BACKGROUND:Unmet social needs (including housing, transport and social inclusion) contribute substantially to health outcomes, especially for people with long-term health conditions such as multiple sclerosis (MS). Whether assessment of unmet social needs occurs in MS clinical care is unclear. This study aims to (1) understand current practices, (2) identify barriers and enablers to social needs assessments in MS care, and (3) explore the feasibility of social needs screening tools. METHODS:This qualitative descriptive study comprised focus groups and interviews with clinicians, carers and people with MS in Australia. We inductively and deductively coded transcripts and used applied thematic analysis to identify themes, using COM-B (Capability, Opportunity, Motivation, Behaviour) and Feasibility frameworks. RESULTS:We collected data from 19 participants (11 clinicians and 8 lived-experience participants). Participants reported inconsistent and unstructured social needs assessment in MS care. Barriers aligned with capability (lack of referral pathway knowledge), opportunity (resources) and motivation (belief in abilities, evidence of value and scepticism). Enablers aligned with capability (clinician rapport and self-advocacy), opportunity (care coordination and self-paced assessment), and motivation (mutual desire for positive patient outcomes). A social needs screening tool was considered acceptable, conditional on adequate resourcing and/or design to ensure identified needs can be addressed. CONCLUSION:Findings from this qualitative descriptive study suggest that the current integration of social care in MS healthcare in Australia is inadequate. We identified opportunities to develop and test a screening tool and supporting referral resources to identify and address unmet social needs in MS patients. Better integrated social and healthcare represents a promising avenue for improving comprehensive MS management.

People with disabilities are a population group that experiences significant health inequities. Increasing evidence demonstrates these inequities stem from systemic barriers in attaining human rights, specifically in relation to the social determinants of health. Yet there is a lack of data driven evidence to inform solutions. The use of linked population health data is increasingly seen as offering potential to generate evidence to inform policy and interventions targeting socially driven inequities. Achieving more equitable solutions, however, requires researchers to adopt human-rights informed frameworks and work in partnership with the people most impacted by inequities and government representatives tasked with developing policy responses. Co-design methodology can support this, but its use within data science, particularly within quantitative and mixed methods research, is not well documented to date. This methods paper responds to this gap by describing the IMPACT Project: a co-designed project that aims to identify and model the impact of hypothetical policy interventions in relation to mental health inequities experienced by people with disability. We reflect on Australia’s novel advances in data linkage and the rationale, opportunities, challenges and our approach to co-design in integrating data linkage techniques in parallel with qualitative approaches in pursuit of a health equity agenda

People with disability experience health inequities and mostly live in low- and middle-income countries (LMICs), because that is where most of the world's population resides. Despite this, existing evidence on health equity for people with disability mostly comes from high-income settings. Monitoring and evaluation of health equity are crucial for countries to address and track progress toward goals, such as the highest attainable standard of health for people with disability. This scoping review summarizes the available literature on approaches and indicators used in LMICs to evaluate health-related outcomes between people with and without disability. Peer-reviewed articles were included that were published between 2008 and 2024 that compared health-related outcomes between these 2 populations. We identified 59 eligible studies from a broad range of LMICs. Disability indicators varied, with most studies using 1 of multiple Washington Group question sets to enable disaggregation of data by disability status. Survey data were the type most frequently used; only 2 studies used administrative data. A wide range of health-related outcomes were explored; themes of maternal and child health and HIV-related outcomes emerged as key areas of focus. Disparities were consistently found, with almost all included studies reporting poorer outcomes for people with compared with people without disability. There was a noticeable lack of action taken to improve future policy or monitoring and evaluation or to enact real and meaningful change in health equity for people with disability.

