Article Types
Research
Distribution of Cardiovascular Disease Risk Based on the Updated 2023 Guideline-Recommended Australian Cardiovascular Disease Risk Algorithm and Comparison With the 2012 Algorithm: An Observational Study
Objectives To quantify cardiovascular disease (CVD) risk, and implications for targeting preventive pharmacotherapy, using the 2023 guideline-recommended Australian CVD risk algorithm, and compare this to the previous (2012) algorithm.Study TypeApplication and comparison of two risk prediction algorithms.Setting and ParticipantsData from 115,873 people aged 45–74 years without existing CVD, who had a clinical encounter between September 2020 and August 2022, recorded within MedicineInsight, a longitudinal primary care database covering 8% of Australian general practices.Main Outcome MeasuresCVD risk distribution and risk categorisation into low-, intermediate- and high-risk groups under the 2023 and 2012 algorithms. Cohen's kappa and Bland–Altman plots were used to assess agreement and concordance.ResultsUsing the 2023 CVD risk algorithm and revised thresholds, 9.7% of participants were at high CVD risk (≥ 10% 5-year risk or clinically determined high risk); 26.4% were at intermediate CVD risk (5% to < 10% 5-year risk) and 63.9% were at low CVD risk (< 5% 5-year risk). Corresponding 2012 figures for CVD risk were 17.6% high (> 15% 5-year risk or clinically determined high risk), 11.6% intermediate (10%–15% 5-year risk) and 70.8% low (< 10% 5-year risk). Differences in proportions at high risk were largely driven by changes to clinically determined criteria for high risk. Overall, there was moderate-to-substantial agreement (linear-weighted kappa = 0.62) and concordance (Kendall's tau-b = 0.74) between algorithms.ConclusionProportions estimated at low risk and not routinely recommended pharmacotherapy align with international standards and were similar between guidelines. Although fewer people would be recommended pharmacotherapy due to being high risk under the updated versus previous guidelines, this likely reflects more accurate updated CVD risk estimation for the contemporary Australian population. The 2023 guidelines include a discretionary step (untested in our study) allowing adjustment based on additional factors. To ensure continued reduction of CVD burden across the population, we emphasise the use of this reclassification step by clinicians and consideration of the benefits of pharmacotherapy for those at intermediate risk.
Nina Lazarevic, Meghana Bhat, Grace Joshy, Danielle C. Butler, Mark Woodward, Anushka Patel, Rod T. Jackson, Garry Jennings, Rosemary Wyber, Ellie Paige, Emily Banks
Time for an Update: The Currency of Clinical Guidelines in Australia—A Cross-Sectional Analysis
Objectives Long-term and chronic health conditions are associated with a significant burden of disease and economic impact in Australia. Although improving health outcomes requires a multifactorial approach, up-to-date clinical guidelines can optimise healthcare delivery by providing clinicians with evidence-based, actionable recommendations. We aimed to determine the currency and key methodological characteristics of national clinical guidelines published in Australia and focussed on areas of highest prevalence and burden of disease.Study Design and SettingWe conducted a cross-sectional analysis by searching PubMed, the Guidelines International Network International Guidelines Library and Australian college and society websites in July 2025 for national clinical guidelines in the five areas of highest prevalence and burden of disease, as defined by the Australian Bureau of Statistics and Australian Institute of Health and Welfare, respectively. Information and metrics relating to time since publication, time since last evidence search and methods and processes (e.g., reporting of clinical questions and Population, Intervention, Comparison, Outcome [PICO] criteria and approval of the guideline by the National Health and Medical Research Council [NHMRC]) were tabulated and analysed.ResultsThirty-one guidelines published between 2002 and 2025 were identified, with most relating to diabetes or mental health. The mean times since publication and last search date were 8.6 and 9.8 years, respectively. Most provided details regarding clinical questions (77%), PICO criteria (61%), search strategies (68%) and other methodological considerations, however, fewer than half used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess certainty of evidence or provided details regarding conflicts of interest (48% each). Of the 18 guidelines approved by the NHMRC, five were developed within the previous 5 years and remain approved.ConclusionFor most high-priority clinical conditions in Australia, there are no up-to-date evidence-based guidelines available to support clinical decision-making. Guideline developers and funders should invest more energy and resources into planning for updates and ensuring that methods and processes are optimised to facilitate this, such as considering a living approach.
Heath White, Ethan Fernandes, Kristina Peduru-Arachchige, Tari Turner, Steven McGloughlin, Steve McDonald
Patterns of Osteoporosis Treatment Initiation Following Low-Trauma Fracture: A Population-Based Retrospective Cohort Study in New South Wales, Australia, Using Linked Administrative Health Data
Objectives To characterise osteoporosis medicine prescribing patterns following low-trauma fractures and identify predictors of early treatment initiation.Study TypeRetrospective population-based cohort study.SettingNew South Wales, Australia, using statewide linked administrative health data.ParticipantsAdults aged ≥ 50 years with an incident low-trauma fracture between January 2011 and June 2019.Main Outcome MeasuresPrimary outcomes were osteoporosis treatment prescribing patterns and timing of initiation after incident fracture over 3 years, categorised as early (within 12 months), late (within 1–3 years) or no initiation. Secondary analyses examined predictors of time to treatment initiation within 12 months using Fine–Gray competing-risk regression.ResultsAmong 132,268 individuals with incident fractures, 63.7% (84,222) were female. Overall, 29,802 (22.5%) initiated osteoporosis medicine, whereas 102,466 (77.5%) remained untreated. Among females (mean [standard deviation] age, 77.7 [10.1] years), 20.1% initiated therapy within 12 months, 7.0% within 1–3 years, and 72.9% remained untreated. Among males (mean [standard deviation] age, 77.2 [10.0] years), the corresponding proportions were 10.8%, 3.7% and 85.6%. After accounting for the competing risk of death, treatment initiation was more likely with non-distal fractures, older age, polypharmacy, prior steroid use, prior dual-energy x-ray absorptiometry and later fracture year, and less likely with greater comorbidity, rural or regional residence and prior hospitalisation for falls. The strongest associations were for hip or vertebral fracture (subdistribution hazard ratio range, 1.90–3.03) and high comorbidity burden (subdistribution hazard ratio range, 0.72–0.75). Almost one in four late initiators had a refracture before starting treatment. Denosumab rapidly replaced oral bisphosphonates as the dominant therapy over time.ConclusionMore than three-quarters of individuals remain untreated after fracture, highlighting persistent and substantial gaps in secondary fracture prevention. Treatment initiation is strongly associated with fracture site and multimorbidity burden, and initiation rates are lower in males. Increasing reliance on denosumab underscores the need for careful long-term treatment planning and strategies.
