CVD risk assessment by ethnicity in Aotearoa New Zealand: a national observational study

Cardiovascular disease (CVD) risk assessment is a key strategy for reducing the burden of, and inequities in, CVD. The aim of this study was to determine whether there are inequities in CVD risk assessment by ethnicity in Aotearoa New Zealand (NZ).

We conducted a cross-sectional analysis of a de-identified national cohort of people aged 25-74 years living in NZ on 31 March 2018, recommended for CVD risk assessment according to current guidelines. The cohort was generated using both Statistics NZ's Integrated Data Infrastructure and health service user populations. People were excluded if they had a prior history of CVD. Univariable and multivariable logistic regression modelling was used to explore associations between ethnicity (Māori, Pacific, Indian, European or Other) and evidence of CVD risk assessment. We used national laboratory claims between 1 April 2018 and 31 March 2023 to find tests related to CVD risk assessment as a proxy for completed assessments.

1,476,747 people (40.5% women, 12.1% with diabetes) were eligible for CVD risk assessment on 31st March 2018. Overall, 67.1% of eligible men (88.9% of those with diabetes) and 65.5% of women (86.3% of those with diabetes) had tests required for a CVD risk assessment between 1 April 2018 and 31 March 2023. This proportion varied by ethnicity, from 62.3% among Māori to 65.7% among European, 69.8% Other, 69.9% Pacific and 80.3% among Indian Peoples. The odds of CVD risk assessment after adjustment for socioeconomic deprivation and residential district were lower for Māori men (adjusted OR, aOR, 0.77 (0.72-0.83) with diabetes, 0.73 (0.72-0.74) without diabetes) and women (aOR 0.93 (0.87-0.99) with diabetes, 0.89 (0.87-0.91) without diabetes) compared with Europeans. Pacific men also had significantly lower odds of CVD risk assessment compared with Europeans (aOR 0.86 (0.78-0.94) with diabetes, 0.72 (0.70-0.74) without diabetes), as did Pacific women without diabetes (aOR 0.95 (0.92-0.98)). Indian people with and without diabetes had significantly higher odds (aOR 1.2-1.7) of CVD risk assessment compared with Europeans.

We found Māori and Pacific Peoples experienced inequities in CVD risk assessment. There is a critical need for strategies that eliminate inequities for these underserved populations.