 2.3 times higher.

Data: Kidney disease

Kidney disease mortality

The age-standardised mortality rate from kidney disease among Pacific peoples was 3.1 per 100,000 people in 2020.

The data for Pacific peoples from 2001 to 2020 shows significant year-to-year variability; there is no consistent long-term trend, but rather a series of peaks and troughs.

Across the time period, Pacific peoples generally had a higher rate of kidney disease mortality than non-Māori, non-Pacific peoples.

Data: Gout

Prevalence of gout

Pacific peoples were much more likely than people in other ethnic groups to have gout in 2023/24.

Around one in 16 (6.1%) Pacific adults in 2023/24 had been told by a doctor that they had arthritis and that one of the kinds of arthritis they had was gout.

Gout occurs more commonly in men than in women. Around one in ten (10.4%) Pacific men had gout in 2023/24, compared to 1.5% of Pacific women.

Pacific adults were 3.98 times as likely as non-Pacific adults to have gout in 2023/24, after controlling for age and gender.

The true number of people with gout may be higher, as some people may not be aware that they have arthritis or gout.

Data: Cardiovascular disease

Cardiovascular disease mortality

The age-standardised mortality rate from cardiovascular disease among Pacific peoples fell by around half (51.4%) between 2001 and 2020.

The cardiovascular disease mortality rate among Pacific peoples was 143.0 per 100,000 people in 2020, down from 294.1 per 100,000 people in 2001.

The rate among Pacific peoples was 1.7 times higher than the rate for non-Māori, non-Pacific peoples in 2020.

Cardiovascular interventions

Pacific peoples had the highest age-standardised rate of cardiovascular interventions of any ethnic group in 2022.

Pacific peoples were also more likely than people in other ethnic groups to receive cardiovascular interventions, such as coronary artery bypass graft (CABG) (up to 2.5 times as likely), heart valve replacement or repair (2.2 times as likely) and angioplasty (1.9 times as likely).

Pacific peoples were less likely to receive most interventions in 2022 than in 2010, with the exceptions of acute angioplasty (up 10.8%) and acute health valve replacement or repair (up 5.6%).

Figure 6: Age-standardised rates of cardiac interventions by ethnicity, 2010–2022

Cardiovascular risk assessment

Pacific peoples had the highest rate of cardiovascular disease risk assessments in 2023.

The proportion of enrolled and eligible Pacific peoples who received a cardiovascular disease risk assessment was 77.7% in the quarter ending 31 December 2023.

Pacific peoples were more likely than people in other groups to have received such assessments. The rate for Māori was 74.1% and the rate for non-Māori, non-Pacific was 73.6% over the same period.

Data: Cancer

Cancer incidence

In 2015–2019 there were 5,715 Pacific peoples diagnosed with cancer.

Due to a growing and aging population, the number of new cancer cases among Pacific peoples is forecast to increase to 14,464 by 2040–2044.

The age-standardised cancer incidence among Pacific males was 380.0 per 100,000 people in 2015–2019. This is forecast to drop to 368.0 per 100,000 people by 2040–2044.

The current rate is lower than the rate for European/Other (389.0) and Māori (421.0), and higher than the rate for Asian people (191.0).

Among Pacific women, the age-standardised cancer incidence rate was 406.0 per 100,000 people in 2015–2019. This rate is forecast to increase to 460.0 per 100,000 people by 2040–2044.

The 2019 rate for Pacific women was lower than that for by Māori women (434) but higher than that for European/Other women (327.0) and Asian women (203.0).

Breast, cervical and bowel cancer screening

Pacific peoples were less likely than people in other ethnic groups to be screened for common cancers.

The rate of bowel screening for Pacific women was 37.6% in 2024, which was lower than the rate for Māori (48.8%) and non-Māori, non-Pacific (59.3%) people.

The rates of cervical screening for Pacific women and Māori women were similar (56.0% and 56.2% respectively), but these rates were lower than the rate for non-Māori, non-Pacific (72.1%).

