Prevention of child maltreatment - incorporating physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence - is a clearly defined global policy priority. Global Burden of Disease studies have focused on estimating burden attributableto childhood sexual abuse omitting other forms of child maltreatment. This study aims to estimate burden attributableto child maltreatment using data from the first comprehensive national study, the Australian Child Maltreatment Study (ACMS), accounting for the co-occurrence of multiple forms, the complex impact of multi-type maltreatment and the contribution of interrelated factors. We estimated burden attributableto child maltreatment by age and gender for Australia in 2021. Risk-outcome pairs that met criteria for sufficient evidence for a causal relationship were included. Relative risks were estimated as a function of exposure based on data from the ACMS incorporating increased risk with multi-type maltreatment and adjustment for confounding. Levels of exposure in each of the 32 mutually exclusive combinations or patterns of child maltreatment were estimated based on ACMS data by age and gender. The theoretical minimum risk exposure level was determined as no exposure to child maltreatment in the population and population attributablefractions (PAFs) were calculated. Attributablemortality, years of life lost, years lived with disability and disability-adjusted life years (DALYs) were estimated by multiplying PAFs by the relevant burden of disease estimates by age and gender for Australia in 2021. Sensitivity analyses were conducted to assess the robustness of the results. Uncertainty was propagated into attributableburden estimates using Monte Carlo simulation methods. Overall, child maltreatment accounted for 6.6% (95% uncertainty interval (UI), 6.2-6.9%) of all DALYs for women and 6.4% (95% UI, 6.0-6.7%) of all DALYs for men in Australia in 2021. An estimated 71.2% of self-harm, 57.1% of anxiety disorders and 49.3% of major depressive disorder (MDD) DALYs in women, and 63.8% of self-harm, 55.9% of anxiety disorders and 42.9% of MDD DALYs in men were attributableto child maltreatment. Child maltreatment contributes to a substantial proportion of burden of disease in Australia, equivalent to leading lifestyle-related risk factors such as high body mass index, high blood pressure and smoking. This research significantly advances knowledge of the disease burden attributableto child maltreatment and provides novel methodology for measuring the impact of all five forms of child maltreatment combined on mental health and health risk behaviours nationally and globally.

Despite the revolution of artificial intelligence (AI), its integration remains limited in healthcare. A comprehensive understanding of the barriers to implementation is crucial to enhance the utilisation of AI. This study applies a conceptual framework-based analysis, to explore stakeholder perspectives of implementation barriers of AI in digital diagnosis in eye care. Purposive sampling was used to identify key individuals across stakeholder groups, including technology developers, clinicians, patients and healthcare leaders. Semi-structured interviews were conducted with 37 stakeholders. Using the updated Consolidated Framework for Implementation Research (CFIR), responses to the question: 'What is the biggest barrier to digital diagnosis or AI for macular disease in Australia?' were analysed. Barriers identified by stakeholders were mapped to thematic constructs of the updated CFIR, and the prominence of each implementation barrier was measured. Data saturation was not assessed. For clinicians and developers, the 'innovation' domain was most frequently cited. Clinicians were most concerned with the costs involved, whereas for developers, a lack of evidence surrounding real-world application was the main challenge. For leaders and patients, 'individuals' domain was the most frequently cited. Leaders were focused on the innovation deliverers: expressing the potential risk of over-reliance on the innovation and the subsequent consequence of clinician deskilling. Patients were more concerned about innovation recipients: emphasising the perceived lack of human empathy with the implementation of AI. Differences were revealed in the identified barriers to the implementation of AI across stakeholder groups. A co-design approach to address the misalignment in key barriers may be essential to the successful implementation of AI in digital health innovations.

Cardiovascular disease remains the leading cause of death in Australia, with primary care playing a crucial role in early intervention. This study aims to understand the facilitators and barriers to collaboration in primary care for the management of cardiovascular disease in Australia. This qualitative study used semi-structured interviews with maximum purposive sampling to capture general practitioners' perspectives on factors that impact collaboration between general practitioners and allied health professionals in cardiovascular disease management. The consolidated framework for implementation research was used to guide the analysis. General practitioners (n=23) across New South Wales were interviewed. Facilitators of collaboration included pre-established professional relationships, effective communication, existing co-location, severity of cardiovascular disease and perceived improvements in patient outcomes. Barriers identified included limited allied health availability, time constraints, complex referral processes, poor communication, low health literacy, inadequate remuneration and the view that collaboration is less necessary for patients with milder cardiovascular disease. Ultimately, the success of collaboration hinges on supportive organisational structures and strong professional relationships. Prioritising systemic integration of primary care with allied health services could improve cardiovascular disease risk and chronic disease management.

