Inequities in primary care respiratory illness presentations in Aotearoa (New Zealand) before, during and after the COVID-19 pandemic: a retrospective cohort study using automated health record analysis

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Abstract
Background: Ethnic and socioeconomic inequities in respiratory illness outcomes are well established. Monitoring primary care presentation rates is important for assessing health system equitable responsiveness, particularly during health crises. Aim: To examine changes in primary care respiratory illness presentation rates in Aotearoa New Zealand (NZ) by ethnicity and socioeconomic status before, during and after the COVID-19 pandemic. Design and setting: Retrospective cohort study using natural language processing (NLP) of electronic health records from 37 general practices across eight districts in NZ. Method: Clinical interactions from 2018 to 2023 (n=10 421 399; 4 66 349 patients) were classified into respiratory categories using a validated NLP algorithm. Age-adjusted monthly presentation rates were analysed by ethnicity and deprivation across pre-pandemic, pandemic and post-pandemic periods. Results: Overall, 15.1% (1 573 631/10 421 399) of interactions were respiratory-related, increasing from 13.7% to 14.2% in 2018–2019 to a peak of 25.2% in 2022, before declining to 15.3% in 2023. Pacific peoples had higher presentation rates than European patients both pre-pandemic (+2.2, p=0.03) and during the pandemic (+3.5, p<0.01), and the presentation rates for Pacific peoples more than doubled during the pandemic peak. Post-pandemic, rates declined across all groups with larger reductions for Pacific peoples. Higher presentation rates were consistently observed among those in the most deprived quintile. Acute respiratory presentations varied more over time, while chronic conditions remained relatively stable. Conclusions: Primary care presentation rates increased during the pandemic, particularly among high-needs populations, suggesting responsiveness to need. Post-pandemic declines in acute presentations, especially among Pacific peoples, may indicate emerging access barriers and widening inequities. NLP applied to routinely collected electronic health record data provides a retrospective approach to analysing primary care presentations and may support future development of surveillance approaches for monitoring equity trends.
Funding Information
  • Flu Lab (3725363)

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