The COVID-19 pandemic and acute rheumatic fever inequities, Aotearoa New Zealand, 2020-2022.

AIM: Acute rheumatic fever (ARF) rates declined in Aotearoa New Zealand during the COVID-19 pandemic (2020-2022). This study aimed to explore the impact of COVID-19 public health measures on ARF hospitalisations and ethnic inequities for Māori and Pacific peoples.

METHODS

We conducted a descriptive Kaupapa Māori epidemiological study using hospital discharge data to calculate frequencies, rates and rate ratios for initial ARF hospitalisations (<35 years), 2000-2022. Multivariable Poisson regression models evaluated the impact of COVID-19 public health measures on ARF incidence.

RESULTS

A temporal association between ARF hospitalisation and COVID-19 elimination-suppression strategies was identified (adjusted rate ratios [aRR] 0.47, 95% confidence interval [CI] 0.33-0.69, p<0.001). The association differed between 2020 and 2021 with the addition of any lockdown. Crude rates trend downwards for Pacific peoples from 2020 to 2022 and were low in 2022 for both Māori and Pacific peoples. In 2022, ethnic inequities were large for Māori (aRR 45) and Pacific peoples (aRR 77) compared with non-Māori, non-Pacific peoples.

CONCLUSIONS

Persistently high rates of ARF in Māori and Pacific peoples are not inevitable. Interpreting hospitalisation trends and health inequities during the period of COVID-19 public health measures requires understanding of how racism and coloniality shape the distribution of risk and protective factors. Structural transformation is required to achieve health equity.