Background

Highly effective direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) have led to reductions in HCV incidence in people with HIV through a treatment-as-prevention effect. However, it is unknown whether the treatment-as-prevention effect differs by gender. We aim to estimate gender differences in HCV primary incidence infection among people with HIV associated with different periods of DAA access.

Methods

The International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) pooled data from Australia, the Netherlands, Spain, and Switzerland. Those with an HCV antibody (HCVab) negative result followed by ≥1 subsequent HCV test were included. Men who have sex with men were excluded. Incidence rates (IR) were estimated by DAA availability period, stratified by gender and cohort country. Using Poisson regression, we estimated IR ratios (IRR) per 100 person years (PY), with patient gender included as an interaction term to assess effect modification.

Results

Of 13,468 eligible participants with a HCVab negative result, 5,847 (43%) were women. We observed 144 incident HCV infections over 51,168PY in men and 61 incident infections over 40,785PY in women. IR in the pre-DAA period was 0.35 per 100PY (95%CI=0.22─0.55) in men and 0.24 per 100PY (95%CI=0.14─0.39) in women. Compared to the pre-DAA period, there was an estimated 33% reduction in HCV incidence in the broad DAA access period among men (IRR=0.67, 95%CI=0.47─0.96) and a similar reduction among women (IRR pre vs broad among women=0.63, 95%CI=0.36─1.08, IRR men vs women interaction term=0.93, 95%CI=0.48─1.8).

Conclusion

Overall, there was evidence of a decline in HCV incidence during the broad DAA access period. We found weak evidence for higher HCV incidence in men than women prior to DAA introduction. Our data were consistent with a similar reduction in HCV incidence by DAA availability period for men and women, suggestive of a treatment-as-prevention effect regardless of gender.

Background
Multimorbidity refers to living with 2 or more chronic conditions at the same time. Australian Institute of Health and Welfare estimates of multimorbidity previously focused on conditions more common among older Australians. Current methods build on previous reporting by including conditions more commonly diagnosed among younger people to better describe multimorbidity across all ages.

Methods
Multimorbidity was determined based on analysis of 72 long-term health conditions self-reported to the Australian Bureau of Statistics 2022 National Health Survey. Prevalence estimates and patterns of multimorbidity are presented by age and sex. Patterns of multimorbidity are identified through analysis of conditions that commonly occur together, and conditions that are common among people with a selected condition (comorbidity analysis).

Results
In 2022, an estimated 9.7 million Australians (38%) were living with multimorbidity. However, the prevalence and patterns of multimorbidity varied by age and sex. In 2022, multimorbidity was more common among:
• older people—affecting 11% of those aged 0–14 and 79% of those aged 85 and over
• females (39%) compared with males (37%) of all ages.

Results show conditions more commonly diagnosed in childhood (such as attention deficit hyperactivity disorder and autism) feature in multimorbidity among younger age groups while conditions that develop over the life course (such as back problems and deafness or hearing loss) feature more with increasing age.

Anxiety and depression commonly co-occur across all age groups, but most prominently among people aged under 65 affecting:
• 197,000 males (4.9%) and 323,000 females (8.5%) aged 0–24
• 311,000 males (8.7%) and 483,000 females (13%) aged 25–44
• 331,000 males (10.9%) and 367,000 females (11.6%) aged 45–64.

Conclusion
Expanding the list of conditions included in multimorbidity analysis better describes multimorbidity among Australians of all ages and establishes a foundation to monitor the progression of multimorbidity over time using linked data.

