Ethnicity Variations in Pathways to Care and Diagnosis of Endometriosis and Persistent Pelvic Pain in Aotearoa New Zealand

BACKGROUND: In Aotearoa New Zealand, there are limited data on ethnicity-specific prevalence and management of endometriosis and persistent pelvic pain. In the international literature, there appears to be a wide variation in both diagnosis and treatment access for these common conditions. AIMS: To explore ethnicity-specific referral data for people with symptoms of endometriosis and pelvic pain referred to two tertiary hospitals in Aotearoa New Zealand. MATERIALS AND METHODS: Referrals to two gynaecology departments, in the North and South Islands of New Zealand, for women aged 16-52 during 2021 were screened and included if the primary referral reason was pelvic pain > 3 months, abdominal pain, dysmenorrhea, endometriosis or dyspareunia. Denominator data were obtained from Statistics NZ. RESULTS: There was a significantly lower referral rate at the North Island unit for Māori, Pacific and Asian people compared to European/MELAA; and a significantly lower referral rate in the South Island unit for Pacific and Asian people compared to European/MELAA and Māori, per 1000 women aged 16-52 years per year. Similar patterns occurred in the rates of waitlisting for surgery. CONCLUSIONS: European women are privileged in Aotearoa compared to Māori, Pacific and Asian people in secondary referral and population waitlisting for surgery. This privilege was not evident in waitlisting for surgery from the gynaecology clinic. We suggest that a nationally consistent approach to the management of endometriosis and persistent pelvic pain is required.