The rates for breast screening showed that 63.8% of eligible Pacific peoples were screened, compared to 60.3% of Māori and 68.2% of non-Māori, non-Pacific people.

Cancer survival

Pacific peoples in New Zealand experience higher cancer incidence rates and a lower survival rate for several cancers, including lung, liver and stomach cancers, when compared to the European population.

Survival rates for Pacific peoples for cancers of the breast, cervix, blood (leukaemia), lymphatic system (non-Hodgkin’s lymphoma), prostate and uterus after five years met or exceeded 60% between 2007 and 2019.

The most lethal cancers were those of the lung and the pancreas, associated with survival rates of 16% and 18% after five years respectively.

Pacific peoples had poorer cancer survival rates than European for multiple cancers.

The greatest disparities were found for leukaemia (age-sex adjusted hazard ratio (HR): 2.1, 95% CI 1.8–2.5), cervical (HR: 1.8, 95% CI 1.3–2.3), breast (HR: 1.7, 95% CI 1.5–1.9) and uterine cancers (HR: 1.7, 95% CI 1.5–2).

Data: Diabetes

Diabetes prevalence

There were 46,515 Pacific people with diabetes in 2023.

The age-standardised prevalence rate of diabetes among Pacific women was 127.1 per 1,000 people in 2023, up from 105.6 in 2013. The comparable rate for Pacific men was 124.0 per 1,000, up from 106.7 in 2013.

The age-standardised prevalence of diabetes increased by 20.4% among Pacific women and 16.2% among Pacific men between 2013 and 2023.

In 2023, Pacific women were more likely than Māori women (1.9 times), Indian women (1.3 times) and European/Other women (4.5 times) to have diabetes.

Similarly, Pacific men were more likely than Māori men (1.6 times), Indian men (1.1 times) and European/Other men (3.5 times) to have diabetes.

Diabetes prevalence by age

Pacific peoples tend to be diagnosed with diabetes earlier in life than people in other ethnic groups.

The prevalence of diabetes increases with age, but Pacific peoples had higher rates at every age group than Māori and non-Māori, non-Pacific people except among those aged 5–9 years.

By age 25–29 years, the prevalence of diabetes among Pacific peoples (3.7%) was already 1.5 times that of Māori (2.4%) and three times that of European/Other people (1.2%).

These rates continue to climb through middle age and beyond. Among Pacific peoples aged 70–74 years, more than half (50.8%) had diabetes.

Hypoglycemic medication use

Two-thirds of Pacific peoples with diabetes were regularly receiving hypoglycemic medication in 2022.

The proportion of Pacific peoples with diabetes who regularly received hypoglycemic medication in 2022 was 66.3%, up from 62.0% in 2018.

The proportion of Pacific peoples regularly using this medication was similar to that of Māori and Indian people but slightly lower (3.0% in 2022) than that for the European/Other group over the 2018–2022 period.

Access to medication for cardiovascular-renal-metabolic disease

Pacific peoples have higher rates of access to medications that benefit people with cardiovascular-renal-metabolic disease (CVRD) than non-Māori, non-Pacific people.

People with CVRD can benefit from particular medications, including several for which access is restricted to patients with specific clinical conditions.

Research indicates that Pacific peoples have high levels of access to more freely available medications like statins and metformin (a difference of no more than +/- 3.0% compared to non-Māori, non-Pacific people), but lower rates of prescribed SGLT2i/GLP1RA than Māori when CVRD was absent or unknown.

Medical and surgical bed days

Over one in three hospital bed days used by Pacific peoples in 2022 was for someone with diabetes.

In 2022 Pacific peoples with diabetes accounted for 35.3% of medical and surgical bed days, an increase of four percentage points since 2018.

The share of bed days associated with diabetes patients was more than twice as high as the proportion recorded for European/Other people (17.0%).