Background
Housing is currently a key issue in Australia and a critical social determinant of health, particularly for Australians with disabilities. There is a growing trend for young people to stay living in the parental home, and this has been linked to poor mental health outcomes. This study explores transitions from parental coresidence for young people with disabilities, where there is very little evidence.
Methods
This study used data from three waves of the Australian Census Longitudinal Dataset (ACLD), a 5% sample of the records from consecutive Censuses linked at the individual level. Two sets of analyses were conducted comparing two consecutive waves of ACLD data: 1) 2011 to 2016; 2) 2016 to 2021. The sample included people in the ACLD dataset aged 15-34 and living with parents in wave 1 who had complete data on disability and housing tenure variables. We describe tenure (ownership, public or private rental, or living with parents) in wave 2, comparing people with and without disabilities and according to sociodemographic characteristics.
Results
Regardless of age, sex, income, engagement in employment or education, and location (in/outside major city), young people with disabilities were less likely to become homeowners, or live in private rentals, and more likely to live in public rentals than people without disabilities. The difference was more pronounced for people with disability: aged 25-29; who lived outside major city; had personal income in highest 60%.
Conclusions
We found housing transition disadvantage for young people with disabilities. As a key social determinant of health, this is likely to have health impacts, particularly on mental health. Young people with disabilities need additional support to leave the parental home and live independently, with government policies required to assist this process in the context of the current housing affordability and cost of living crisis.

Background
Young people with intellectual disability face persistent disparities in key social determinants of health such as economic and social outcomes. However, no Australian study has yet quantitatively compared post-school outcomes between young people with and without intellectual disability, leaving it unclear whether disparities exist or if they are improving or worsening over time. This study will address this gap in the evidence, estimating trends in post-school outcomes for young people with intellectual disability, other disability types and no disability over an 11-year period.

Methods
Cross-sectional analyses of the Survey of Disability, Ageing and Carers (SDAC) were conducted at four-time points between 2012-2022. Individuals with intellectual disability were identified based on functional difficulties and primary health conditions. Post-school outcomes were addressed across two domains: economic participation and independence and living and community engagement. Absolute and relative differences in post-school outcomes between young people with intellectual disability, other disability types and no disability were calculated to examine inequalities over time.

Results
Analyses indicate large and persistent absolute and relative inequalities in post-school outcomes for young people with intellectual disability compared to their peers with other disability types and no disability. Analyses indicate large absolute and relative inequalities in all post-school outcomes for young people with intellectual disability compared to their peers with other disability types and no disability. The largest inequalities were for employment and income. Importantly, there was evidence that the inequalities were persistent over the 11-year period.

Conclusion
This study highlights enduring inequities in post-school outcomes for young Australians with intellectual disability, despite evolving societal and policy landscapes. We provide nuanced insights into these inequalities. Findings underscore the need for targeted interventions and improved population-based data and quantitative approaches for this marginalised group to address the complex, dynamic nature of post-school transitions for young people with intellectual disability.

Background
The Australian Burden of Disease Study 2024 includes national estimates of disease burden for 220 diseases and injuries in 2024 based on projections using historical trends in data. It also includes estimates of the disease burden attributed to 20 risk factors. Attributable burden is the amount of health loss that would be prevented if risk factor exposure had been avoided or reduced to the lowest possible level.

Methods
The study measures the years of healthy life lost due to living with disease/injury or dying prematurely using the Disability-Adjusted Life Year (DALY) metric. Nowcasting was first used in 2023 to project estimates of disease burden to the current year, providing a timely snapshot of Australia’s health. In 2024, nowcasting was used for the first time for risk factors. Population attributable fractions (PAFs) were projected to 2024 where possible using available data. The nowcast PAFs were applied to the nowcast disease burden estimates to estimate attributable DALY in the current year.

Results
In 2024, 36% of disease burden in Australia could have been prevented by reducing or avoiding exposure to the modifiable risk factors included in the study.

Overweight (including obesity) became the leading risk factor contributing to disease burden in 2024, overtaking tobacco use (excluding nicotine vaping). This trend is largely a result of a substantial fall (41%) in the age-standardised rate of total burden attributable to tobacco use between 2003 and 2024.

Alcohol use and illicit drug use were the leading risk factors contributing to disease burden for males aged 15–44, while child abuse and neglect was the leading risk factor for females of the same age.

Conclusion
Addressing modifiable risk factors such as overweight and obesity could prevent over one-third of disease burden in Australia. Findings from the study can inform preventative health policy and service planning.