WCN26-7261 An Aboriginal Kidney Care Together Improving Outcomes Now (AKction) Co-design Study: Qualitative methodologies exploring pregnancy care for First Nations women with kidney disease

To evaluate the cost-effectiveness of donanemab, an anti-amyloid-β monoclonal antibody recently approved in Australia, for treating early-stage Alzheimer disease with confirmed amyloid-β pathology from healthcare system and societal perspectives. A Markov microsimulation model simulating long-term Alzheimer disease progression, treatment costs and health outcomes for donanemab compared with standard care. Australian healthcare context, applying published clinical and economic inputs. A hypothetical cohort of people with early symptomatic Alzheimer disease, consistent with TRAILBLAZER-ALZ eligibility criteria: mean age 75 years, amyloid-β-positive, with mild cognitive impairment or mild dementia because of Alzheimer disease and excluding individuals with APOEE4 homozygotes, in line with the Australian labelling. Donanemab administered every 4 weeks with magnetic resonance imaging (MRI)-based amyloid-β-related imaging abnormalities monitoring and treatment suspension upon amyloid-β clearance or progression to severe Alzheimer disease, compared with standard care. Incremental costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Secondary analyses included sensitivity and distributional equity analyses. Donanemab increased total healthcare costs ($300,689 vs. $178,121) and societal costs ($389,113 vs. $283,618) compared with standard care per capita, while improving health outcomes (4.38 vs. 4.01 QALYs) per capita. The ICER was $342,424 per QALY from the healthcare perspective and $294,701 per QALY from the societal perspective, exceeding frequently cited Australian willingness-to-pay thresholds. Sensitivity analyses identified drug cost and efficacy as key drivers of uncertainty. Distributional analysis suggested inequitable health gains by remoteness because of differences in diagnostic and treatment infrastructure. Donanemab provides clinical benefits but is unlikely to be cost-effective under current Australian thresholds. Policymakers should balance economic evidence with unmet need, equity considerations and healthcare sustainability when making reimbursement decisions. Further research using real-world evidence and disaggregated analyses by geography and socioeconomic status is warranted.

Tobacco smoking is an important preventable cause of death and disease in Australia. Smoking rates are higher in the Northern Territory (NT) among Aboriginal peoples living in remote areas. Understanding smoking-attributable mortality and burden of disease in the NT population is important for building awareness and implementing targeted public health strategies. To estimate the impact of tobacco smoking on mortality and morbidity in the NT Aboriginal and non-Aboriginal populations aged 30 years and above between 2014 and 2018. NT, Australia. Adults (> 30 years) who were NT residents. We used the NT Burden of Disease study (2014-2018) results and Global Burden of Disease methods to estimate smoking-attributable deaths and smoking-attributable burden of disease for the NT Aboriginal and non-Aboriginal populations. The smoking prevalence data were based on 2018-19 National Aboriginal and Torres Strait Islander Heath Survey and 2016 National Drugs Strategy Household Survey. Smoking was attributable to 18.3% of the total deaths for NT adults aged 30 years and above with 23.8% in Aboriginal and 13.9% in the non-Aboriginal population. Smoking explained 19.5% and 10.7% of total disability adjusted life years among the NT Aboriginal and non-Aboriginal populations respectively. The top three smoking-attributable burden of diseases for the Aboriginal population were ischaemic heart disease, diabetes and chronic obstructive pulmonary disease. In the non-Aboriginal population, lung cancer, chronic obstructive pulmonary disease and back pain were the leading causes of smoking-attributable burden. Leading causes of smoking-related mortality in the Aboriginal population were ischaemic heart disease, chronic obstructive pulmonary disease, lung cancer and diabetes, while in non-Aboriginal population the most common causes were lung cancer, chronic obstructive pulmonary disease, ischaemic heart disease, and Alzheimer's disease. Tobacco smoking was associated with a higher burden of disease among the Aboriginal population than the non-Aboriginal population. Our study quantifies the disproportionate impact of tobacco smoking within the Aboriginal population and the NT as a whole compared to the rest of Australia.