Mike Lin, Huy Nguyen, Thach Tran, Robert D. Blank, Dana Bliuc, Jacqueline R. Center
Gabapentinoid Poisoning Presentations to Victorian Emergency Departments: A 15-Year Trend Analysis
This study identified and characterised 1207 emergency department presentations related to gabapentinoid overdose in Victoria from 2009–2010 to 2023–2024. Presentation rates increased substantially since 2009–2010, and about half (49.5%; 597/1207) of all presentations were classified as intentional. Co-ingestants were common, although 36.2% (437/1207) of presentations were reported to involve gabapentinoids alone.
Bishaal Tej Gurung, Amy McNeilage, Angus Skeen, Tina Lam, Joanna F. Dipnall, Jane Hayman, Suzanne Nielsen, Ting Xia
Temporal Trends in Preterm Birth Associated With Hypertensive Disorders of Pregnancy in Victoria, Australia: A Population-Based Interrupted Time-Series Study
Objectives Hypertensive disorders of pregnancy (HDP) are a leading reason for medically indicated preterm birth (PTB), yet their contribution to population-level PTB trends is poorly understood. We examined temporal trends in PTB overall and HDP-associated PTB in Victoria over an 11-year period spanning the COVID-19 pandemic, and distinguished changes in HDP prevalence from changes in preterm delivery among affected pregnancies.Study TypePopulation-based interrupted time-series study using seasonal autoregressive integrated moving average (SARIMA) models, with July 2018 (launch of a national preterm birth prevention program) pre-specified as a temporal reference point.SettingAll hospitals in Victoria, Australia.Participants779,325 singleton births at ≥ 20 weeks' gestation between 1 January 2012 and 31 March 2022.Main Outcome MeasuresMonthly rates (per 1000 singleton births) of overall PTB, HDP and HDP-associated PTB. Decomposition analyses separated changes in HDP prevalence from changes in preterm delivery among affected pregnancies.ResultsOverall PTB was lower after July 2018 (5.8%–5.6%), while HDP prevalence increased (6.4%–7.0%). HDP-associated PTB increased before mid-2018 (+0.75 per 1000 births per month; 95% confidence interval [CI], 0.50–1.00) but declined thereafter (−1.12 per 1000 births per month; 95% CI, −1.88 to −0.36). This reversal was driven predominantly by reduced iatrogenic PTB with HDP; spontaneous PTB with HDP showed no significant change. Despite rising HDP prevalence, decomposition analyses estimated 89 fewer HDP-associated PTB cases than expected under pre-2018 patterns, reflecting a decline in the proportion of HDP pregnancies delivered preterm. PTB without HDP showed no significant temporal change.ConclusionPTB among HDP-complicated pregnancies declined despite increasing HDP prevalence, consistent with a shift towards later gestational age at delivery rather than reduced disease incidence. These findings may reflect improvements in care and demonstrate that reductions in iatrogenic PTB are achievable even as major risk factors become more prevalent.
Melvin Marzan, Heng Jiang, Daniel Lorber Rolnik, Joanne M. Said, Lisa Hui
Early-Onset Colorectal Cancer With Liver-Only Metastases: A Retrospective Cohort Study Integrating Prospectively Collected Real-World Clinical and Molecular Data From an Australian National Database (2009–2024) to Guide Treatment Planning
Objective To leverage the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry (an Australian cancer database) to explore the ideal timing and sequence of therapies and the factors influencing these decisions in colorectal cancer (CRC) patients with liver-only metastases to inform contemporary decision-making and future trials.Study TypeRetrospective registry-based cohort study using the TRACC registry.Setting and ParticipantsConsecutive patients with liver-only metastatic CRC enrolled in the TRACC registry.Main Outcome MeasuresTo explore cancer biology, intended treatment at presentation, actual treatment received and the resultant outcomes for early-onset CRC (EOCRC) (≤ 50 years) and late-onset CRC (LOCRC) (> 50 years) patients with liver-only metastases from a real-world perspective.ResultsBetween 14 January 2009 and 2 September 2024, 1691 patients with liver-only metastatic CRC were enrolled in TRACC. These included 276 EOCRC patients (16.3%) and 1415 LOCRC patients (83.7%). In the EOCRC subset, there were more females (48.2% vs. 34.5%, p < 0.001), less comorbidity (Charlson comorbidity index score 0, 90% vs. 59%, p < 0.001), more left-sided primaries (76.1% vs. 65.7%, p < 0.001), more synchronous disease (53.3% vs. 42.1%, p < 0.001) and BRAF V600E mutations (13.9% vs. 8.1%; p = 0.010). Overall, EOCRC patients had a longer median survival compared with LOCRC patients (3.20 vs. 2.38 years, p < 0.001). For the 662 patients (39.1%) undergoing liver resection, median survival was 5.99 years in EOCRC patients and 5.88 years in LOCRC patients. For all patients and for those undergoing resection, respectively, B-Raf proto-oncogene, serine/threonine kinase (BRAF) (hazard ratio, 1.97 [p < 0.001] and hazard ratio, 2.25 [p < 0.001]) and Kirsten rat sarcoma viral oncogene homologue (KRAS) mutations were associated with worse outcomes (hazard ratio, 1.29 [p < 0.001] and hazard ratio, 1.34 [p = 0.003]).ConclusionDifferences in sex distribution, BRAF mutation rates, primary tumour site and overall survival suggest biological differences between EOCRC and LOCRC. Liver resection was associated with improved survival in LOCRC, with the benefits of all therapies varying depending on age, primary tumour site and whether patients presented with synchronous or metachronous liver-only metastases.