Background
Silicosis is a major health concern among artificial stone benchtop workers in Australia. The respiratory disease is caused by the inhalation of crystalline silica dust produced during the processing and installation of benchtop products made of artificial stone. In response, a WorkSafe Victoria funded health screening program began in 2019, which showed a high proportion of migrant workers (~50% born overseas) compared to the general Australian workforce (30%). We wished to compare silicosis prevalence between migrant and non-migrant workers, with further analysis by interpreter use.

Methods
Data were extracted for persons attending screening between 2019–2024. Australian-born workers were classified as non-migrants and those born elsewhere as migrants. Interpreters were available for the assessment. Prevalence was compared between groups using Poisson regression with robust standard errors adjusting for age, smoking status and duration of exposure, and risk ratios (RR) with the 95% confidence interval (CI) were reported.

Results
There were 1,080 workers assessed, including 536 (49.6%) migrant workers and 23.8% of migrant workers had used the interpreting service. Majority were men (92.8%) and the median age was 33 (interquartile range (IQR) 27-42) and 39 years (IQR 31-47) among non-migrant and migrant workers, respectively. Overall, silicosis prevalence was higher in migrant than non-migrant workers (23% vs 15%, RR=1.54, 95% CI 1.16–2.04). Prevalence among workers <45years was comparable but in those age ≥45years, prevalence was higher among migrant workers (RR=2.86, 95% CI 1.62-5.06). Migrant workers who used an interpreter were at increased risk of silicosis than those who did not use one (32.3% vs 13.3%, RR=2.24, 95% CI 1.61-3.10).

Conclusions
This study showed disproportionate silicosis prevalence by migration status and interpreter use, the latter being a surrogate for language proficiency. It is therefore important for employers and workplace safety policymakers to seriously consider ways to overcome this disparity.

Background: There is a geographic maldistribution of oral health workforce in Australia, contributing to inequities in accessing dental care and oral health disparities. The aim of this research was to investigate trends in the geographic distribution of dentists from 2019 to 2023.
Methods: Data on the number of full-time equivalent dentists practising clinically was sourced from Health Workforce Australia. Population data was sourced from the Australian Bureau of Statistics. This data was aggregated to Local Government Areas (LGA) and the number of dentists per 100,000 population was calculated. LGAs were classified by remoteness as Major Cities, Inner Regional, Outer Regional, Remote and Very Remote. The change in dentists per 100,000 population and the trends for LGAs were analysed by remoteness.
Results: The number of FTE dentists increased from 53.0 per 100,000 in 2019 (Major Cities 69.7, Inner Regional 41.5 and Outer Regional 46.7) to 55.4 in 2023 (Major Cities 71.7, Inner Regional 40.7 and Outer Regional 48.1). There were 198 LGAs in 2019 and 205 in 2023 with no dentists, covering a population of 737,000 (3%) and 775,000 (2.9%) respectively. 195 LGAs saw in increase in the dentist:population ratio, 152 saw a decrease, and 181 had no dentists in both 2019 and 2023. LGAs in Major Cities were significantly more likely to see an increase, with 77.2% increasing, whilst more than 75% of Remote and Very Remote LGAs continued to have no dentists, and 10.7% to 19.1% experiencing a decline respectively (p<0.001).
Conclusions: Although there has been a large increase in the number of dentists in Australia over the past decade the distribution continues to be uneven across and within states. The greatest growth in dentists per capita is in Major Cities, with people living more remote experiencing challenges in accessing dental care.

Background
Gender and gender inequality are key determinants of health worldwide. Despite this, capturing and assessing gender inequality is difficult, and has typically been done at an international level by comparing countries. Such approaches do not provide sufficient granularity or nuance to guide gender equality approaches within countries. To address this gap, we developed a multi-dimensional measure of gender equality for Australia. Here we report on the development of this index and preliminary findings on the distribution of gender equality across Australia.