Chronic kidney disease (CKD) is a significant public health challenge in Australia, affecting ~10% of the adult population and contributing to substantial morbidity and mortality. Diabetes, hypertension, cardiovascular disease and CKD frequently co-exist; therefore, a multidisciplinary approach is necessary to manage these conditions. Recent advances in pharmacological therapies, particularly for diabetic kidney disease (DKD), can improve clinical outcomes. Current guidelines may not fully address the complexities of CKD management across all levels of care in the Australian context. To develop simple, practical, evidence-based recommendations to guide healthcare practitioners in improving CKD management across Australia. A multidisciplinary panel of eight healthcare practitioners (nephrologists, cardiologists, endocrinologists and general practitioners) employed an adapted virtual nominal group technique to achieve consensus on CKD management recommendations. The panel developed nine unique recommendations; five achieved consensus, and four were in accordance with GRADE guidance: Both urine albumin-to-creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR) should be assessed regularly in patients at increased CKD risk. Most patients with CKD can be managed in primary care, with specialist referral when required. Ensure all cardiometabolic risk factors are assessed and managed proactively. For patients with diabetic kidney disease, consider the four pillars of therapy. These multidisciplinary consensus recommendations provide actionable guidance for Australian healthcare practitioners to improve CKD management across all levels of care, addressing the unique needs of the Australian healthcare landscape.

The financial burden of diabetes-related foot disease (DFD) in Australia remains inadequately understood. This study aimed to explore the direct costs and resource utilisation associated with DFD management, incorporating insights from healthcare professionals actively involved in the treatment of individuals with DFD. A three-step approach informed the economic evaluation. First, a systematic review identified existing Australian cost data. Second, semi-structured interviews with healthcare professionals generated estimates of resource utilisation and addressed data source gaps. Third, a Markov model evaluated the costs of DFD management at both the individual and health system levels. The model included direct costs related to hospital admissions, outpatient/community visits, medications, diagnostics, wound care, offloading devices and amputation-related expenses. The average annual cost per patient for DFD management was AUD $44 691. The primary cost drivers were hospital admissions ($21 566), outpatient/community visits ($14 212) and wound debridement ($5918). The total cost to the Australian healthcare system in 2026 is estimated at AUD $3.08 billion, with projections reaching AUD $3.81 billion by 2030. This study provides essential cost estimates for DFD management at both the individual and health system levels, offering critical insights for policymakers seeking to optimise service delivery and improve patient outcomes in Australia.

Genomic sequencing has transformed the diagnostic approach for mitochondrial disease, yet integration into standard clinical practice is limited by access and funding. We conducted a post-implementation evaluation of genome sequencing (GS) for mitochondrial disease in Australia, which became publicly funded through the Medicare Benefits Scheme (MBS) in November 2023, to allow for broader access to testing. Test request data, including demographics, phenotypic information, and the diagnostic outcomes, were collected from November 2023 to May 2025 from the Victorian Clinical Genetics Services, the current laboratory provider of the MBS-funded service. Test uptake was 26% of predicted, with lower test rates in regional and remote areas. Over the first 19 months, 300 individuals suspected of mitochondrial disease underwent GS with a median turnaround time of 84 days (8 days-218 days). The diagnostic yield was 20%, with 56% of diagnoses in known mitochondrial disease genes. Of these, 70% (24 of 34) were in mitochondrial DNA. Seventeen diagnoses were in individuals who had prior non-diagnostic testing (exome sequencing or gene panel). We demonstrate that publicly-funded GS can deliver meaningful diagnostic outcomes for mitochondrial disease on a national scale. To maximise its impact, attention must now shift towards ensuring equitable access, particularly for regional and remote areas, and embedding sustainable mainstreaming models that support both genetic and non-genetic clinicians.

Plain Language SummaryGlomerular diseases are rare with limited epidemiological and long-term outcome data. This study used linked health records to identify patients with glomerular disease and then track their long-term outcomes in Australia. Our findings show that glomerular disease affects about 89 in every 100,000 people, with 12 new cases per 100,000 people each year. Over an average period of 6 years, we found that those with glomerular disease had a 31 times higher risk of kidney failure and 2–4 times higher risk of death, heart disease, blood clots, and severe infections, compared to people without these conditions. These risks were similar whether the disease was newly diagnosed or had been present for some time. People with glomerular disease were hospitalised more often and for longer periods of time than those who did not have the condition. The poor outcomes of patients with glomerular diseases highlight the need for improved monitoring and treatment, with linked health data offering insights into the epidemiology and clinical outcomes of these rare kidney diseases.

