Investigating equity in access to Australian clinical genetic health services for Aboriginal and Torres Strait Islander people

Abstract

Globally, there is a recognised need for a greater commitment to an equity agenda in clinical genomics and precision medicine. Fundamental to this, is the equitable access by all to services providing genomic health care. However, achieving this remains constrained by a paucity of evidence that quantifies (in)equity of access to clinical genomics, particularly amongst Indigenous populations. Using administrative data from clinical genetic health services located in three jurisdictions (States/Territories) in Australia, we investigate equity in the scheduling and attendance of appointments among Aboriginal and/or Torres Strait Islander people, compared to non-Aboriginal and/or Torres Strait Islander people. For 15554 appointments scheduled between 2014-2018, adjusted Multivariate Poisson Regression models revealed that Aboriginal and/or Torres Strait Islander people were scheduled fewer appointments (IRR 0.73 [0.68-0.80], <0.001) and attended at lower rates (IRR 0.85 [0.78-0.93], <0.001). Within this population, adults, females, people living in remote locations, and those presenting in relation to cancer or prenatal indications experienced the greatest disparity in access. As the first quantitative, multi-jurisdictional study to measure access to clinical genetic health services, these results provide important baseline data related to the reach and equity of these services in Australia and contribute to the global effort to address equity in genomic health.