BACKGROUND:Cancer is a major yet under-recognised contributor to the mortality gap between people with and without disability. Our study aims to quantify these inequalities to inform cancer control efforts to reduce the gap. METHODS AND FINDINGS:We used nationally-linked data (2011-2022) to construct a cohort of over 10 million adults in Australia aged 25-74 years. Disability was measured in 2011 Census as requiring assistance in core daily activities and cancer related deaths identified in national death registrations. We estimated age-standardised and age-specific cancer mortality rates, and absolute and relative mortality inequalities (rate differences and ratios) between people with and without disability. The study included 10,414,951 people. Of the 5,403,503 females, 185,801 (3.4%) reported disability; 183,594 of the 5,011,448 males (3.7%) reported disability. Over 93,940,222 person-years (9.2 years on average), 219,257 cancer-related deaths occurred. After age-standardisation, per 100,000 person-years, there were 314 (95% confidence intervals [CI]: 301, 328) more cancer related deaths in females and 410 (95% CI: 394, 427) more in males with disability (1.96 [95% CI: 1.92, 2.00], and 1.83 [95% CI: 1.80, 1.87] times higher, respectively) than those without disability. The largest absolute inequalities were for lung cancer in both females and males (67 [95% CI: 60, 73] and 103 [95% CI: 95, 111] more deaths per 100,000 person-years, respectively), followed by breast cancer in females (54 [95% CI: 49, 60] more deaths), prostate cancer in males (31 [95% CI: 26, 36] more deaths), and colorectal cancer in both sexes (30 more [95% CI: 25, 34] deaths in females and 44 [95% CI: 38, 49] more in males). By 5-year age group, lung cancer was the leading contributor to absolute inequalities in females and males aged 35 years and older. In females, across most age groups, breast cancer was the second largest contributor to absolute inequalities, followed by colorectal cancer. In males, colorectal cancer was the second largest contributor across most age groups, with prostate cancer contributing substantially to absolute inequalities in those aged 55 years and older. A substantial proportion of differences in cancer-related deaths between people with and without disability, across most age groups in both females and males were driven by cancers linked to smoking, obesity, and alcohol consumption. We found similar-sized relative inequalities between individuals with and without disability in mortality due to individual cancers in both sexes. The main limitation of the study was that disability status was measured at a single time point. CONCLUSIONS:People with disability had higher cancer mortality overall and in relation to specific cancers than people without disability. To close the gap, effort should prioritise interventions that work for people with disability across the cancer control pathway.

People with disability experience substantial disadvantage. Relative to people without disability, they have lower education, poorer employment outcomes, and higher rates of poverty, social exclusion, discrimination and violence. Inadequate disability data risk perpetuating these inequalities. Linked administrative data can strengthen disability research and policy by producing more comprehensive and representative evidence, which is fundamental to progressing towards equity. We used data from the Australian Person Level Integrated Data Asset, which brings together individual-level linked data from various administrative sources, to identify disability items within linked data collections that aligned with a functional conceptualisation of disability. We created two algorithms to derive disability flags and conducted a comprehensive validation, evaluating the sensitivity and specificity of each flag against the Survey of Disability, Ageing and Carers (SDAC). We used data items from social services, disability supports, medical services, and prescription medicines datasets that met defined inclusion criteria. The disability flags had high specificity and moderate sensitivity. Compared to SDAC, we found that working aged people and people with moderate-to-high family income were underrepresented in the disability flags and that specificity decreased substantially for ages 65+ years. Disability flags in linked administrative data increase the visibility of people with disability in data and have the potential to advance disability research. This is critical for conducting research and generating evidence to improve outcomes, advance equity, realise human rights, and design effective policy. However, when interpreting findings using disability flags, it is important to understand the disability cohort identified and which subgroups are systematically underrepresented.

Background Australians with disability experience significantly poorer mental health outcomes compared to the general population, with inequalities increasingly linked to intersecting forms of socio-economic disadvantage and exclusion. However, research on how multiple experiences of social exclusion impact the mental health of people with disability is nascent. This study aims to address this gap. Methods The IMPACT project is a co-designed mixed methods project examining factors influencing the mental health of Australians with disability. For this paper, we analysed nationally representative household data to quantify the impact of individual and multiple domains of exclusion on mental health. In parallel, we conducted a reflexive thematic data analysis of qualitative interviews with people with disability, family carers and key stakeholders to examine experiences of exclusion and its mental health implications. Results Quantitative results showed single domains of exclusion were associated with differences in mental health scores for people with disability (3.9 to 18.1 point) and people without disability (1.8 to 14.7 point), with multiple experiences of exclusion resulting in declining mental health scores for both groups. Qualitative findings help illustrate the compounding relationships between socio-economic exclusion and mental health for people with disability, demonstrating how early experiences of exclusion within key domains, such as education, disrupt mental health and continue to exacerbate subsequent experiences of exclusion, especially for people with limited social supports. Conclusions Addressing disability-related mental health inequalities requires coordinated policy and programmatic responses to address social exclusion as a driver of poor mental health. These responses should be holistic, simultaneously targeting multiple domains of exclusion aiming to mitigate the disadvantage experienced by people with disability by their compounding impact on mental health.