An exploration of the factors influencing the uptake of non-invasive ventilation by people with motor neurone disease in Australia: a qualitative study of patient and health professional perspectives

Hellebores (Helleborus spp.) are herbaceous perennial plants that are widely grown for their winter and early spring flowers (Eastwell et al. 2009; Liefting et al. 2010). In 2022, hellebores (Helleborus orientalis) exhibiting severe virus-like symptoms characterised by dark brown to black streaking on sepals, bracts, and stems, as well as irregularly shaped dark lesions on foliar tissues (Figure 1), were collected from a private garden located in the Blue Mountains region of New South Wales (NSW), Australia. It was noted that approximately 10% of the hellebore population in the garden exhibited symptoms. The collected symptomatic tissues were subjected to diagnostic screening at the NSW Department of Primary Industries and Regional Development Plant Health Diagnostic Service laboratory. The symptoms observed appeared consistent with those of hellebore black death, which is associated with Helleborus net necrosis virus (HeNNV, Carlavirus necroretis), a member of the Carlavirus genus (Eastwell et al. 2009; Liefting et al., 2010; Rubino 2024). A composite from multiple samples consisting of symptomatic sepal, bract, and leaf tissues was subjected to transmission electron microscopy following a negative-stain preparation. The electron microscopy analysis revealed filamentous virus-like particles measuring 650-700 nm length, with slightly flexuous and curved properties (Figure 2), which were consistent with those belonging to the Carlavirus genus. In addition, total RNA was extracted from a composite of multiple samples comprised of symptomatic sepal, bract, and leaf tissues using the Bioline ISOLATE II RNA Plant Kit (Meridian Bioscience), following the manufacturer’s instructions. The total RNA integrity was verified via High Sensitivity RNA ScreenTape Analysis (Agilent Technologies) and used to prepare an RNA-Seq library followed by sequencing as described in Maina et al. (2021), using the MiSeq cycle 2 x 251 v3 kit (Illumina). The obtained raw reads were trimmed and de novo assembled as described in Maina et al. (2021). Assembled contigs were subjected to BLASTn analysis, and a single contig of 8,534 nucleotides (nt) sharing 99.3% sequence identity with a HeNNV genome (GenBank accession NC_012038.1) was obtained. The contig of interest was represented by 2.6% of the total reads (79,136 reads out of 3,006,106 total reads), giving an average genome coverage of 1336x. The genome sequence was deposited in GenBank under accession PV165322 (isolate M22-15435). To confirm the presence of HeNNV in the original hellebore sample, specific primers targeting the HeNNV coat protein gene were designed (Sol_F-CCACTCAGCTCTCCAATTGTTA and Sol_R-CCTTCCTGTGCCTGGTTAAA) and used to conduct RT-PCR (at 57°C annealing temperature) using the original RNA sample followed by Sanger sequencing, yielding an amplicon of the expected size (604 bp) that shared 100% identity with the HTS contig. To our knowledge, this is the first detection and report of HeNNV infecting hellebores in Australia. The introduction of HeNNV to Australia may have inadvertently occurred through the importation of infected hellebore propagules. This HeNNV detection reinforces the importance of stringent biosecurity screening of imported plant propagules entering Australia. In addition, the identification of this virus contributes to the knowledge of hellebore black death aetiology. Furthermore, this report will enhance HeNNV awareness, assisting hellebore growers to adopt management strategies aimed at reducing the potential spread and impact of HeNNV disease in Australia.