Savio G. Barreto, Christos S. Karapetis, Shahid Ullah, Matthew Burge, Susan Caird, Angus Campbell, Azim Jalali, Ross Jennens, Muhammad A. Khattak, Belinda Lee, Stephanie H. Lim, Shehara Mendis, Louise Nott, Timothy J. Price, Jeremy D. Shapiro, Jeanne Tie, Javier Torres, Colin Williams, Rachel Wong, Vanessa Wong, Peter Gibbs
Uneven Ground: Survival Differences Among Victorian Lung Cancer Patients by Location of Residence (2011–2023): A Retrospective Cohort Study
Objectives Patients in regional and rural areas consistently experience poorer lung cancer survival rates compared with those in metropolitan centres, but the reasons remain unclear. This study examined survival differences in non-small cell lung cancer (NSCLC) across Victoria and identified key prognostic factors contributing to these differences.DesignRetrospective cohort study.Setting and ParticipantsNSCLC patients diagnosed between 1 July 2011 and 22 May 2023 identified from the Victorian Lung Cancer Registry (VLCR).Main Outcome MeasuresResidential address and treatment institution were classified using the Modified Monash Model (MMM): Modified Monash (MM) category 1 (MM1) as metropolitan, MM2 as regional and MM3–MM7 as rural/remote. Demographic, socio-economic and cancer-specific factors were analysed as potential predictors of all-cause mortality.ResultsAmong 13,548 patients, 4244 (31%) lived in regional or rural/remote areas. Compared with metropolitan patients, these groups had higher smoking prevalence (metropolitan, 2848/9304 [31%] vs. regional, 366/1083 [34%] vs. rural, 1148/3161 [37%]) and were more likely to be Australian-born (metropolitan, 4919/9304 [53%] vs. regional, 873/1083 [81%] vs. rural, 2603/3161 [82%]; p < 0.001). Comorbidity burden was similar across groups (median, 1; interquartile range, 0.0–1.0; p = 0.19). Socio-economic disadvantage was more marked in regional and rural patients (median Index of Relative Socio-Economic Advantage and Disadvantage [IRSAD] deciles: metropolitan, 8.0 vs. regional, 5.0 vs. rural, 3.0; p < 0.001), and average travel times to treatment were longer (metropolitan, 0.4 vs. regional, 1.9 vs. rural, 2.8 h, respectively). Patients treated at regional institutions had poorer survival (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.19–1.35; p < 0.001). This difference persisted after adjustment for age, stage, performance status, smoking and comorbidities (HR, 1.11; 95% CI, 1.04–1.18; p = 0.001).ConclusionsRegional, rural and remote patients with NSCLC face greater socio-economic disadvantage and travel burdens, and experience poorer survival even after accounting for clinical and demographic factors. These findings highlight enduring inequities in lung cancer care and emphasise the need for targeted interventions to strengthen access, treatment equity and outcomes for non-metropolitan populations.
Evangeline Samuel, Eldho Paul, Mike Lloyd, Sanuki Tissera, Craig Underhill, Sagun Parakh, Phillip Parente, Inger Olesen, Javier Torres, Katharine See, Gavin M. Wright, David Langton, Thomas John, Matthew Conron, James Bartlett, Nicola Atkin, Nikolajs Zeps, Susan V. Harden, Wasek Faisal, John R. Zalcberg, Rob G. Stirling
Estimating Eligibility for GLP-1 Receptor Agonists for Chronic Weight Management and Cardiovascular Disease in Australia: Cross-Sectional Analysis of National Health Survey Data
Objective To estimate population-level eligibility for glucagon-like peptide-1 receptor agonist (GLP-1RA) medications among adults in Australia, according to Therapeutic Goods Administration-approved indications for chronic weight management and secondary prevention of cardiovascular disease in individuals with overweight or obesity.Study TypeCross-sectional analysis of data from the Australian Bureau of Statistics 2022 National Health Survey.Setting, ParticipantsNon-pregnant adults aged ≥ 18 years who were residents of Australia living in a private dwelling.Main Outcome MeasuresTotal number of adults eligible for GLP-1RA medications according to approved indications for chronic weight management and secondary prevention of cardiovascular disease in individuals with overweight or obesity, across subgroups defined by body mass index, weight-related comorbidities and/or sociodemographic factors.ResultsOverall, 39.7% (95% confidence interval [CI], 38.4%–41.0%) of adults were eligible for GLP-1RA use for chronic weight management, accounting for 7.8 million (95% CI, 7.6–8.1 million) individuals. Among those eligible, 2.9 million (95% CI, 2.7–3.1 million) adults had no weight-related comorbidities, 3.3 million (95% CI, 3.1–3.4 million) adults had one weight-related comorbidity and 1.7 million (95% CI, 1.6–1.8 million) adults had at least two weight-related comorbidities. The proportion of adults eligible under this indication varied across clinical and sociodemographic factors. Among those eligible under the chronic weight management indication, up to 338.9 thousand (95% CI, 271.3–406.5 thousand) adults also met the indication criteria for secondary prevention of cardiovascular disease.ConclusionAbout 7.8 million Australian adults are eligible to access GLP-1RAs for chronic weight management, with up to 338.9 thousand adults also qualifying according to the indication for established cardiovascular disease. This study provides a valuable reference for policymakers to understand the number of adults in Australia who may access GLP-1RA medications based on approved indication criteria and under various coverage scenarios.