ABSTRACT Background Social determinants of health account for approximately 50% of health outcomes, yet social needs are rarely assessed as part of routine clinical care. We aimed to conduct a scoping review of screening tools for assessing social needs within clinical practice in Australia and New Zealand. Methods This scoping review was conducted according to our preregistered protocol (https://osf.io/d6evu). We searched scientific and grey literature for Australian or New Zealand studies that developed and/or evaluated social needs screening tools for adult patients. Extracted data included tool characteristics, validity, comprehensiveness, and proposed interventions. Actionability, that is, detailed specification of behaviour, was assessed using the Action, Actor, Context, Target and Time framework. Results Eight studies were included, describing five Australian screening tools (none from New Zealand), with varied characteristics and validity measures. Tools frequently screened for employment, economic stability, housing, support systems, and social and community context. Two tools covered all social need domains, and one provided detailed behavioural specifications. However, none outlined referral pathways for identified needs. Conclusions We identified five social needs screening tools. Most lacked comprehensiveness and actionability, and none integrated referral pathways. While these tools may represent a first step in identifying social needs in clinical care, addressing these gaps is essential for meaningful impact. Patient or Public Contribution Our research team comprised people living with chronic health conditions, clinicians, researchers, and social epidemiologists who all contributed to study design, conduct and interpretation of data.

The increased availability of big data has improved the capacity of epidemiologists to examine complex questions related to health equity for marginalized populations. Although data science methodologies enable reproducible and complex quantitative analyses, using these approaches without sufficient contextualization risks erroneous findings or interpretation, resulting in ineffective or potentially damaging public health recommendations that do not meet the needs of the population. Incorporating lived experience into the research process is one way to improve the quality and relevance of the research and its findings. Here we present a case study of a project that involved quantitative analysis of a large established population-based longitudinal survey that was informed by lived experience expertise. This research used the Household, Income and Labor Dynamics in Australia (HILDA) Survey to investigate the associations between loneliness, social isolation, and mental health in young people with disability. We show how we used lived experience to refine research questions, select outcome measures and covariates, develop statistical models, interpret results, contextualize findings, generate policy recommendations and future research ideas. We also discuss challenges and potential solutions. Our case study demonstrates a new way for undertaking quantitative health equity research that promotes the voice of the population of interest.

Employment is a key determinant of mental health, with evidence suggesting greater benefits for people with disability relative to people without disability. However, little is known about how retirement impacts mental health for people with disability. This study examined the mental health effects associated with voluntary and involuntary changes in employment status for adults in later working life and explored differences by disability status. We used 13 waves of data from the Household, Income and Labour Dynamics in Australia Survey, comprising 9,162 adults aged 45–69 years. Employment status was classified as employed, voluntarily unemployed, or involuntarily unemployed. Mental health was measured using the Mental Health Inventory (MHI-5). Effects of employment transitions on mental health were estimated using fixed effects regression models, including interaction terms to explore differential effects for people with persistent disability, fluctuating disability, or no disability. For people with persistent and fluctuating disability, both involuntary (persistent: -4.51, 95

