Work

Socioeconomic dispersion of publicly funded intravenous iron therapies for iron deficiency during pregnancy in Australia: a retrospective population-based cohort study

Year: 2026

Type: article

Abstract: OBJECTIVES: Iron 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 TYPE: Retrospective, population-based cohort study. METHODS: The 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). RESULTS: Diagnosed 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). CONCLUSIONS: The 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.

Source: Public Health Research & Practice

DOI: 10.1071/pu25102

Authors: Hannah Jackson, Luke Grzeskowiak, Joanne Enticott, Sarah Wise, Emily Callander

Institutions: University of Technology Sydney, Flinders University, South Australian Health and Medical Research Institute, Monash University

Language: English

Topic: Iron Metabolism and Disorders

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDGs: Reduced inequalities, Good health and well-being, No poverty

Open Access status: diamond

Funders: Queensland Health, University of Technology Sydney