Jasmin Castrillon, Chris Schilling, Sharmala Thuraisingam, Michael W. Hii, Priya Sumithran, Peter F. Choong, Michelle M. Dowsey, Cade Shadbolt
Watchful Waiting Compared With Immediate Antibiotics for Urban Aboriginal and Torres Strait Islander Children With Uncomplicated Acute Otitis Media (WATCH): A Non-Inferiority Randomised Controlled Trial
Objective Determine whether watchful waiting is non-inferior to immediate oral antibiotics for uncomplicated acute otitis media among urban Aboriginal and Torres Strait Islander children.Study TypeNon-inferiority unblinded randomised controlled trial.Setting and ParticipantsEight Aboriginal Medical Services across three Australian states and territories between 25 August 2014 and 2 June 2023. Children (aged 1.5–16 years) with type B tympanograms and bulging tympanic membrane or acute pain/irritability were randomised by site and age (1.5–6 years and 7–16 years), with stratification using randomly allocated, permuted blocks of four and six in length.Main Outcome MeasuresWatchful waiting compared with immediate oral antibiotics using modified intention-to-treat (using only available data) and per-protocol analyses of Day 7 clinical resolution with non-inferiority threshold set at 10 percentage points.ResultsChildren were randomly allocated to watchful waiting (134), six of whom were lost to follow-up or immediate antibiotics (129) with three lost to follow-up. Resolution occurred in 57/106 (53.8%) watchful waiting and 68/113 (60.2%) immediate antibiotic group of those with complete Day 7 data (−6.4 percentage points difference; 90% confidence interval [CI], −17.4 to 4.6) (modified intention-to-treat analysis). Per-protocol analysis similarly demonstrated reduced resolution in the watchful waiting group (49/97; 50.5%) compared with immediate antibiotics (67/112; 59.8%) with −9.3 percentage points difference (90% CI, −20.6 to 2.0). There was less Day 3 diarrhoea in watchful waiting (3/90; 3.3%) than in the immediate antibiotic group (13/93 [14.0%]; −10.7 percentage points difference; 95% CI, −18.6 to −2.7) but no other differences in vomiting, diarrhoea or rash (Days 3–14). Day 7 analgesia use was higher in the watchful waiting (53/107 [49.5%]) than immediate antibiotic group (37/116 [31.9%]; 17.6 percentage points difference; 95% CI, 4.9 to 30.1). There were no intervention-related severe adverse events or perforations.ConclusionAlthough our results are numerically similar to those reported in other low-risk populations and no unexpected safety signals were observed in the watchful waiting arm, non-inferiority was not established. Larger, adequately powered trials are required to determine whether watchful waiting is non-inferior in this population.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN#12613001068752
Jennifer S. Reath, Hasantha Gunasekera, Sanja Lujic, Amanda J. Leach, Letitia Campbell, Robyn Walsh, Tim Usherwood, Geoffrey K. Spurling, Claudette A. Tyson, Deborah A. Askew, Kelvin Kong, Chelsea J. Watego, Peter Morris, Wendy Hu, Penelope A. Abbott
The Impact of Heat and Bushfire Smoke on Health System Utilisation in Australia
Objective To characterise the associations of heat and bushfire smoke with health services utilisation and medication use at a national scale to support Australia's first National Climate Risk Assessment.DesignCross-sectional, population study, covering health conditions with the highest burden of disease.Setting and ParticipantsPeople in Australia accessing public health services between 2014 and 2020 for care related to cardiovascular, respiratory and mental health conditions.Main Outcome MeasuresRelative risks of heat and bushfire smoke (particulate matter ≤ 2.5 μm in diameter [PM2.5]) on health system utilisation and medication use, measured as emergency department (ED) presentations, hospital inpatient admissions, Medicare Benefits Schedule service claims in primary care and Pharmaceutical Benefits Scheme prescriptions dispensed. Relative risks (RRs) and 95% confidence intervals were estimated for short-term lags between exposure periods and health system usage.ResultsHeat was most strongly associated with ED presentations, with a RR of 1.033 (95% CI, 1.023–1.043; p < 0.001) per degree temperature change for respiratory conditions and 1.023 (95% CI, 1.016–1.031; p < 0.001) for mental health conditions. PM2.5 at a 1-day lag had the highest association with hospital admissions, with a RR of 1.014 per 1 μg/m3 change in particulate density for both cardiovascular (p = 0.001) and respiratory (p = 0.002) conditions. Primary care visits for mental health conditions were strongly associated with levels of PM2.5 (RR, 1.049 [95% CI, 1.040–1.058]; p < 0.001) and with temperature (RR, 1.027 [95% CI, 1.014–1.039]; p < 0.001), while medication use increased across respiratory, cardiovascular and mental health categories in response to both exposures, with particulate matter showing stronger effects for cardiovascular, respiratory and mental health prescriptions. Mental health outcomes consistently showed vulnerability across all domains.ConclusionHeat was strongly associated with acute ED presentations, while particulate matter was strongly associated with hospital admissions and medication use. Mental health services are broadly sensitive to both exposures. These findings emphasise the need for integrated air quality management and heat-health polices to reduce system-wide health burdens.
Hwan-Jin Yoon, Justin Boyle, Ibrahima Diouf, Rajiv Jayasena
Roadmap to Support International Medical Graduates for Satisfying Rural General Practice Careers: A Realist Evaluation Approach
Objectives Develop a roadmap of contextualised strategies to support international medical graduates (IMGs) on the pathway into satisfying rural general practitioner careers in Australia.DesignRealist evaluation approach.Setting, ParticipantsOnline semi-structured interviews, focus groups and intermittent feedback cycles developed, refined and confirmed a contextualised roadmap of strategies between 1 November 2024 and 27 July 2025. Participants were purposefully selected for IMG background and different pathways into rural general practice careers across Australia. This included a 10-person project advisory group and 31 external participants covering decision-makers, training teams, supervisors and trainees. Questions explored practical strategies to drive comfort, confidence, competence, belonging and bonding.Main Outcome MeasuresContextualised strategies for IMGs to achieve satisfying rural general practice careers.ResultsThe roadmap identified that when migrating and acclimatising, providing IMGs with centralised resources and information on rural general practice training and careers promotes comfort and empowerment. When moving to new workplaces and communities, providing IMGs with supportive workplaces for early supervised practice, skill bridging and opportunities to connect with other doctors', families and communities stimulates IMG confidence, competence and sense of community belonging. When training to become a general practitioner rurally, providing IMGs with family-focused, equitable training matched to the IMG and the community, and training that builds on IMG capabilities, promotes a sense of professional belonging and bonding. We identified that early intervention and a continuity of supports are important for more comprehensively supported IMGs.ConclusionsOngoing timely support, when multi-layered, tailored and integrated, may assist IMGs to gain specialist general practice qualifications, feel valued and to settle in rural general practice roles. The roadmap provides a basis for planning coordinated longitudinal support by distributed agencies.
Belinda G. O'Sullivan, Kim J. Omond, Neysan Sedaghat
Multimorbidity Clusters Among People Aged 65 Years and Over in Australia: A Nationwide Cross-Sectional Data Linkage Study
Objectives To identify sex-specific multimorbidity patterns in Australia, using the Rx-Risk index (a medication-based measure), to: (i) estimate the prevalence of chronic treated conditions; (ii) map network-based multimorbidity clusters; and (iii) examine how these clusters vary by age, socio-economic status and geographic remoteness.DesignAustralian nationwide cross-sectional study using linked Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data.SettingAustralian residents aged ≥ 65 years with at least one PBS and/or MBS claim between 1 July 2022 and 30 June 2023.Main Outcome MeasuresSex-specific network-based multimorbidity clusters and cluster profiles by age, socio-economic status and geographic remoteness.ResultsA total of 4,435,784 individuals (mean age, 74.8 years; 53.2% female) were included. Multimorbidity (≥ 2 conditions) was present in 76.1% of the cohort. Three consistent multimorbidity clusters were identified in both sexes: cardiovascular–metabolic, neuropsychiatric–functional decline and inflammatory–musculoskeletal–cancer. The prevalence of these clusters and their component conditions varied across sociodemographic groups, with higher prevalence observed in individuals aged ≥ 85 years and those living in socio-economically disadvantaged areas. Minimal differences were observed between metropolitan and non-metropolitan regions.ConclusionsMultimorbidity was highly prevalent among older Australians with at least one PBS and/or MBS claim during the study year, with multimorbidity clusters showing marked sociodemographic variation in prevalence. These findings highlight the heterogeneity in treated conditions captured in administrative claims and provide insights to inform future research and policy planning for prevention and management of multimorbidity in an ageing population.
