Research

Objective To identify barriers and facilitators to the timely detection and optimal management of chronic wet cough (CWC) in children from the perspectives of carers, across multiple, diverse First Nations Australian communities.Study TypeQualitative participatory action research study.Setting and ParticipantsEight Australian communities across three states and territories. Semi-structured interviews and focus groups with 167 parents and carers of Aboriginal children were conducted between May 2021 and July 2023.Main Outcome MeasuresBarriers to and facilitators of detection and management of CWC in Aboriginal children in a primary care setting.ResultsKey barriers identified included inadequate health promotion, the common perception that CWC is normal and high turnover among health staff, leading to mistrust of newly onboarded health staff. The overarching facilitator identified was knowledge dissemination through health promotion, delivered in person by Aboriginal health staff using culturally secure resources, supplemented by posters placed in the community and the use of radio and social media. Individual communities expressed varied preferences regarding specific health promotion methods and designs. Communities valued staff who had spent considerable time within the community, allowing for the development of trust and rapport.ConclusionThe barriers and facilitators to detecting and managing CWC in children were generally consistent across the settings we studied. Implementation approaches to facilitate care require tailoring to local settings. Further, to reduce identified barriers for the detection and management of CWC in children, the incorrect perception that CWC is normal must be addressed and the potential harms of staff turnover need to be recognised.

Gloria T. Y. Lau, Pam Laird, Robyn Aitken, Melanie Barwick, Liam Bedford, Emily R. Bowden, Jamie Everingham, Angela Fuery, Reece Griffin, Neha Jain, Mina Kinghorn, Renae Knapp, Gabrielle B. McCallum, Peter Morris, Richard Norman, Peter C. Richmond, Aarti Saiganesh, Slade Sibosado, Cameron Taylor, Maree Toombs, Roz Walker, Joan Wilson, Anne B. Chang, André Schultz

Objectives To estimate the direct medical costs of the Hep B Partnership Program (Hep B PAST) model of care compared with chronic hepatitis B (CHB) usual care from the health system perspective (Northern Territory (NT) Department of Health and the Commonwealth).Study TypeRetrospective cohort study (2014–2023) that linked primary care with inpatient, emergency, outpatient and outreach datasets. Costs were applied using National Weighted Activity Units, the Pharmaceutical Benefits Scheme and NT Government costings. A pre- and post-implementation design from a health system perspective was applied, with costs in 2023 Australian dollars.SettingRemote communities in the NT, Australia.ParticipantsThe cohort included all First Nations people living with CHB who were attending a clinic in a remote community that had consented to the Hep B PAST program, and who received care between 1 July 2014 and 31 May 2023.Main Outcome MeasuresAnnual mean and median healthcare costs per contact and per individual across service types, with comparisons of annual mean costs per individual between pre- and post-Hep B PAST using partially overlapping t-tests.ResultsAmong 1063 First Nations individuals with CHB, annual median costs per individual were similar for usual care ($639 [interquartile range, $366–1156]) and Hep B PAST ($770 [interquartile range, $400–1272]); mean costs were also similar for usual care versus Hep B PAST ($1701 vs. $1970; p = 0.12). By service type, annual median costs were similar for inpatient services ($7777 vs. $7795), primary care ($327 vs. $302) and outpatient visits ($1985 vs. $1858), and higher for Hep B PAST for emergency services ($1339 vs. $1672) and outreach care ($373 vs. $746).ConclusionsIn remote First Nations communities, Hep B PAST was delivered with a modest increase in direct medical costs compared with usual care. These findings can be used to inform future cost-effective evaluations. Future cost savings from decreased hepatocellular carcinoma and liver failure were not included.