Abstract Background Digital health offers transformative potential in facilitating healthcare delivery amid the compounding burden of IBD. The 2025 Australian ‘State of the Nation’ report highlights widespread healthcare navigation challenges for people with IBD1. These include fragmented care coordination and high reliance on emergency services, contributing to poor consumer experiences and rising healthcare expenditure. The methodology for developing a consumer/clinician co-created IBD app is described. Methods A core working group comprised of three gastroenterologists and a GI-specialised psychologist as clinical leads, and a six-person software team (software engineers, AI developer, project coordinator, and a user experience/design expert) was established. Additional input was sought from key stakeholders, including IBD nurse specialists and a paediatric gastroenterologist. Horizon scanning to systematically evaluate the mobile app landscape in IBD was performed to contextualise consumer needs. Two independent surveys by Crohn’s Colitis Cure and the software team identified consumer needs and preferences. Focus groups were held iteratively until data saturation, enabling the co-creation of job stories that reflected real-world needs. Job stories were translated into app features and scored out of 5 by importance as a feature, and the commonality/frequency amongst responders. Regular meetings of the core group were held to refine job stories and guide feature set design and development. Results 364 participants/consumers (median age: 40, 61% female) responded to surveys. 76% of respondents were from Australian/New Zealand and 24% from the UK/USA. Crohn’s Disease and ulcerative colitis comprised 59.1%/39.8% of the cohort respectively. The final features identified for development include symptom tracking, healthcare team communication, mental health screening, personal clinical data integration, care organisation, and an interactive large language model built on trusted information. The design allows for both independent function and bi-directional integration with Crohn’s Colitis Care (CCCare) electronic medical records. Conclusion Through consumer/clinician co-creation, we identified key app features to address healthcare navigation challenges, improve clinical care quality and efficiency. The resulting feature set of the patient-facing mobile app has been designed for bi-directional integration with the CCCare and clinical practice integration. Reference: 1. Crohn’s Colitis Australia. State of the Nation in Inflammatory Bowel Disease in Australia: Final Report. February, 2025. Accessed May 1, 2025. https://crohnsandcolitis.org.au/wp-content/uploads/2025/05/CCA_State-of-the-Nation-in-IBD-1.pdf Conflict of interest: Dr. Chan, Patrick: No conflicts of interest. Connor, Susan Jane: Research Support: Abbvie, Agency for Clinical Innovation, Amgen, BMS, Chiesi, Celltrion, DrFalk, Ferring, Janssen, Medical Research Future Fund, Pfizer, South Western Sydney Local Health District, Sydney Partnership for Health, Research and Enterprise, Takeda and The Leona M and Harry B Helmsley Charitable Trust Ad Boards: Abbvie, Amgen, BMS, Celltrion, Eli Lilly, Ferring, GSK, Janssen, Organon, Pfizer, Takeda Speaker Fees: Abbvie, Cornerstones Health, Dr Falk, Ferring, Janssen, Pfizer, Sandoz, Sydney IBD School, Takeda Educational Support: DrFalk, Sandoz, Takeda Knowles, Simon Robert: No conflicts of interest. Andrews, Jane Mary: Grant: This project is supported from a grant by The Leona M. and Harry B. Helmsley Charitable Trust. The work I will present was funded via CCCure. CCCure’s funding sources include grants for research and payments for data reports from Pharma including AbbVie, J&J, Takeda, Celltrion, Falk, Ferring, BMS, Janssen, Pfizer, Sandoz