Weisi Chen, Christine Y. Lu, Sarah N. Hilmer, Alice A. Gibson, Edwin C. K. Tan
Drivers of Vaccine Uptake for Aboriginal and Torres Strait Islander Children to Inform Tailored Strategies: A Qualitative Study Exploring Health Service Provider Perspective
Objectives To identify drivers of routine vaccination for Aboriginal and Torres Strait Islander children, from a health service provider perspective, to increase and maintain uptake.DesignThis qualitative study was designed, analysed and guided by Indigenous data sovereignty and governance principles. Data were analysed using inductive content analysis. Subcategories were refined using Miro (Miro Inc), an online collaboration platform. Aboriginal and Torres Strait Islander worldviews were privileged, with Aboriginal researchers leading data analysis in New South Wales (NSW) and contributing to analysis in the Northern Territory (NT).SettingThe study was conducted in NSW and the NT, Australia, with health service providers from urban, rural and remote settings.ParticipantsIndividual and group interviews were undertaken in person or online between 2 May and 28 August 2024, with 18 health service provider participants in the Hunter New England Local Health District in NSW and 17 health service provider participants in the NT.ResultsWe identified six key themes addressing drivers of vaccination for Aboriginal and Torres Strait Islander children for families (knowledge, attitudes and information sources; decision-making), health staff (workforce roles, responsibilities and relationships) and health services (improving access; health service operations; data for decision-making). Providers recommended strategies to improve uptake.ConclusionsHealth service providers in urban, rural and remote locations in Australia can provide valuable insights to inform tailored strategies to improve declining vaccine coverage for Aboriginal and Torres Strait Islander children, aligned with the priorities of the National Immunisation Strategy 2025–2030.
Bianca F. Middleton, Kristy Crooks, Kylie Taylor, Elizabeth Harwood, Katrina K. Clark, Caitlin Kent, Kelly McCrory, Marita Hefler, Jessica Kaufman, David N. Durrheim, Margie H. Danchin
Self-Poisoning With Prazosin and Its Off-Label Use in Australia, 2014–2024: Analysis of NSW Poisons Information Centre Data
NSW Poisons Information Centre data identified 1030 deliberate prazosin self-poisonings over 11 years, rising from 13 to 170 per year (2014–2024). Young women predominated, likely due to expanded off-label (but accepted) psychiatric use of prazosin. Better evidence on benefits of off-label use is needed to justify increasing risks.
Olivia B. E. Lal, Nicholas A. Buckley, Rose Cairns
Intergenerational Child Protection Contact and Child Development Outcomes: A Whole Population Linked Data Study
Objectives To investigate maternal child protection histories, and offspring child protection contacts and developmental outcomes, for children at age 5 years.Study DesignObservational cohort study using linked South Australian administrative birth, perinatal, child protection and child development data.Participants, SettingChildren with a South Australian birth registration and a record in the 2009, 2012, 2015 or 2018 Australian Early Development Census (AEDC).Main Outcome MeasuresHighest level of child protection system contact for children before starting school, and developmental vulnerability on one or more AEDC domains.ResultsOf 69,332 children, 7522 (10.8%) had a mother with a history of any child protection contact, and 1019 (1.5%) had a mother with at least one out-of-home care placement. Maternal child protection history was associated with increasing levels of socio-economic and health disadvantage around the time of birth. For example, overall there were 8245/69,332 (11.9%) children born into a home where the parent(s) were unemployed, compared with 549/1019 (53.9%) with a maternal out-of-home care history. For children whose mothers had child protection contact, 3793/7522 (50.4%) had their own child protection contact by age 5 years, compared with 7033/61,810 (11.4%) for children whose mothers had no contact. Of 6771 children whose mothers had child protection contact, 2724 (40.2% [95% confidence interval], 39.1%–41.4%) were developmentally vulnerable on one or more AEDC domains when they started school, compared with 12,002/58,165 (20.6% [95% confidence interval], 20.3%–21.0%) children with no maternal child protection history.ConclusionChild protection contact is common in both mothers and children, and maternal child protection history carries an increased burden of poor development outcomes at school entry. The scale and intersection of child protection system contact, early life disadvantage and poor development outcomes have implications for appropriately resourcing health-led supportive responses as early as possible during the perinatal and early childhood periods.
Meredith Forsyth, Alicia Montgomerie, Kathleen Falster, Deepa Jeyaseelan, Paul Hotton, John Lynch, Rhiannon M. Pilkington
Treatment and Survival Outcomes for Indigenous and Non-Indigenous Australians Within the Victorian Lung Cancer Registry: A Retrospective Cross-Sectional Cohort Study
Objectives Our goal was to explore and compare risk factors, patterns of management and survival outcomes in Indigenous compared with non-Indigenous Australian patients using the Victorian Lung Cancer Registry (VLCR).Study TypeA retrospective observational cohort study of the VLCR.SettingData collected from the VLCR between 18 January 2011 and 24 January 2024.ParticipantsPrimary lung cancer patients in the VLCR.Main Outcome MeasuresPatient, disease and management characteristics of Indigenous and non-Indigenous Australian patients. Impacts of patient and clinical variables on treatment and survival, measured by multivariable Cox regression and propensity-matched survival analysis.ResultsWe included 186 Indigenous and 17,439 non-Indigenous Australian patients. Indigenous Australian lung cancer patients were younger in age {median, 62 years (interquartile range [IQR], 55–69 years) vs. median, 71 years (IQR, 63–77 years); p < 0.001}, had lower socio-economic status (lowest quintile, 57 patients [31%] vs. 3274 patients [19%]; p < 0.001), were more likely to be current smokers (118 patients [65%] vs. 5963 patients [35%]; p < 0.001) and had higher levels of respiratory comorbidity (64 patients [34%] vs. 4088 patients [23%]; p < 0.001). There were no statistically significant differences in receipt of guideline-concordant treatment (82 patients [51%] vs. 8036 patients [56%]; p = 0.12) and survival outcomes (median survival, 1.4 vs. 1.5 years; hazard ratio, 1.06 [95% confidence interval, 0.88–1.27]).ConclusionWe found lung cancer patients of Indigenous status were more likely to have demographic disadvantage and clinical risk factors that may contribute to discrepancies in management compared with patients of non-Indigenous status. Identifying barriers to healthcare and treatment in the Indigenous Australian population is an important research priority to improve disparities between the two populations.