Methods
Using Australian census-linked data collected in 2016, we assembled a measure of gender inequality operationalised at Statistical Area 3 & 4 and comprising of 12-indicators. These were: poverty; housing stress; receipt of single parent pension; annual income; investments and wealth; time spent on domestic chores; caregiving; STEM education; full-time employment; occupational skill level; retirement savings; and valued male dominated occupations. We used three different weighting approaches to derive the overall index: (1) an equally weighted average of indicators, (2) a scaled weighted average with weights determined by principal components analysis (PCA), and (3) a weighted average of indictors, with weights determined by a survey of a panel of experts.

Results
There was high correlation between the measures derived using the different weighting approaches. Applying the gender equality index, we calculated that on average, Australian women are approximately 70% more disadvantaged than men, with this inequality consistent across all areas and at both geographic levels.

Discussion
We derived a composite measure of gender equality across Australia called the Australian Gender Equality index (AGEI). Applying this new measure, we calculated that Australian women are disadvantaged relative to Australian men across Australia. Given the role of gender equality as a determinant of health, there is a need for further analyses to assess the implications of this on health outcomes.

Background: Drowning is the world’s third leading cause of unintentional injury deaths. We undertook a systematic analysis of drowning mortality and its related risk factors.
Methods: Mortality, years of life lost (YLLs), and risk factor data for drowning for 204 countries and territories were obtained from the Global Burden of Disease 2021. Countries and territories were classified into five Socio-demographic Index (SDI) groups. Global standard population data were used to calculate the age-standardized mortality rate (ASMR), and the age-period-cohort (APC) model was used to determine age, period and cohort effects, as well as the net drift, which represented the annual percentage change. We additionally analyzed drowning mortality attributable to three risk factors: high alcohol use, high temperature, and occupational injuries.
Results: In 2021, there were 233 906 premature deaths and 15.0 million YLLs globally from drowning, a 54.5% and 66.2% reduction, respectively, when compared to 1980. The global ASMR also greatly reduced from 11.09 per 100 000 in 1980 to 3.16 per 100 000 in 2021. Low-middle and low SDI countries had the highest ASMR for drowning (3.81 and 4.47 per 100 000), nearly four times higher than high SDI countries (0.99 per 100 000). Some countries such as China (net drift: -2.54%), India (-1.75%), and Brazil (-2.45%), have made great progress. From 1990 to 2021, we found that the ASMR of drowning mortality attributable to high temperature or occupational injuries had decreasing trends. In contrast, the ASMR attributable to high alcohol use was increasing in some middle, low-middle, and low SDI countries. Conclusion: Despite impressive reductions, drowning persists as a major contributor to premature mortality, especially in middle, low-middle, and low SDI countries. Since premature drowning deaths are primarily caused by preventable and modifiable risk factors, targeted strategies addressing these factors are essential to further reduce such fatalities.

Background

There is limited research on how government regulation affects tobacco outlet density over time.

Objectives

To examine the association between government-imposed tobacco control laws and outlet density between 2002 – 2019.

Methods

Records of all outlets were obtained from the government mandated tobacco sellers licensing scheme in Tasmania (population ~500,000). Trends in density i.e. retailers per 1000 people, between 2002 and 2019, were analysed as annual percentage change (ACP) and through identification of inflection points using standard Joinpoint regression analysis. Trends by retailer type were analysed from 2010 to 2019.

Results

The highest retailer density was observed in 2002 (3.17 retailers per 1000 people) and lowest, in 2019 (1.20 retailers per 1000 people). We observed a mean ACP of -5.1% of retailer density (CI -5.9% to -4.3%, p>0.001) over the study period. A dramatic decrease in APC 7.9 % density per year (CI9.7% to 6% p<0.01) was observed between 2009 and 2013, which corresponded to changes tobacco packaging laws and import taxes. An APC decrease of 8.9 % density per year (CI -10.7% to -7.1% p<0.001) between 2016-2019, which corresponded with a tripling in government licensing fees. Liquor licensed premises, food businesses, mixed businesses and newsagencies were all affected, (-7.8, -19.8,-9.9,-10.2% APC respectively) per year. No change was observed for supermarkets and tobacconists and wholesalers from 2010 to 2019.

