Māori patients with newly diagnosed epilepsy had lower treatment rates and worse health outcomes in an analysis of hospital admissions and prescription data for 3366 patients diagnosed with epilepsy between 2007–2015. After diagnosis with epilepsy, 92.8% of patients received immediate treatment, 3.7% received delayed treatment and 3.5% were untreated. Māori patients were less likely to receive treatment, had higher mortality (HR 1.41; 95% CI 1.08–1.83) and were more likely to develop liver disease (HR 4.67; 95% CI 1.32–16.4) and alcohol or drug dependence (HR 2.55; 95% CI 1.44–4.51). An increased risk of acute myocardial infarction was evident in patients who received delayed treatment or were untreated (HR 9.64; 95% CI 1.83–50.8).