Paediatric Medicine—Aotearoa New Zealand

Background: The Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031 (IGAP) directs nations to identify health disparities for Indigenous people as the first step towards reducing the burden of epilepsy in these high-risk groups. 1 In Aotearoa New Zealand, children from areas with high levels of deprivation have higher rates and poorer outcomes of epilepsy. 2,3Despite the similar prevalence of treated epilepsy for M aori and non-M aori children, 2 M aori suffer an increased burden of epilepsy compared to non-M aori populations. 3,4 Aim: To describe and compare epilepsy types, aetiology, and access to epilepsy healthcare in M aori and non-M aori-non-Pasifika children.Methods: This is a population-based retrospective study using a Kaupapa M aori approach.Medical records of 337 M aori and 421 age/sex matched non-M aori-non-Pasifika children (<18 years) with treated epilepsy were reviewed to determine epilepsy type, aetiology, access to epilepsy healthcare, and time to access services.Results: M aori children (relative to non-M aori-non-Pasifika children) had lower odds (OR = 0.51, 95% CI 0.30-0.83) of having a self-limited epilepsy syndrome, were less likely to have a developmental and epileptic encephalopathy (OR = 0.59, 95% CI 0.40-0.88),and were more likely to have intellectual disability and epilepsy (OR = 1.65, 95% CI 1.18-2.32).M aori were more likely to have a structural (OR = 1.5, 95% CI 1.08-2.16),or infectious aetiology (OR = 4.7, 95% CI 1.66-16.50),and less likely to have a genetic aetiology (OR = 0.70, 95% CI 0.52-0.95).After adjustment for socioeconomic status and rurality, M aori children were more likely to have a preventable aetiology (OR = 2.5, 95% CI 1.49-4.22).In children with new onset epilepsy, M aori children were more likely to be discharged from the emergency department (OR = 1.72, 95% CI 1.12-2.66).When indicated, M aori were less likely to receive an MRI (OR = 0.28; 95% CI 0.18-0.45)or see a paediatric neurologist (OR = 0.55, 95% CI 0.30-0.63).Median wait times were also consistently longer for M aori children for EEGs (3 weeks longer), paediatric outpatient visits (4.5 weeks longer), MRIs (12 weeks longer), and paediatric neurology visits (5 years longer).Conclusion: This study directly addresses the aims of IGAP.In Aotearoa New Zealand, we identified significant disparities in the aetiology of epilepsy and access to epilepsy healthcare in M aori children compared to non-M aori-non-Pasifika children.In order to decrease the burden of epilepsy in M aori, health policy needs to be developed that ensures health care is delivered in an equitable, culturally appropriate and responsive manner.