Smoking - Nicotine Replacement Therapy (NRT)
NRT treats nicotine addiction, where tobacco smoking is the key contributing risk factor for cardiovascular events - heart attacks, strokes - as well as other conditions (e.g. lung cancer, chronic obstructive respiratory disease, other cancers). These diseases are associated with significant impairments in quality and quantity of life for the patient and appreciable costs to the health care sector. Male and female smokers lose 13.2 and 14.5 years of life on average (Annual Smoking Attributable Mortality, 2002).
The prevalence of smoking (age-standardised) in New Zealand is 21.2%, the prevalence of smoking among Māori and Pacific peoples is significantly higher, 41.6% and 29.8% respectively and contributes to disparities in disease burden between Māori, Pacific and non-Māori non-Pacific (Ponniah and Bloomfield, 2008). As evident in the following graph (PHARMAC analysis of NZ Census data), age-standardised prevalence rates of current smokers vary by DHB, but ethnicity has a stronger influence. Pacific Island people are likeliest to be still smoking than to have stopped.
2006 NZ Census Data
NRT is a smoking cessation aid, reducing withdrawal systems by continuing nicotine delivery, without the carcinogenic effects of tobacco constituents, making it easier to quit smoking. Systematic literature reviews of meta-analyses and randomised controlled-trials illustrate that use of NRT during a quit attempt doubles the likelihood of abstinence after 6 to 12 months, compared to placebo (Ministry of Health, 2008). With no intervention, quit rates are 3-5%, with NRT, quit rates increase by 2-3%, with counselling added to NRT, quit rates increase by another 8% (Stead, Perera, Bullen et al., 2008).
By DHB, during 2007, West Coast, Hawkes Bay and Tairawhiti had the highest prescribing rates for Māori and West Coast, South Canterbury and Tairawhiti DHB regions had the highest prescribing rates for nMnP (Figure 1).
Wairarapa, Hutt Valley and Canterbury DHB regions had the lowest prescribing rates for Māori and Capital and Coast, Canterbury and Auckland had the lowest for nMnP people.
Prescribing rates were generally higher in Māori than nMnP except in Wairarapa and South Canterbury. Hutt Valley DHB regions prescribed equally to Māori and nMnP. The greatest difference in prescribing between Māori and nMnP was seen in Counties Manukau DHB.
Figure 1: Age-standardised NRT Prescriptions for the year ending Dec 2007 by DHB patients aged 20+ years.
Figure 2: Age-standardised*prescription rates per 1000 populations compared with the NZ average for the year ending June 2007 - NRT.
To explain the above graph, Auckland and Canterbury DHB regions had lower numbers of prescriptions per 1000 population (prescription rates) for non-Māori non-Pacific (nMnP) compared with the NZ average for nMnP. West Coast DHB had a higher prescription rate for nMnP compared with the NZ average for nMnP (Figure 2).
Canterbury DHBs had a lower prescription rate for Māori compared with the NZ average for Māori. West Coast DHB had a higher prescription rate for Māori compared with the NZ average for Māori.
All DHBs with the exception of Canterbury (above the horizontal dotted line) had a higher prescription rate for Māori compared with the NZ average of nMnP
Counties Manukau in the top left hand quadrant had approximately 8 prescriptions per 1000 population more for Māori than the NZ average for Māori and only 1-2 prescriptions per 1000 population less for nMnP than the NZ average for nMnP.
West Coast DHB is in the top right hand quadrant and had around 23 prescriptions per 1000 population more for Māori than the NZ average for Māori, and around 20 prescriptions per 1000 population more for nMnP than the NZ average for nMnP.
Canterbury DHB is in the bottom left hand quadrant and had around 16 prescriptions per 1000 population less for Māori than the NZ average for Māori and around 6 prescriptions per 1000 population less for nMnP than the NZ average for nMnP.
South Canterbury DHB is in the bottom right hand quadrant and had around 7 prescriptions per 1000 population less for Māori than the NZ average for Māori, but around 13 prescriptions per 1000 population more for nMnP than the NZ average for nMnP.
Lakes DHB is near the centre, and had similar prescription rates for Māori and nMnP as for New Zealand overall;
Canterbury DHB, not only had a prescription rate for Māori lower than the national average for Māori by 16 prescriptions per 1000 population, but this rate was lower than the national average for nMnP by around 1-2 prescriptions per 1000 population. (In addition, its prescription rate for nMnP was also lower than the nMnP national average).
The further away from either of the solid lines, then the worse off (Canterbury DHB) or better off (West Coast DHB) was a DHB’s situation compared with the NZ average.