A study of the epidemiology of acute rheumatic fever (ARF), in Auckland during 2010-2016, showed that the mean annual rate of hospitalisation with a first episode of ARF (per 100,000 person years) was: 0.0 in people of Asian ethnicity, 0.4 in people of European/Other ethnicity, 35.5 in Māori, and 98.3 in Pacific Island people. The rates in Māori and Pacific Island people were 36 and 98 times greater than in people of European/Other ethnicity.

A similar study of the epidemiology of acute rheumatic fever (ARF), in New Zealand during 2000-2018, showed that the mean annual rate of hospitalisation with a first episode of ARF (per 100,000 person years) was: 0.6 in people of Asian ethnicity, 0.9 in people of European/Other ethnicity, 16.8 in Māori, and 38.1 in Pacific Island people. The rates in Māori and Pacific Island people were 12 and 24 times greater than in people of European/Other ethnicity.

These studies show that rates of ARF in Pacific and Māori people are very much higher than in Asian and European people, and that this is particularly the case in the Auckland region.

The mean annual incidence of microbiologically confirmed Streptococcus pyogenes (group A streptococcus =GAS) pharyngitis (per 100,000 person years) at primary health clinics in the Auckland region were approximately: 30 in Asian people, 60 in European/Other people, 80 in Māori, and 100 in Pacific people. The markedly higher rates of ARF in Pacific and Māori people, than in European/Other and Asian people, is not solely a consequence of higher rates of GAS pharyngitis in Pacific and Māori people.

Better identification and treatment of GAS pharyngitis in Pacific and Māori people could reduce the high incidence of ARF in these people. In contrast, excessive effort is expended identifying and treating GAS pharyngitis in European/Other and Asian people, in whom ARF is extremely unusual.