Conclusion

Tobacco import tax, a ban on advertising, packaging laws and licence fee increases were associated with reduced tobacco outlet density. Supermarkets and tobacconists - large volume sellers - were impervious to these levers and may require direct regulation. Whether the changes in tobacco retail outlet density are associated with reduced smoking rates is currently being investigated.

Background: In 2015 the UK government abolished means-tested child-related social security payments to households for third or subsequent children born from April 2017 (the “two-child limit”). From 2017 to 2021 there was a sustained increase in the number of abortions annually in England, following a previously flat trend.

Methods: We undertook descriptive analysis and interrupted time series modelling using abortion-level microdata from the Department for Health and Social Care, to analyse whether this increase was primarily among women with 2+ existing children in more deprived areas, consistent with being a response to the two-child limit.

Results: The increase in numbers of abortions over time was not associated with having more children or living in more deprived areas. Instead, from 2017 onwards the previously declining trend among people with 0 or 1 previous births reversed. The pattern of change at area level was nearly identical across deciles of the Index of Multiple Deprivation.

Conclusion: The cumulative impoverishing effects of austerity may affect abortion decision-making in England generally, but the two-child limit specifically is not associated with the change that followed its introduction. The primary drivers of recent increases in abortions may be non-material, such as uncertainty about the future beyond immediate financial considerations.

Background: People with disability have poorer mental health than people without disability. While the reported prevalence of mental health conditions in rural and remote Australia is similar to people living in major cities, no previous research has considered the intersections between three key characteristics – disability, age, and remoteness – in estimating the prevalence of common mental disorders and psychological distress.
Methods: Using cross-sectional data from the National Study of Mental Health and Wellbeing (2020-2022), we estimated the prevalence of 12-month affective and anxiety disorders (WHO CIDI) and psychological distress (K10) by disability status and remoteness (major cities, all other areas) for 10-year age groupings. We then age-standardized to the population of people with disability in the sample and generated prevalence estimates across major cities, inner regional, and outer regional and remote areas.
Results: People with disability had a higher prevalence of 12-month affective and anxiety disorders and distress than people without disability regardless of where they lived. The prevalence of the outcomes was similar across major cities and regional and remote areas when considered within age groups and disability status. In the age standardized analysis, we found that people with disability had a prevalence of affective disorders, anxiety disorders, and distress that were approximately 4.5 times, 3 times, and 4.5 times higher respectively than people without disability.
Conclusion: Our results emphasize that people with disability are much more likely to experience mental health conditions and distress regardless of where they live. Given geographic differences in disability and health service availability and access, there is a need for future research to examine how inequalities in access may be contributing to inequalities in mental health outcomes, including suicide and self harm.

Background: Mortality and life expectancies at birth are crucial indicators of population health. This paper provides a comprehensive overview of the latest mortality trends in the Northern Territory (NT) from 1967 to 2020, emphasising the role of health surveillance and monitoring.

Methods: Mortality data were obtained from the Australian Bureau of Statistics and the Australian Coordinating Registry to examine causes of death, and trends in the NT. Age-adjusted mortality rates per 100,000 population were calculated using the 2001 Australian standard population. Age-specific mortality rates informed life table construction, from which we derived life expectancy at birth, stratified by gender and Aboriginal status.

Results: All-cause mortality declined by 40–46% in Aboriginal populations and 62–63% in non-Aboriginal populations, while infant mortality dropped from 52 to 8 deaths per 1,000 births. The average life expectancy at birth for Aboriginal peoples increased from 53 to 67 years for males and from 54 to 70 years for females. From 2011–2020, non-communicable diseases (NCDs) accounted for 69% of deaths, with disproportionate impact upon Aboriginal peoples compared to with their counterparts (1057.0 vs 439.1 deaths per 100,000). Leading causes of death included coronary heart disease and dementia, with Aboriginal males nearly three times more likely to die from coronary heart disease (248.7 vs 87.1) and Aboriginal females twice as likely to die from dementia (107.6 vs 50.4).