Melanie Wong, Mike Lloyd, Jessie Zeng, Sanuki Tissera, Kalinda E. Griffiths, Justine Clark, Jonathan Gillies, Lisa Briggs, Jacqueline Lesage, Tom Wood, Craig Underhill, Sagun Parakh, Louis B. Irving, Wasek Faisal, Rob Blum, Gary E. Richardson, Phillip Parente, Michelle Caldecott, Inger Olesen, Javier Torres, Evangeline Samuel, Christopher Lyne, Katharine See, David Langton, Thomas John, Gavin Wright, Matthew Conron, James Bartlett, Golsa Adabi, Maggie Moore, Susan Harden, Zoe K. McQuilten, John R. Zalcberg, Rob Stirling
Worsening Asthma Outcomes in Australian Adults: A Comparison of Stratified Sample Surveys in 2012 and 2021
Objectives To report patterns of asthma control, medications and healthcare utilisation in Australian adults with asthma in 2021, and assess changes since a similar survey in 2012. Study Type Cross-sectional web-based survey (February–March 2021; n=5427), compared with a similar 2012 survey (n=2686). Setting/Participants Adults (≥18years) with asthma, recruited from large web-based panels, with enrolment stratified by age group, gender and state/territory. Main Outcome Measures Asthma control test (ACT), healthcare utilisation and medications. Results Median age was 46years; 59% of participants reported female gender. Compared with 2012, fewer participants had well-controlled symptoms (ACT≥20: 2021, 48.0%; 2012, 54.4%; p<0.001), and more had very poorly controlled symptoms (ACT 5–15: 2021, 26.8%; 2012, 22.9%; p<0.001). Urgent asthma healthcare had increased (2021, 37.9%; 2012, 28.6%; odds ratio 1.53 [95% confidence interval, 1.37–1.69]; p<0.001). Inhaled corticosteroid (ICS) use in the previous year was similar (2021, 60.9%; 2012, 60.8%) but adherence was lower (p<0.001). Fewer participants had good symptom control while taking little/no ICS (2021, 33.4%; 2012, 40.1%), and more had uncontrolled symptoms with little/no ICS (2021, 38.1%; 2012, 25.6%; p<0.001); among the latter group, urgent healthcare utilisation had increased (2021, 63.5%; 2012, 41.2%; p<0.001). In 2021, 28.7% reported using oral corticosteroids for asthma in the previous year; only 42.0% of ICS users recalled their inhaler technique having been checked in the past 12months. Overuse of short-acting beta2-agonists was common: 56.3% adults obtained ≥3 inhalers in the previous year, and 10.5% obtained ≥12 inhalers. For symptom relief in the previous 4weeks, only 13.3% adults reported using an anti-inflammatory reliever (ICS–formoterol). Conclusion Our comparison of these two large nationally stratified sample surveys demonstrates significant worsening of key asthma indicators between 2012 and 2021, including worse symptom control and urgent healthcare use, but also indicates opportunities for improvement. The findings highlight an urgent need for system-wide implementation of the 2025 Australian asthma guidelines to reduce preventable morbidity. Trial Registration ACTRN12620000977976p
Helen K. Reddel, Maria R. Ampon, Leanne M. Poulos, Sharon R. Davis, Brett G. Toelle, Guy B. Marks, Taehoon Lee
Stigmatising Attitudes Towards People With Depression, Bipolar Disorder, Borderline Personality, ADHD and Early and Long-Term/Untreated Schizophrenia: Representative Survey of Australian Adults
Objectives To examine the prevalence in Australia of stigmatising attitudes towards people with six different mental health conditions: depression, early and long-term/untreated forms of schizophrenia, bipolar disorder, borderline personality disorder and attention-deficit/hyperactivity disorder (ADHD). Design Cross-sectional population-based survey using the probability-based online panel Life in Australia. Participants responded to one of six vignettes describing a person with a mental health condition. Setting Australia, 11–25 November 2024. Participants Representative sample of 6032 adult residents of Australia. Main Outcome Measures Proportions of participants who agreed or strongly agreed with 13 stigmatising attitudes and proportions who were definitely or probably unwilling to interact in five different social situations with the person in the vignette. Results Stigmatising attitudes were generally lowest for depression and highest for long-term schizophrenia and borderline personality disorder. Beliefs about unpredictability had the highest endorsement: 61.9% (95% confidence interval [CI], 58.2%–65.5%) for long-term schizophrenia; 56.3% (95% CI, 52.5%–59.9%) for borderline personality disorder; 52.8% (95% CI, 49.0%–56.6%) for early schizophrenia; 50.7% (95% CI, 47.0%–54.4%) for bipolar disorder; 29.2% (95% CI, 25.9%–32.7%) for ADHD and 23.3% (95% CI, 20.2%–26.7%) for depression. Forcing treatment was endorsed by 25.9% (95% CI, 22.6%–29.5%) for early schizophrenia and 24.1% (95% CI, 21.0%–27.6%) for long-term schizophrenia. For all conditions, at least 20% of participants did not agree that the person in the vignette was a person of worth, with agreement ranging from 78.5% (95% CI, 75.1%–81.6%) for early schizophrenia to 67.4% (95% CI, 63.8%–70.9%) for long-term schizophrenia. There were high levels of unwillingness for the person in the vignette to marry into the family: ranging from 29.7% (95% CI, 26.4%–33.2%) for ADHD to 64.4% (95% CI, 60.7%–67.9%) for long-term schizophrenia. Conclusions Stigma related to mental health conditions remains prevalent in Australia and contributes to social and economic exclusion among those affected. Sustained action is needed across multiple sectors to address stigma, particularly towards conditions such as schizophrenia and borderline personality disorder, which are poorly understood within the community.