Hoa Nguyen, Anh Le Tuan Nguyen, Paula Binks, Melita McKinnon, Emily Vintour-Cesar, Karen Wills, Nicola Stephens, Benjamin Cowie, Joshua S. Davis, Yuejen Zhao, Peter Nihill, Julie A. Campbell, Andrew J. Palmer, Jane Davies, Barbara de Graaff

Objective To identify barriers and facilitators to the timely detection and optimal management of chronic wet cough (CWC) in children from the perspective of health care providers (HCPs) across primary care clinics providing services to Australian Aboriginal people in multiple, diverse communities.Study TypeQualitative participatory action research study.Setting and ParticipantsEight Australian primary care clinics across three states and territories. Semi-structured interviews and focus groups were conducted with 83 HCPs from eight primary care clinics across metropolitan, regional and remote health service settings between May 2021 and July 2023.Main Outcome MeasuresBarriers to, and facilitators of, detection and optimal management of CWC in Aboriginal children in primary care settings.ResultsKey barriers identified included limited condition-specific knowledge, time constraints and competing priorities. HCPs identified key facilitators, such as the need for additional training, educational resources and various modifications to clinic systems. Barriers and facilitators were similar across settings. Proposed solutions varied and were based on several factors, such as community size, availability of existing infrastructure and local preferences. In addition, HCPs highlighted the importance of a culturally secure environment in fostering engagement and communication with Aboriginal families.ConclusionAlthough the barriers and facilitators to the detection and management of CWC in Aboriginal children were largely consistent across settings, solutions must be tailored to each community's unique circumstances. A comprehensive approach is required to overcome barriers and deliver the intervention within a culturally secure framework.

Gloria T. Y. Lau, Pamela Laird, Robyn Aitken, Melanie Barwick, Liam Bedford, Emily R. Bowden, Corey Dalton, Jamie Everingham, Angela Fuery, Reece Griffin, Neha Jain, Mina Kinghorn, Renae Knapp, Gabrielle B. McCallum, Peter Morris, Richard Norman, Peter C. Richmond, Aarti Saiganesh, Slade Sibosado, Maree Toombs, Roz Walker, Joan Wilson, Anne B. Chang, André Schultz

Objectives To examine the epidemiology of stroke and transient ischaemic attack (TIA), and quality of care provided to Aboriginal and Torres Strait Islander (‘Indigenous’) patients presenting to emergency medical services (EMSs) with stroke or TIA.DesignRetrospective population-based data linkage study.Setting, ParticipantsVictoria, Australia. Patients aged ≥ 18 years with hospital-confirmed stroke or TIA who presented to EMSs between 1 January 2015 and 30 June 2019 and were successfully linked with hospital or mortality datasets.Main Outcome MeasuresThirty- and 90-day mortality, crude and age-standardised incidence rates, EMS quality of care.ResultsAmong 32,163 patients, 287 (0.9%) were Indigenous. Indigenous patients were younger than non-Indigenous patients (median age, 62 vs. 77 years, p < 0.001). Age-standardised incidence of EMS attendance was higher within the Indigenous population (343 vs. 144 per 100,000 person-years; incidence rate ratio, 2.383 [95% confidence interval (CI), 2.084–2.711]). Rates of call-taker identification of stroke or TIA and hospital diagnoses were comparable; however, Indigenous patients were less likely to receive a stroke assessment from paramedics (166/285 [58.2%] vs. 21,271/31,605 [67.3%]; p = 0.001) and more frequently taken to stroke-capable hospitals (257/275 [93.5%] vs. 27,371/30,647 [89.3%]; p = 0.027), but less frequently taken to endovascular thrombectomy-capable hospitals (67/275 [24.4%] vs. 10,015/30,647 [32.7%]; p = 0.003). Adjusted mortality was similar between groups (30 days: hazard ratio, 0.814 [95% CI, 0.518–1.279]; 90 days: hazard ratio, 0.805 [95% CI, 0.534–1.214]). However, age-standardised incidence of 90-day mortality was higher within the Indigenous population (39 vs. 24 per 100,000 person-years; incidence rate ratio, 1.621 [95% CI, 1.031–2.398]). Indigenous patients also more often recontacted EMSs for any reason within 90 days (subdistribution hazard ratio, 1.548 [95% CI, 1.194–2.007]).ConclusionsThe age-standardised incidence of EMS attendance for stroke in the Indigenous population was more than double that for the non-Indigenous population. Although there was no difference in stroke identification at the time of the emergency call, Indigenous patients were less likely to be evaluated by paramedics for stroke.