Breast and cervical cancers are two of the most common cancers and major public health concerns worldwide. Early detection can reduce morbidity and mortality from breast and cervical cancer. Evidence suggests strong associations between screening participation and race and/or ethnic background. In Australia, Muslim populations are growing and they have unique religious customs, socio-economic backgrounds, and cultures than other minority population groups. There is a significant gap in the literature with respect to understanding the participation of Muslim populations in different preventive health care programs. This study investigated the participation of Muslim women in cancer screening and HPV vaccination programs to advance knowledge that informs culturally sensitive public health programs. This study also applied the socio-ecological model of health to develop a conceptual framework that informed to investigate breast and cervical screening participation among women born in Muslim countries and HPV vaccination participation among female students of Islamic schools in comparison to non-Islamic schools. This study used the record linkage data between hospital admission records and cervical or breast screening register data from Victoria, Australia. This study also explored the HPV vaccination coverage using school-level HPV vaccine dose data from Victoria. This study revealed lower rates of breast and cervical screening participation among women born in Muslim countries. It also found that there was considerable diversity in screening participation among women born in different Muslim countries. Lower coverage of HPV vaccination in Islamic schools than in non-Islamic schools was found, suggesting disparities in vaccination. The public health significance of the study is, for instance, lack of high HPV vaccination coverage in population groups with lower levels of future cervical screening participation may reduce population-level impact of vaccination program and increase disparities in the incidence of cervical and other cancers caused by HPV. Disparities in cervical screening participation and HPV vaccination may affect Australia’s target to eliminate cervical cancer. This study highlights the importance of culturally sensitive preventive health programs for equitable screening and vaccination coverage among migrant Muslim women and adolescents. The study emphasizes the multifaceted influences of socio-ecological factors on migrant Muslim women's preventive health care choices. It suggests the need to develop and evaluate targeted interventions to address disparities and potential interventions span individual, interpersonal, institutional, community, and policy levels, including strategies such as providing translated health information, interpreter services, culturally appropriate promotional and educational materials, cultural competence training for healthcare professionals, access to screening services for underserved communities, and policy initiatives to reduce disparities among migrant Muslim women. Tahira Yeasmeen, Anne Kavanagh, Julia Brotherton, Michael Malloy. Preventive health experiences of migrant Muslim women in Australia: Breast and cervical screening participation and HPV vaccination uptake [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C165.

Background: As neurodevelopmental disabilities emerge in early childhood, reporting them as the underlying cause of death in mortality statistics effectively establishes the cause of death at birth. This hampers efforts to address causes of premature mortality and improve life expectancy for this population. Objective: To quantify the reporting of neurodevelopmental disabilities as the underlying cause of death in Australian data and determine whether it is due to death certification practices or statistical coding rules. Methods: Our observational study analysed Australian death data (2007-2022). We identified ICD-10 codes for neurodevelopmental disabilities and determined whether these were documented on death certificates as a direct or contributing cause and whether, following statistical coding, they were reported as an underlying or associated cause of death. Results: ICD-10 codes for neurodevelopmental disabilities were present in 9878 deaths. For 40% of these, neurodevelopmental disability was reported as the underlying cause. This varied by disability type-from 8% for intellectual disability to 61% for Down syndrome. We found this was not always due to certifier practices. For 29% of deaths with a neurodevelopmental disability reported as the underlying cause, the corresponding condition was correctly recorded by the certifying practitioner as a contributing cause. Conclusions: Neurodevelopmental disabilities are being reported as the underlying cause of death in Australian mortality statistics, due to both medical practitioners' assessments and statistical coding. To ensure mortality statistics better inform efforts to reduce premature mortality in people with neurodevelopmental disabilities, both education for certifying practitioners and a change to statistical coding rules are required.

Background People with disability experience worse cancer outcomes than people without disability. One potential pathway is through low screening participation leading to delayed cancer diagnosis and late disease presentation. Objective To summarise and evaluate evidence quantifying disability-related inequalities in (1) cancer mortality, (2) fatality among cancer patients; and for cervical, breast, colorectal and lung cancers: (3) screening participation and (4) stage at diagnosis. Methods We searched MEDLINE, Embase, PsycInfo and Scopus up to November 2023 for studies that quantified disability-related inequalities in the four outcomes. Studies were evaluated using the Risk Of Bias In Non-randomized Studies - of Exposures tool. Results We found 73 eligible articles globally. People with disability had higher cancer mortality compared to those without. This inequality was most pronounced among people with intellectual disability. Evidence showed substantially higher fatality among cancer patients with disability compared to those without consistently across disability groups and cancer types. Screening uptake for breast, cervical and colorectal cancers was consistently lower for people with various disability types in multiple countries. Evidence regarding inequalities in stage at diagnosis for people with disability was limited and inconsistent. The main methodological challenges for future research are: complexity in defining disability, underestimation of inequalities due to over-adjustment of mediating factors, under-representation of people with severe disability in data, and reporting inequalities on relative scales only. Conclusions Existing evidence reinforces the need for high-quality cancer inequality research for this population, and a multi-pronged, inclusive approach to prioritise people with disability in the whole cancer control pathway.

Summary box The population of Gaza is experiencing a health and humanitarian crisis.

