{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:02:02Z","timestamp":1790182922681,"version":"4.1.0"},"reference-count":69,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,25]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Early childhood health and economic burdens are disproportionately distributed across population groups. We examined the vulnerability-related (First Nations status and remoteness) disparities of early childhood healthcare costs from birth to age 5 years and quantified the contribution of adverse perinatal outcomes, such as preterm birth (PTB), small-for-gestational-age (SGA) and low birthweight, to these disparities in the Northern Territory (NT), Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and participants<\/jats:title>\n                    <jats:p>We conducted a population-based retrospective cohort study of all singleton live births in the NT, Australia, between 1 July 2000 and 30 June 2016, using the Perinatal Trends dataset. Birth records were linked to hospitalisation, emergency department (ED) and national hospital costing data and followed to age 5.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes and analysis<\/jats:title>\n                    <jats:p>Healthcare costs, adjusted to 2024 Australian Dollars (AUD), from a health system perspective, included hospitalisation and ED costs. A generalised linear model with log link and gamma distribution was fitted, and Oaxaca-Blinder decomposition was used to partition cost differences into explained (differences in population characteristics) and unexplained (differential effects\/responses) components.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall median hospitalisation costs per child were AUD 9608 (IQR: 4873 to 20 681) and ED costs AUD 2156 (IQR: 1075 to 4274) in the first 5 years. Among children with PTB and SGA, median hospitalisation costs were AUD 30 527 (IQR: 16 765 to 54 365) for First Nations and AUD 16 098 (IQR: 7577 to 28 048) for non-First Nations children; within this subgroup, costs were AUD 29 614 (IQR: 15 085 to 51 400) in remote areas compared with AUD 19 776 (IQR: 9620 to 33 263) in urban areas. After adjustment, mean hospitalisation costs were 98% higher for First Nations children (AUD 23\u2009223 vs 11 716; difference AUD 11 507, 95%\u2009CI 10 798 to 12 215) and 19% higher for children in remote areas (AUD 19\u2009454 vs 16 322; difference AUD 3132, 2479 to 3786); corresponding differences in mean ED costs were 67% (AUD 1866, 95%\u2009CI 1750 to 1982) and 17% (AUD 557, 95%\u2009CI 460 to 655). Remoteness-related disparities in hospitalisation costs were largely explained by child characteristics (85.7%;\n                      <jats:italic>\u03b2E<\/jats:italic>\n                      =\u22120.549, 95%\u2009CI \u22120.581 to \u22120.517), while disparities by First Nations status were primarily driven by differential cost responses (71%;\n                      <jats:italic>\u03b2<\/jats:italic>\n                      c=\u22120.606, 95%\u2009CI \u22120.651 to \u22120.561). For ED costs, characteristics explained 42% of the remoteness-related gap and 3.4% of the gap by First Nations status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings highlight that vulnerability-related disparities in healthcare costs were substantial, with adjusted costs 67% to 98%\u2009higher for First Nations children and 17% to 19%\u2009higher for children in remote areas, and driven by distinct mechanisms. Thus, strategies addressing structural disadvantage and inequitable experiences are needed to reduce avoidable healthcare costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119376","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:12:40Z","timestamp":1790179960000},"page":"e119376","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Vulnerability-related disparities in early childhood healthcare costs in the Northern Territory, Australia: a population-based retrospective cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7076-6146","authenticated-orcid":false,"given":"Tsegaye G.","family":"Haile","sequence":"first","affiliation":[{"name":"Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia"},{"name":"Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Norman","sequence":"additional","affiliation":[{"name":"Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winnie","family":"Chen","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"},{"name":"Leeder Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Pereira","sequence":"additional","affiliation":[{"name":"Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia"},{"name":"WHO Collaborating Centre for Climate Change and Health Impact Assessment, Curtin University, Perth, Western Australia, Australia"},{"name":"Faculty of Medicine, Universitas Negeri Malang, Malang, Indonesia"},{"name":"Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4784-8151","authenticated-orcid":false,"given":"Gizachew A.","family":"Tessema","sequence":"additional","affiliation":[{"name":"Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia"},{"name":"Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia"},{"name":"School of Population Health, College of Health, Adelaide University, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"2026092309102483000_16.9.e119376.1","unstructured":"Australian Institute of Health and Welfare . 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