Candice Menezes, Ziad Nehme, Luke J. Burchill, Tegwyn McManamny, Angela Dos Santos, Michelle Crilly, Luke P. Dawson, Benjamin Clissold, David Anderson, Emily Nehme

Objective To examine short-term safety outcomes following vaccination at 2-, 4-, 6- and 12-month timepoints, comparing infants receiving meningococcal B (MenB) vaccines concomitantly with National Immunisation Program (NIP) vaccines to those receiving vaccines at separate visits.Study TypeObservational cohort survey study.Setting, ParticipantsOnline surveys via AusVaxSafety were sent 3 days post-immunisation to collect reports of adverse events following immunisation (AEFIs). Infants aged < 15 months were included if, between 1 April 2022 and 31 March 2025, they received NIP and MenB vaccines concomitantly or separately at schedule timepoints, and their carer completed an AusVaxSafety survey.Main Outcome MeasuresBayesian multinomial logistic regression estimated the risk of reporting any AEFI, medical review and impact on daily activities following each vaccination strategy.ResultsOf 45,215 infants receiving NIP and MenB vaccines at the 2-, 4-, 6- and 12-month timepoints (with or without other vaccines), 72% (32,751/45,215) received concomitant vaccination. Excluding those with additional vaccines, 10,959 were included in the analysis. The adjusted model showed the cumulative risk of any AEFI was lower under the concomitant strategy compared with the separate strategy at 2 months (29% [95% credible interval (CrI), 26% to 31%] vs. 35% [95% CrI, 31% to 40%], risk difference −6.7 [95% CrI, −11.5 to −2.2]) and similar at 4 months (45% [95% CrI, 43% to 48%] vs. 47% [95% CrI, 43% to 52%]), 6 months (45% [95% CrI, 42% to 49%] vs. 44% [95% CrI, 38% to 50%]) and 12 months (47% [95% CrI, 45% to 50%] vs. 52% [95% CrI, 48% to 56%]). Medical review within 3 days was lower at 12 months in the concomitant group (4.1% [95% CrI, 3.4% to 5.0%] vs. separate 6.3% [95% CrI, 4.7% to 8.3%], risk difference −2.2 [−4.3 to −0.4]) and comparable across earlier time points (concomitant 2.3%–4.2% vs. separate 3.6%–3.9%). Impact on daily activities was low (concomitant 1.1%–8.5% vs. separate 1.6%–8.3%) with no differences observed between strategies.ConclusionsSeparating MenB vaccines from routine NIP vaccines does not reduce, and may increase, the cumulative reaction burden across visits. Findings support concomitant administration.

Thuy Nguyen, Evelyn C. S. Tay, Michael Dymock, Thomas L. Snelling, Lucy Dawes, Julie Marsh, Yue Wu, Alan Leeb, Nicholas Wood, Lucy Deng

Objective To identify factors contributing to the known increased age-standardised incidence and mortality rates for lung cancer for Aboriginal and Torres Strait Islander people in Victoria, Australia.Study TypeRetrospective, population-based, case–control study using Victorian Cancer Registry (VCR) data and linked health administrative datasets.Setting and ParticipantsSelf-identified Aboriginal and Torres Strait Islander people (respectfully referred to hereon as Aboriginal) and non-Aboriginal people (aged > 18 years) diagnosed with lung cancer from 1 January 2008 to 31 December 2022.Main Outcome MeasuresClinical, pathological, demographic, socio-economic factors and biomarkers (programmed cell death-ligand 1 [PD-L1], anaplastic lymphoma kinase [ALK] and c-ros oncogene [ROS1]) were assessed. Endpoints were all-cause and lung cancer-specific mortality. Survival analyses were conducted using Cox regression.ResultsAboriginal people (N = 512) were younger (p < 0.001), more likely to live outside a major city (p < 0.001) and in areas of greatest disadvantage (p < 0.001) than non-Aboriginal people (N = 43,468). More Aboriginal females had small cell lung cancer compared with non-Aboriginal females (17% vs. 10%), more Aboriginal males had adenocarcinomas (41% vs. 36%) and squamous cell carcinomas (26% vs. 20%), compared with non-Aboriginal males. There were no differences in the proportions of PD-L1-positive disease nor ALK or ROS1 gene rearrangements. A higher risk of all-cause mortality (hazard ratio, 1.12; 95% CI, 1.01–1.24; p = 0.03) for Aboriginal people after stratification for age, sex and lung cancer subtype was identified.ConclusionThis study identified that Aboriginal people were younger, more likely to be living outside of major cities and in areas of greatest inequity than non-Aboriginal people, which is an ongoing manifestation of colonisation. Aboriginal people diagnosed with lung cancer had an increased all-cause mortality compared with non-Aboriginal people.

