Abstracts

Rationale:
Māori, the indigenous peoples of New Zealand, have a longstanding history of inequitable access to health services and worse overall health outcomes than non-Māori. The World Health Organization’s Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031 emphasises the need for improved epilepsy healthcare and the elimination of health disparities in high-risk groups such as Indigenous peoples. Māori people suffer an increased burden of epilepsy compared to non-Māori people in New Zealand, however the reason for this is unclear.  We describe access to epilepsy healthcare for Māori children and compare this to non-Māori-non-Pasifika children.

Methods:
A cohort of 337 Māori children and 421 non-Māori-non-Pasifika children (< 18 years) with treated epilepsy were identified from a search of the New Zealand Pharmaceutical Collection database. Their medical records were reviewed to determine access to appropriate epilepsy investigations and specialist medical care, and the timeliness of such access.

Results:
The majority of children with new onset epilepsy presented to health services via the emergency department (ED). Once in ED, Māori children were more likely to be discharged home compared to non-Māori-non-Pasifika children (OR = 1.72, 95% CI 1.12 - 2.66). Māori children were similarly likely to receive an EEG (OR: 0.80; 95% CI 0.24 – 2.61) but the median wait to an EEG was three weeks. When clinically indicated, Māori children (relative to non-Māori-non-Pasifika children) were less likely to receive an MRI scan (OR: 0.28; 95% CI 0.18 – 0.45) and less likely to see a Paediatric Neurologist (OR: 0.44; 95% CI 0.30 – 0.63). For this group, median wait time for an MRI scan was twelve weeks longer for Māori than for non-Māori-non-Pasifika children. Māori children who were referred to paediatric outpatient services after the onset of epileptic seizures had a longer median wait-time of 4.5 weeks to see a medical specialist; and a median time of five years longer to see a Paediatric Neurologist. While socioeconomic status and rurality both contributed to many of these disparities, after adjusting for these variables Māori children were still less likely to receive an MRI scan and more likely to wait longer to receive an MRI scan and see a medical specialist.

Conclusions:
This study is the first to describe provision of epilepsy care to New Zealand children. Our results identified that Māori children have inequitable access to epilepsy healthcare compared to non-Māori-non-Pasifika children, and that inequities are evident within numerous areas of the New Zealand health system. Both social factors contribute to these inequities. In order to decrease the burden of epilepsy in Māori children, New Zealand needs to ensure health policy is accessible, delivered equitably, culturally appropriate, and responsive to the needs of the Māori community so that barriers to care are eliminated.

Funding:
Neurological Foundation, Health Research Council of New Zealand, Royal Australasian College of Physicians