Abstract Background Inflammatory Bowel Disease (IBD) is experiencing compounding prevalence with Australian prevalence expected to grow by 258% by 20301. Digital technologies hold promise for improving care quality and accessibility by virtue of scalability. Patient-facing mobile applications can be implemented across different stages including diagnosis, monitoring, facilitation of treatment, and research. These tools can empower patients, enhance engagement, and reduce care navigation stress Despite a number of IBD apps being described in literature or available to consumers, very few are accessible locally, whilst existing solutions offer limited functionality and fall short in supporting meaningful clinical use. Methods Two independent reviewers conducted a systematic search of the Australia/New Zealand Apple App Store and Android Play Store. The following search terms were included “colitis”, “ulcerative colitis”, “IBD”, “inflammatory bowel disease”, and “Crohn’s”. Apps were included if the title/description referenced IBD, excluding those focused on other gastrointestinal conditions. Non-English apps, and those limited or locked to a specific institution were also excluded. Results Within both stores, 49 apps were identified and 16 met the inclusion criteria. Most were free (14/16), though three required paid subscriptions. Only four apps reported medical professional input. Symptom tracking was the most common feature (10/16), followed by dietary logging (9/16). Fewer apps included medication management (5/16), educational content (4/16), or administrative tools (2/16). Symptom-tracking functionality was heteregenous, with only four incorporating validated measures such as SCCAI or HBI. Two apps included AI-based flare prediction. Dietary tools ranged from basic logging to AI-driven analysis. Four apps offered educational content covering topics such as lifestyle and wellbeing, medication, and disease-related information. Sources varied, with two providing expert-curated or medically reviewed material, while others were unsourced or AI-generated content. Additional features includ ed remote calprotectin testing, administrative tools and community support forums. Overall, functionality was fragmented across different apps, with nearly half (43.7%) of apps including one of the above categories, and the majority (62.5%) incorporated two or fewer feature categories. Conclusion The growing burden of IBD and its associated costs remain a challenge within current health system constraints. Digital technology holds promise in augmenting clinical care, yet most existing IBD apps offer narrow feature sets, lack health system integration, and are not personalised to individuals, thus limiting their usefulness in clinical settings. Reference: 1. Crohn’s Colitis Australia. State of the Nation in Inflammatory Bowel Disease in Australia: Final Report. February, 2025. Accessed May 1, 2025. https://crohnsandcolitis.org.au/wp-content/uploads/2025/05/CCA_State-of-the-Nation-in-IBD-1.pdf Conflict of interest: Dr. Chan, Patrick: No conflicts of interest. Wu, Rodger: No conflicts of interest. Andrews, Jane Mary: The work I will present was funded via CCCure. CCCure’s funding sources include grants for research and payments for data reports from Pharma including AbbVie, J&J, Takeda, Celltrion, Falk, Ferring, BMS, Janssen, Pfizer, Sandoz Connor, Susan Jane: Grant: This project is supported by a grant from The Leona M. and Harry B. Helmsley Charitable Trust. Research Support: Abbvie, Agency for Clinical Innovation, Amgen, BMS, Chiesi, Celltrion, DrFalk, Ferring, Janssen, Medical Research Future Fund, Pfizer, South Western Sydney Local Health District, Sydney Partnership for Health, Research and Enterprise, Takeda and The Leona M and Harry B Helmsley Charitable Trust Ad Boards: Abbvie, Amgen, BMS, Celltrion, Eli Lilly, Ferring, GSK, Janssen, Organon, Pfizer, Takeda Speaker Fees: Abbvie, Cornerstones Health, Dr Falk, Ferring, Janssen, Pfizer, Sandoz, Sydney IBD School, Takeda Educational Support: DrFalk, Sandoz, Takeda

Crusted scabies is a rare but severe skin condition that predominantly affects immunocompromised and elderly individuals, with potentially fatal outcomes if untreated. It can also trigger institutional outbreaks, complicating public health responses. Diagnosis can be challenging due to overlapping features with other dermatological conditions. In 2016, crusted scabies was classified as a notifiable disease in Australia’s Northern Territory. This review aims to summarize the pathogenesis, clinical features, diagnostic methods, and treatment options for crusted scabies over a period of 20 years ending in December 2022. A critical literature review was conducted using PubMed, Google Scholar, and Research4life for studies published between January 2003 and December 2022. Relevant articles in English discussing pathogenesis, clinical manifestations, diagnostic approaches, and treatment strategies were reviewed. Crusted scabies is characterized by a Th1-to-Th2 immune shift, leading to hyperkeratosis, extensive scaling, and minimal pruritus. Diagnostic methods include microscopy, dermatoscopy, biopsy, PCR, and serodiagnosis. Treatments involve topical scabicides, keratolytic agents, and oral ivermectin. Standardized protocols for diagnosis and treatment are needed to address variability in current practices. Early diagnosis and timely management are critical to improving patient outcomes and preventing complications, including sepsis and nosocomial outbreaks.

The burden of disease estimates from the Australian Institute of Health and Welfare are influential in driving priorities for actions across research, policy and practice. Following the latest estimates in 2024, much attention focused on top risk factors including obesity, tobacco and diet. Meanwhile, upstream social, economic and political drivers were overlooked. In this perspective, we argue that to effectively move the dial on disease burden, we must shift our focus from downstream action on individual-level risk factors to upstream action on structural causes. Failure to do so represents a missed opportunity to improve population health and tackle health inequity.