Alice R. T. Bergin, Luc te Marvelde, Roger L. Milne, Benjamin J. Solomon, Kris Ivanova, Peter Savas, Stephen J. Luen, Jay Hamann, Andrea Casey, Nicole Watt, Sue M. Evans, Gail Garvey, Sherene Loi

This study evaluated Australia's national respiratory syncytial virus (RSV) burden and highlighted key data gaps. Hospitalisations (2016–2019) peaked in infants aged < 3 months (4014/100,000) and adults aged ≥ 65 years (122/100,000), nearly doubling over the period. Unspecified causes comprised ≈55% of bronchiolitis hospitalisations in children aged < 24 months. Laboratory notifications (2023) peaked at 6–11 months (7778/100,000). Real-time data integration addressing case-ascertainment and diagnostic testing frequency is essential for accurate burden estimates and future immunisation strategies.

Chisato Imai-Boulter, Jean Li-Kim-Moy, Clayton Chiu, Sanjay Jayasinghe, Kristine Macartney

Objectives Climate change, associated with heat spikes, floods, wildfires and changing patterns of vector-borne diseases, is a major determinant of health, and health system functioning. Understanding public perceptions of climate-related health risks and system preparedness can support equitable policy responses and effective health messaging.Study TypeCross-sectional.SettingOnline survey from 20 June to 27 August 2025.Participants6030 adults, aged ≥ 18 years, broadly representative of the Australian population.Main Outcome MeasuresThe AUstralian-CLimate and Health Attitudes, RIsk and Trust in the sYstem (AU-CLARITY) survey collected data on demographics, health status, experiences of climate-related events, and views on climate change and health system preparedness.ResultsRespondents (65%, 3910/6030) were concerned about climate change, yet only 45% (2735/6030) perceived it as a serious risk to their own health. Personal risk perception declined with age (odds ratio [OR] = 0.98; 95% confidence interval [CI], 0.98–0.98) and was higher among females (OR = 1.28; 95% CI, 1.15–1.43), First Nations people (OR = 1.44; 95% CI, 1.22–1.71), multilingual individuals (OR = 1.44; 95% CI, 1.22–1.71) and those with higher education (OR = 1.28; 95% CI, 1.12–1.46). Personal experience of a climate-related event increased perceived risk (OR = 1.97; 95% CI, 1.73–2.24). Regional and remote residents were less likely to perceive health risk (OR = 0.76; 95% CI, 0.65–0.89). A third (37%; 2209/6030) of respondents believed that the healthcare system was prepared for climate change. Being female (OR = 2.35; 95% CI, 2.10–2.65), having a chronic condition (OR = 1.47; 95% CI, 1.28–1.68) and older age (OR = 1.01; 95% CI, 1.01–1.01) increased perceptions that the system was unprepared. Those with higher education, who had been personally impacted, or identified as First Nations had more confidence in the system's preparedness.ConclusionsMany Australians recognise climate change as a health challenge; personal risk perception and confidence in system preparedness vary. Targeted health policies are needed to effectively communicate health risks and support healthcare's climate change resilience.

Jeffrey Braithwaite, Carolynn L. Smith, Yvonne A. Zurynski, Louise A. Ellis, Georgia Fisher, Kate Churruca, Lisa Pagano, Samantha Spanos, Janet C. Long, Christina Rojas, S. Bruce Dowton

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

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

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

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

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

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

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