Introduction Cancer is a leading cause of death and has a significant impact on individuals, families and society. Emerging evidence shows that people with disability face challenges in accessing services which could assist in early cancer diagnosis and optimal treatment, like cancer screening. Consequently, cancer patients with disabilities may present with later-stage disease, have reduced treatment options and experience lower survival rates compared with people without disability.This systematic review aims to summarise and evaluate the existing evidence on (a) inequalities in cancer survival and mortality between people with and without disability, (b) the inequalities in cancer screening and (c) stage at diagnosis that may contribute to the survival/mortality gap.Methods and analysis A literature search will be performed on MEDLINE, Embase, PsycInfo and Scopus up to May 2023. The review will include quantitative studies that reported inequalities in cancer survival and mortality, screening and stage at diagnosis between adults with and without disability. A summary of the characteristics and findings of the included studies will be provided. We will assess the quality of each study using the Risk Of Bias In Non-randomised Studies—of Exposure tool. Depending on the heterogeneity of studies, we will assess whether meta-analysis is appropriate.Ethics and dissemination Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration number CRD42023427288.

People with disability are an 'at-risk' group in a pandemic context for various clinical and structural reasons. However, in the early stages of the COVID-19 pandemic, people with disability were not identified as a priority group, which exacerbated this risk, particularly for those living in congregate settings. This paper examines inter-organisational issues during the second wave of the COVID-19 pandemic in disability residential settings gathered from senior managers, team leaders, and disability support workers. We use Victoria as a case study since several Victorian disability residential settings were in mid-transition from state provision to non-profit organisations. We argue that residential settings in mid-transition had clearer lines of organisational accountability and communication, which was thought to reduce the impact of outbreaks compared to residential settings in other States and Territories with multiple lines of communication and blurred accountability. The paper contributes to the literature on inter-organisational collaboration by reinforcing the necessity of clear lines of accountability and leadership in collaborative governance during emergencies. The evidence suggests how government and disability residential settings could better support residents and staff in future COVID-19 outbreaks or other pandemics. Points for practitionersPeople with disability, particularly those living in congregate settings, are often at heightened risk during public health emergencies.Clearer lines of responsibility, administrative, and communication arrangements across organisations and governments, alongside tailored responses within residential settings, are required to keep 'at-risk' individuals safe.Emergency management block funding could be designed to alleviate the financial pressures identified in this study for residential disability services in future pandemic responses.

Background Experiencing loneliness can be distressing and increasing evidence indicates that being lonely is associated with poor physical and mental health outcomes. Cross-sectional studies have demonstrated that people with disability have increased risk of experiencing loneliness compared to people without disability. However, we do not know if these inequalities have changed over time. This study investigated the prevalence of loneliness for people with disability in Australia annually from 2003 to 2020 to examine whether disability-related inequalities in loneliness have changed over time, and disaggregated results for subgroups of people with disability by age group, sex, and disability group. Methods We used annual data (2003–2020) from the Household, Income and Labour Dynamics in Australia Survey. Loneliness was measured by a single question assessing the subjective experience of loneliness. For each wave, we calculated population-weighted age-standardised estimates of the proportion of people experiencing loneliness for people with and without disability. We then calculated the absolute and relative inequalities in loneliness between people with and without disability for each wave. Analyses were stratified by 10-year age groups, sex, and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). Results From 2003 to 2020, the prevalence of loneliness was greater for people with disability, such that people with disability were 1.5 to 1.9 times more likely to experience loneliness than people without disability. While the prevalence of loneliness decreased for people without disability between 2003 and 2020, the prevalence of loneliness did not decrease for people with disability during this period. Inequalities in loneliness were more substantial for people with intellectual or learning disabilities, psychological disability, and brain injury or stroke. Conclusion This study confirms that people with disability have increased risk of loneliness compared to people without disability. We add to the existing evidence by demonstrating that disability-related inequalities in loneliness have persisted for two decades in Australia without improvement. Our findings indicate that addressing inequalities in loneliness for people with disability is a critical public health concern given that loneliness is associated with a wide range of poor health outcomes.

This study examined associations between changes in neighbourhood walkability and body mass index (BMI) among 1041 residents who relocated within Brisbane, Australia between 2007 and 2016 over five waves of the HABITAT study. Measures included spatially-derived neighbourhood walkability (dwelling density, street connectivity, and land use mix) and self-reported height and weight. No associations were found between any neighbourhood walkability characteristics and BMI. Examining these associations over the life course, and the impact of residential relocation in the younger years, remains a priority for future research.