Quantitative assessment of the Pacific gout health burden and treatment need in Auckland

The aim of this study is to determine the size of the problem related to the low uptake of urate-lowering therapy by Pacific people with gout in comparison to Maori and non-Pacific non-Maori people. Routinely collected data stored by electronic health records and provided by the four primary health organisations (PHO): Alliance Health Plus, Pro Care, Tamaki Health and National Hauora Coalition data. We will use the secondary anonymised dataset from the Health Quality and Safety Commission Atlas of Healthcare Variation – gout national and three Auckland metro DHBs (Waitemata, Auckland, Counties Manukau). In addition, four Primary Health Organisations (PHOs), ProCare, Tamaki Health, Alliance Health Plus (AH+) and National Hauora Coalition), will provide routinely collected clinical data of their de-identified enrolled patient populations. Collectively, these four PHOs have the majority of Pacific and Maori enrolled patients in the three Auckland DHBs. ProCare has 175 practices representing 52.7% of the Auckland DHBs’ population, of whom 22% are Pacific or Maori. Tamaki Health has an enrolled population of 230,000 across 45 Auckland clinics, with 540,700 Pacific patients from South Auckland. AH+ has a network of 40 general practices with a total of approximately 126,000 enrolled patients of all ages, 32% of whom are Pacific and 14% Maori, and the National Hauora Coalition has over 120,000 patients in 26 general practices in Auckland Metro, with 22% Pacific and 33% Maori. The study denominator will be all people enrolled with all four PHOs, at 1 October 2021, are aged 20 years or older and the numerator is the number of people diagnosed with gout. The following variables will be obtained for individual visit data from the PHO: • Patient identifier - All four PHOs will de-identify data and apply codes to replace NHI. • Sex • Date of birth • Ethnicity - prioritised o Total Pacific (as a binary variable – any Pacific ethnicity reported Y/N) o Total Tokelauan (ethnicity group Level 2; binary) o Total Niuean (ethnicity group Level 2; binary) o Total Tongan (ethnicity group Level 2; binary) o Total Cook Island Maori (ethnicity group Level 2; binary) o Total Samoan (ethnicity group Level 2; binary) o Total Other Pacific Peoples (ethnicity group Level 2; binary) o Total Pacific Peoples not further defined (ethnicity group Level 2; binary) o Total Fijian (ethnicity group Level 2; binary) *excluding Indo-Fijian o Maori (ethnicity group Level 1; binary) o European (ethnicity group Level 1; binary) o Asian (ethnicity group Level 1; binary) o MELAA (ethnicity group Level 1; binary) o DHB (domicile) o NZ Deprivation (NZDep) index decile o A current primary care-coded diagnosis of gout (binary) o Date of gout diagnosis o Numbers and dates of prescriptions for urate-lowering therapy (allopurinol) in the period 30 September 2016 to 1 October 2021 o Numbers and dates of serum urate tests requested in the period 30 September 2016 to 1 October 2021 o Numbers and dates of serum urate test done (i.e. have results) in the period 30 September 2016 to 1 October 2021 o Serum urate test results in the period 30 September 2016 to 1 October 2021 (actual value in mmol/L) o Hospital admission(s) with the primary diagnosis of gout The duration of observations is between the period of 30 September 2016 to 1 October 2021.