Amy J. Morgan, Anna M. Ross, Gayle McNaught, Rachel Green, Nicola J. Reavley
Continuity of Care in General Practice in Australia: A Whole-Of-Population Serial Cross-Sectional Study
Objective To quantify continuity of care in general practice in the Australian population, including variation according to patient characteristics and over time, to support ongoing policy reforms directed towards improving general practice care. Design and Setting Repeated cross-sectional analyses of linked whole-of-population data from the Medicare Benefits Schedule, the Medicare Consumer Directory and the Census of Population and Housing (2021). Participants Continuity was assessed in people with at least four general practitioner visits in a 2-year period (about 80% of the population). Main Outcome Measure Relational continuity of care in general practice, measured with the Usual Provider Index, for eight overlapping 2-year periods (2016–2017 to 2022–2023). High continuity was defined as having ≥70% of visits with one provider. Results About one-third of the population had high continuity of care (range: 31.3% in 2018–2019 to 37.2% in 2020–2021). After adjustment for age, sex and remoteness, high continuity was more common among those with greater care needs, including those who were older (≥70years vs. 0–14years: adjusted prevalence ratio [aPR], 1.88) or with health conditions (e.g., ≥3 vs. none: aPR, 1.14) and those who were living in more disadvantaged areas (e.g., most vs. least disadvantaged: aPR, 1.22), born overseas (e.g., born in Southern or Eastern Europe vs. born in Australia or New Zealand: aPR, 1.20) or not proficient in English (aPR, 1.29). However, it was less common for females compared with males (aPR, 0.90) and those living remotely (e.g., very remote vs. major cities: aPR, 0.43). Conclusion While most people in Australia do not receive continuous care in general practice with a specific provider, those with greater healthcare needs are more likely to. With ongoing policy reforms, monitoring continuity of care may provide insights into the consequences for quality of care.
Rosemary J. Korda
Short-Term Safety and Adverse Event Risk Profiles for SARS-CoV-2 Booster Vaccine Doses in Australian Adults: A Survey Study
Objective This study quantifies the short-term risk profiles of seven severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2) vaccines—Comirnaty Bivalent BA.1, Comirnaty Bivalent BA.4-5, Comirnaty XBB.1.5, Spikevax Bivalent BA.1, Spikevax Bivalent BA.4-5, Spikevax XBB.1.5 and Nuvaxovid—administered as booster doses in Australia. Design This is a survey study using data collected from online surveys sent via AusVaxSafety, the Australian active vaccine safety surveillance system, 3days post-vaccination, soliciting reports of adverse events following vaccination. Participants and Setting Individuals 18years and older who received a SARS-CoV-2 vaccine booster at an AusVaxSafety vaccine surveillance site between 1 January 2023 and 31 August 2024. Main Outcome Measures Bayesian logistic regression was used to estimate risk of reported adverse events, seeking medical advice and impact on daily activities. Results Of 197,476 respondents, 59,089 (29.9%) reported at least one adverse event, of which the most commonly reported symptoms were injection site reaction (23.8% [46,988/197,476]) and fatigue (19.4% [38,352/197,476]). Symptom resolution was reported by 69.9% (41,299/59,089) by day 3 and 5.6% (11,006/197,476) reported any time lost from daily activities. The unadjusted proportion of respondents who sought medical advice was higher in those who received Spikevax XBB.1.5 (1.2% [212/17,551]) than the other vaccines (0.5% [379/69,493] to 0.7% [147/20,271]), but the modelled, adjusted mean risk of medical advice was similar (<2.5%) across subgroups for vaccine brands, co-administered vaccines, medical conditions, age, sex and Indigenous status. The modelled risk of any adverse event at age 40years ranged from 35.2% (95% credible interval [CrI], 32.2%–38.5%) for men who had received Comirnaty XBB.1.5 to 75.5% (95% CrI, 71.9%–78.8%) for women who had received Spikevax XBB.1.5. At age 80years, this risk was lowest across all vaccines, ranging from 12.0% (95% CrI, 11.2%–13.0%) for men who had received Comirnaty BA4-5 to 36.7% (95% CrI, 34.6%–38.7%) for women who had received Spikevax XBB.1.5. Conclusions The results of this study confirm the short-term safety and low impact on daily living of SARS-CoV-2 booster vaccine administration to Australian adults.
Evelyn Tay, Michael Dymock, Lucy Dawes, Lucy Deng, Thuy Nguyen, Alan Leeb, Julie A. Marsh, Nicholas Wood, Kristine Macartney, Thomas L. Snelling
Hospital-Admitted Injection-Related Infections Among Incarcerated People Who Inject Drugs in Australia: A Retrospective Cohort Study
Objectives To characterise the clinical, microbiological and economic burden of hospital-admitted, injection-related infections among incarcerated people who inject drugs. Study Type Retrospective observational cohort study. Setting Secure unit of the Princess Alexandra Hospital, Brisbane, Australia. Participants Adults incarcerated in Queensland prisons who were admitted to hospital with an injection-related infection between 1 July 2019 and 30 June 2023. Main Outcome Measures Types of injection-related infection, microbiological findings, requirement for surgical or radiological source control, hospital length of stay and inpatient healthcare costs. Results There were 321 hospital admissions for injection-related infection among 265 patients, accounting for 282 unique infections. Most patients were male (241; 90.9%), with a mean age of 33years (standard deviation [SD], 7.4years), and 76 (28.7%) identified as First Nations. The most frequent infections were soft tissue infections (77/282; 27.3%), acute hepatitis C (64/282; 22.7%) and cellulitis (43/282; 15.2%). Surgical or radiological source control was required in 95 infections (34.0%), and infectious diseases consultation occurred in 130 infections (46.1%). Among 39 true-positive blood cultures, Staphylococcus aureus was identified in 17 (43.6%), Burkholderia species in 10 (25.6%) and non-tuberculous Mycobacterium species in 3 (7.7%). Among the 218 non-acute hepatitis C infections, 50 (22.9%) were hepatitis C virus (HCV) RNA positive. Overall, HCV RNA was present in 114 of 282 infections (40.4%). The total inflation-adjusted inpatient cost was $8.39 million, with a median cost per infection of $11,602 (interquartile range, $7426–$34,544). Conclusion Injection-related infections among incarcerated people who inject drugs were associated with substantial morbidity and healthcare costs in this large hospital cohort. A wide clinical spectrum was observed, including atypical pathogens, and clinically overt acute hepatitis C requiring hospital admission. These findings describe a significant burden of preventable disease in custodial settings and support the introduction of established primary prevention and harm-reduction interventions in prisons.
