Socioeconomic dispersion of publicly funded intravenous iron therapies for iron deficiency during pregnancy in Australia: a retrospective population-based cohort study
5 affiliations
- 1ASchool of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia.BCollege of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
- 2BCollege of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.CSAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
- 3DMonash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.
- 4ASchool of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia.
- 5ASchool of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia.DMonash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.
Abstract
ObjectivesIron deficiency in pregnancy poses significant risks to maternal and fetal health, which are exacerbated by socioeconomic disadvantage. The objective of this study was to assess the socioeconomic distribution of publicly funded intravenous iron therapies for iron deficiency in pregnant women, evaluating the capacity of public policy to promote equal access to medications.Study typeRetrospective, population-based cohort study.MethodsThe Maternity1000 dataset was used to analyse access to and public expenditure on intravenous iron therapies dispensed via the Pharmaceutical Benefits Scheme (PBS) during 176,036 pregnancies (July 2015 to June 2018) in Queensland, Australia; stratified by socioeconomic status. Inequalities were assessed through benefit incidence analyses and concentration indices (C).ResultsDiagnosed iron deficiency was more common among women living in less disadvantaged areas (Q5: 7.58% vs Q1: 5.06%). Access to ferric carboxymaltose showed no significant socioeconomic-related inequality overall (Coverall = 0.004; P = 0.594). However, annual concentration indices increased incrementally over the study timeframe, with a small shift in the distribution of access towards women living in less disadvantaged areas in 2017/18 (C2017/18 = 0.038; P < 0.001). In contrast, access to iron polymaltose showed no evidence of socioeconomic inequality (Coverall = −0.024; P = 0.358). Government expenditure on iron polymaltose was consistently concentrated among more disadvantaged areas; reflecting its lower cost and reduced government contribution for less disadvantaged women. Government expenditure on ferric carboxymaltose was evenly distributed overall (Coverall = −0.011; P = 0.130), with annual stratification showing public expenditure became increasingly concentrated among less disadvantaged areas in 2017/18 (C2017/18 = 0.027; P = 0.011).ConclusionsThe PBS plays an important role in supporting intravenous iron access in pregnancy, although minor socioeconomic disparities may be emerging for newer, higher-cost formulations. Ongoing monitoring is needed to ensure rising public expenditure delivers equitable, high-value maternal care without deepening existing inequalities.
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BibTeX
@article{jackson2026socioeconomic,
title = {{Socioeconomic dispersion of publicly funded intravenous iron therapies for iron deficiency during pregnancy in Australia: a retrospective population-based cohort study}},
author = {Hannah Jackson and Luke Grzeskowiak and Joanne Enticott and Sarah Wise and Emily Callander},
journal = {Public Health Research \& Practice},
year = {2026},
month = nov,
doi = {10.1071/pu25102},
url = {https://doi.org/10.1071/pu25102},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Socioeconomic dispersion of publicly funded intravenous iron therapies for iron deficiency during pregnancy in Australia: a retrospective population-based cohort study
AU - Hannah Jackson
AU - Luke Grzeskowiak
AU - Joanne Enticott
AU - Sarah Wise
AU - Emily Callander
PY - 2026
DA - 2026/11/04
JO - Public Health Research & Practice
DO - 10.1071/pu25102
UR - https://doi.org/10.1071/pu25102
AB - ObjectivesIron deficiency in pregnancy poses significant risks to maternal and fetal health, which are exacerbated by socioeconomic disadvantage. The objective of this study was to assess the socioeconomic distribution of publicly funded intravenous iron therapies for iron deficiency in pregnant women, evaluating the capacity of public policy to promote equal access to medications.Study typeRetrospective, population-based cohort study.MethodsThe Maternity1000 dataset was used to analyse access to and public expenditure on intravenous iron therapies dispensed via the Pharmaceutical Benefits Scheme (PBS) during 176,036 pregnancies (July 2015 to June 2018) in Queensland, Australia; stratified by socioeconomic status. Inequalities were assessed through benefit incidence analyses and concentration indices (C).ResultsDiagnosed iron deficiency was more common among women living in less disadvantaged areas (Q5: 7.58% vs Q1: 5.06%). Access to ferric carboxymaltose showed no significant socioeconomic-related inequality overall (Coverall = 0.004; P = 0.594). However, annual concentration indices increased incrementally over the study timeframe, with a small shift in the distribution of access towards women living in less disadvantaged areas in 2017/18 (C2017/18 = 0.038; P < 0.001). In contrast, access to iron polymaltose showed no evidence of socioeconomic inequality (Coverall = −0.024; P = 0.358). Government expenditure on iron polymaltose was consistently concentrated among more disadvantaged areas; reflecting its lower cost and reduced government contribution for less disadvantaged women. Government expenditure on ferric carboxymaltose was evenly distributed overall (Coverall = −0.011; P = 0.130), with annual stratification showing public expenditure became increasingly concentrated among less disadvantaged areas in 2017/18 (C2017/18 = 0.027; P = 0.011).ConclusionsThe PBS plays an important role in supporting intravenous iron access in pregnancy, although minor socioeconomic disparities may be emerging for newer, higher-cost formulations. Ongoing monitoring is needed to ensure rising public expenditure delivers equitable, high-value maternal care without deepening existing inequalities.
SN - 2204-2091
ER -