Conclusion: Premature mortality in the NT has improved overall, yet the health gap between Aboriginal and non-Aboriginal populations persists. The inequitable impact of NCDs highlights the need for strengthening culturally appropriate primary and secondary prevention programs and addressing social determinants of health. Targeted interventions implemented under NT Health’s Healthy Well and Thriving framework co-designed with affected communities, combined with ongoing surveillance of mortality data can help track progress in closing the gap in mortality and life expectancies for Aboriginal Territorians.

Background
Australian households with both parents in paid employment has been increasing over the last decades, with growing numbers of dual-earner couples and working parents with dependent children. These shifts have led to increased household and work responsibilities. This presents challenges in organising work and non-work responsibilities around children which may impact parents’ mental health.
Methods
In this longitudinal population-based cohort study, data across 21 waves of the Household, Income, and Labour Dynamics in Australia (HILDA) survey were used to employ within person fixed effects regression analysis to examine associations between work-family conflict and mental health in working-age (aged 25–64 years) Australian adults with parental responsibilities for children 14 years of age and under. Mental health was assessed using the MHI-5 scale. Both dimensions of the work-family conflict (work to family and family to work) were interrogated, as were the gender differences.
Results
Of the 10,130 participants (58,064 observations) across waves 2001-2021 of the HILDA survey who were working-age parents engaged in paid employment with children ≤14 years, 7,264 participants (46,527 observations) with at least two waves of data and non-missing data and were included in the analyses. Increasing work to family conflict was negatively associated with mental health in both women (β coefficient = -1.37 (95% CI: -1.56, -1.19)) and men (β coefficient = -1.37 (-1.55, -1.18)). While increasing family to work conflict was associated with worse mental health in women (β coefficient = -0.66 (-0.82, -0.49)), the association for men was stronger (β coefficient = -0.97 (-1.14, -0.80)).
Conclusion
Both work to family conflict and family to work conflict are independently associated with adverse mental health for women and men. More attention needs to be devoted to identifying and implementing strategies to enable working parents to cope with or reduce work-family conflict.

Introduction
Opioid agonist treatment (OAT) is the gold standard for managing opioid dependence during pregnancy. Retention in OAT throughout pregnancy is crucial to mitigate risks of relapse and poor pregnancy outcomes. An understanding of OAT retention during pregnancy and associated characteristics can inform engagement strategies.
Methods:
We conducted a retrospective study, linking OAT prescription authority data to records of pregnancies resulting in birth in New South Wales (NSW) between 2004 and 2021. OAT use during pregnancy was defined as prescription authority duration overlapping the gestation period. We calculated the proportion of pregnancies that retained in OAT from initiation through childbirth, both overall and stratified by timing of initiation (pre-conception, first, second, and third trimester) and OAT type (methadone, buprenorphine). We used logistic regression to identify characteristics associated with OAT retention, stratified by initiation timing.
Results:
We identified 4,676 pregnancies (2,820 women) with OAT use. Overall OAT retention was 84.2%, although varied by initiation timing: pre-conception 87.4% (95% CI: 86.2–88.5), first trimester 65.8% (95% CI: 61.6–70.0), second trimester 80.5% (95% CI: 76.5–84.4), and third trimester 85.2% (95% CI: 80.8–89.7); and OAT type: methadone 87.7% (95% CI: 86.6–88.8) and buprenorphine 72.3% (95% CI: 69.4–75.2). Women initiating OAT pre-conception or in the first trimester had lower retention odds if they gave birth after 2018, had a late first antenatal booking, gave birth for the first or second time, were on buprenorphine, or (for first trimester initiation only) were in custody. Retention patterns among those initiating in the second and third trimester were similar but less precise due to smaller groups.
Conclusions:
Reassuringly, most women retained in OAT during pregnancy. Enhanced monitoring and support are crucial for pregnant women who initiated OAT in early pregnancy, and those on buprenorphine, especially as buprenorphine is emerging as a preferred treatment.