Andrew Palmer, Matthew Carter, Jeremy Yeo, Cecilia Shim, Jason Connor, Jeremy Hayllar, Gerald Holtmann, Naomi Moy, Elliott G. Playford, Naomi Runnegar, Paul J. Clark
The Effects of Social Media on Adolescent Mental Health: Findings From a Population-Based Cohort Study in Australia
Objectives To examine the effects of social media on future mental health problems (depressive symptoms, anxiety symptoms, poor well-being and self-harm) in adolescents aged 12–18years, overall and stratified by sex and age periods (early, middle and late adolescence).Study TypeProspective longitudinal study.SettingParticipants were recruited in 2012 through schools in Melbourne, selected using stratified random sampling. In wave 1 (2012), 1239 Grade 3 students participated and have since completed annual surveys.ParticipantsThe analysis used data up to wave 11 (2022). Participants with no data on mental health, social media and confounders were excluded, leaving a sample of 1195 (552 [46%] male participants).Main Outcome MeasuresExposure was self-reported duration of daily social media use at each wave, from waves 4 to 10 (ages 12–18years). Outcomes (self-reported depressive symptoms, anxiety symptoms, well-being, self-harm) were assessed at the subsequent annual wave, from waves 5 to 11 (ages 13–19years).ResultsAcross adolescence, >2h versus <1h of daily social media use was associated with a small increase in risk of high depressive symptoms (risk difference [RD] per 100, 6.3 [95% CI, 2.7–9.9]) and poor well-being (RD, 4.9 [95% CI, 1.1–8.6]) at the subsequent annual wave. Estimated risks for all mental health problems were greatest in early adolescence (12–13years), with the largest effects observed for high depressive symptoms in female participants (>2h vs. <1h: RD, 10.8 [95% CI, 2.7–18.9]).ConclusionsHigher levels of social media use were associated with small increases in future risk of high depressive symptoms and poor well-being across adolescence. The largest risks for all mental health problems were observed during early adolescence for both male and female participants, supporting the need to consider policies that mitigate the adverse effects of social media on the mental health of younger adolescents.
Nandita Vijayakumar, S. Ghazaleh Dashti, Louise Canterford, Susan Ellul, Anthony J. A. Parissi, Anne-Lise Goddings, Russell M. Viner, Paul Moran, Rohan Borschmann, Lisa K. Mundy, Ellie M. Robson, Susan M. Sawyer
Impact of the 2025 New South Wales Respiratory Syncytial Virus Prevention Program on Infant Notifications and Hospitalisations: A Population-Based Analysis
The 2025 NSW RSV Prevention Program, which achieved an estimated coverage of 63% maternal vaccination and 18% for infant immunisation, led to more than 40% reduction in RSV notifications and hospitalisations among infants aged younger than 6months.
Janaki Amin, Sally L. Ellis, Christopher Lambeth, Jessica Gugusheff, Christine Selvey
Impact of Prescription Drug Monitoring Program Implementation on Rates and Characteristics of People Seeing Multiple Prescribers in Primary Care: A Controlled Interrupted Time-Series Analysis
Objective To examine changes in rates of primary care patients seeing multiple prescribers and characteristics of patients who ceased seeing multiple prescribers for monitored medicines after voluntary implementation of the Victorian prescription drug monitoring program (PDMP). Study Design Controlled interrupted time series analysis of primary care electronic medical records. Setting A total of 562 general practices across three Victorian healthcare networks (Monash Health, Peninsula Health, Eastern Health). Patients People prescribed at least one PDMP-monitored medicine (e.g., opioids, benzodiazepines) and/or non-monitored psychotropic medicines (e.g., antidepressants, antipsychotics) between 1 January 2017 and 30 June 2023. Intervention Voluntary (1 April 2019) and mandatory (1 April 2020) implementation of the Victorian PDMP. Main Outcome Measures Changes in the monthly rate of people seeing multiple prescribers (defined as four or more prescribers) following PDMP implementation for monitored medicines, with non-monitored medicines used as a control; characteristics of people who ceased seeing multiple prescribers for monitored medicines following PDMP implementation. Results Following voluntary PDMP implementation (1 April 2019), there was a significant reduction in the differential step and trend changes in the rates of seeing multiple prescribers between people prescribed monitored and non-monitored medicines (differential step change: β, −3.55 [95% confidence interval (CI), −5.08 to −2.03]; differential trend change: β, −0.29 [95% CI, −0.46 to −0.12]). Following mandatory PDMP implementation (1 April 2020), there was no significant step change difference. However, there was an increase in the differential trend change in the rate of seeing multiple prescribers between those prescribed monitored and non-monitored medicines (differential trend change: β, 0.21 [95% CI, 0.05–0.37]; p=0.009). Logistic regression revealed that older age (95% CI, 1.39–1.75), male gender (95% CI, 1.09–1.25), metropolitan residence (95% CI, 1.04 and 1.23) and substance use disorder diagnosis (95% CI, 1.07–1.28) were associated with significantly higher odds of seeing multiple prescribers before PDMP implementation. Conclusions Implementation of the PDMP was associated with meaningful reductions in people accessing monitored medicines from four or more prescribers.
Louisa Picco, Monica Jung, Grant Russell, Samanta Lalic, Mahbod A. Fini, Dan I. Lubman, Rachelle Buchbinder, Ting Xia, Suzanne Nielsen
Two Decades of Primary Care Funding in Australia: A Descriptive Time-Series and Distributional Analysis
Objectives To examine two decades of Australian expenditure trends across components of primary health and to assess whether recent expenditure changes have been equitably distributed. Study Type Descriptive modelling using standardised framework for classifying primary care expenditure. Setting Australian public and private health expenditure data (2002–03 to 2022–23) were disaggregated into: broad primary health care services (Tier A); direct primary care, predominantly funding general practice (Tier B); and funding for enhanced primary care for people with greater needs (Tier C). Distributional analysis was conducted across geographies. Participants No individual participants; analysis used aggregated health expenditure data across 327 Statistical Area Level 3 geographies. Main Outcome Measures Proportions of total and public expenditure allocated to each tier; equity in public Tier B and Tier C spending across areas, assessed using standardised slope indices. Results The share of total health spending allocated to primary care declined over the period. Tier A spending declined from 36.3% to 33.0% of total health spending; Tier B fell more sharply from 8.0% to 5.5%; and Tier C remained flat at 0.7%. Public spending trends were similar, but declines were more muted, with Tier C unchanged at 1.0%. Public spending on Tier B was 13% higher in the most disadvantaged areas than in the most advantaged areas in 2013–14; by 2023–24, this declined to 7%. Public Tier C spending remained progressive at 35% higher in the most disadvantaged areas, but decreased from 51% over the decade. Exploratory multivariate analyses suggested that Tier C spending was more redistributive than Tier B after accounting for need. Conclusions Data indicate that primary care has declined as a funding priority in relative terms in Australia, and investment in high-value care has remained stagnant and appears increasingly less redistributive. These patterns may have implications for health equity.
Rafal Chomik, Shona M. Bates, Michael Wright