BackgroundCutaneous malignant melanoma (CMM) represents a substantial health burden for the elderly; however, data regarding its impact and epidemiology within this demographic remain scarce. This study aims to evaluate the global, regional, and national trends of CMM among individuals aged 60 and elderly from 1990 to 2021.MethodsWe retrieved data on the age-standardized incidence, prevalence, and mortality rates, and disability-adjusted life years (DALYs) of CMM among individuals aged 60 and above across 204 countries and territories from 1990 to 2021, sourced from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study 2021. We calculated the estimated annual percentage changes in age-standardized incidence and DALY rates of CMM, categorized by age, sex, and socio-demographic index (SDI), to quantify temporal trends. Additionally, we employed Spearman correlation analysis to examine the relationship between age-standardized rates and SDI.ResultsThis study analyzed global trends in CMM from 1990 to 2021 using the GBD database. The findings indicate a significant increase in the incidence (EAPC=0.65, 95% CI: 0.33–0.96) and prevalence (EAPC=1.02, 95% CI: 0.64–1.41) of CMM, while a significant decreasing trend was observed for mortality (EAPC=−0.43, 95% CI: −0.57- −0.30) and DALYs (EAPC=−0.67, 95% CI: −0.82- −0.53). In 2021, high-income North America exhibited the highest prevalence of CMM but the lowest growth rate. In contrast, the Middle East and North Africa experienced the fastest growth rate, while Latin America also demonstrated a significant increase in prevalence. The growth rates of incidence and prevalence were notably higher among male patients compared to females, reflecting gender-specific behavioral differences. Furthermore, an analysis of the relationship between the burden of disease and the SDI for CMM across various regions from 1990 to 2021 revealed that the burden of disease in Australia significantly exceeded model predictions. The APC analysis indicated that the prevalence of CMM among elder population (≥60 years old) declined with age, but the overall disease burden continues to rise annually, demonstrating higher prevalence rates in later birth cohorts. Similar trends were observed for incidence, DALYs, and mortality.ConclusionThis study reveals that the burden of CMM disease is rapidly increasing among populations residing at lower latitudes. The findings underscore the necessity for dynamic optimization of global prevention and control strategies, considering regional disparities.

High temperatures increase the burden of cardiovascular disease in Australia.

OP 29: Health Status 4, B302 (FCSH), September 4, 2025, 16:00 - 17:00AimInternational evidence has found that receipt of primary prevention for cardiovascular disease (CVD) can differ by ethnicity. Prior Australian research has demonstrated undertreatment of CVD risk factors in Aboriginal and Torres Strait Islander Australians. However, inequalities in the receipt of preventive therapies have not been examined in Australia’s non-Indigenous population. The aim of this study is to determine the presence of inequalities in primary preventative drug therapy for CVD by ethnicity in Australia.MethodsWe used data from a Census-linked cohort study of the New South Wales population aged 30 years and over. We created a cohort of individuals without prior history of a CVD event, who experienced their first CVD event during the period August 9, 2016 to June 2022. Incident CVD events were identified from hospitalisation or death records using relevant ICD-10-AM codes. We examined use of any preventative drug therapy (blood pressure and lipid lowering medications) in the two years prior to the first CVD event using linked prescription record data.ResultsIn preliminary analyses, we found that the proportion of individuals receiving at least one prescription of preventative drug therapy was overall high in the cohort (0.88, 95%CI [0.87, 0.88]). A higher proportion of females (0.89, 95%CI [0.89, 0.89]) were prescribed preventive therapy compared to males (0.86, 95%CI [0.86, 0.87]). In addition, we found a lower proportion of Asian males (0.81, 95%CI [0.78, 0.84]), Pasifika males (0.72, 95%CI [0.63, 0.82]) and Māori females (0.69, 95%CI [0.52, 0.86]) were prescribed preventive medication before their first CVD event compared to the population average.ConclusionThese fundings suggest that access to preventive medication for CVD in Australia differs by ethnicity and sex. Lower prescriptions in males and in Māori and Pasifika ethnic groups are concerning given their higher incidence of CVD.

The prevalence of immune-mediated inflammatory diseases (IMIDs) is rising, associated with increasing disease burden and healthcare expenditure. Medical therapy is the major driver of healthcare costs associated with IMIDs, owing to the need for lifelong therapy. However, many patients exhaust medical options, highlighting the need for new therapies with novel mechanisms of action. Recently, a highly effective class of medical therapy gained registration for use in Australia for IMIDs but was unsuccessful in attaining Pharmaceutical Benefits Scheme reimbursement. There is a growing need to reevaluate the reimbursement process for medicines in Australia, aiming to balance access to new therapies with prudent health-economic policy.