Lawton, PD and Cunningham, J and Zhao, Y and Gray, NA and Chatfield, MD and Baade, PD and Murali, K and Jose, MD, Survival of Indigenous Australians receiving renal replacement therapy: closing the gap?, Medical Journal of Australia, 202, (4) pp. 200-204. ISSN 0025-729X (2015) [Refereed Article]
Copyright 2015 Medical Journal of Australia
Objectives: To compare mortality rates for Indigenous and non-Indigenous Australians commencing renal replacement therapy (RRT) over time and by categories of remoteness of place of residence.
Design, setting and participants: An observational cohort study of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data on Indigenous and non-Indigenous Australians registered with ANZDATA who commenced RRT from 1 January 1995 to 31 December 2009 and were followed until 31 December 2011.
Main outcome measures: Five-year all-cause mortality for Indigenous and non-Indigenous patients in three cohorts (1995–1999, 2000–2004 and 2005–2009) and five remoteness (of place of residence) categories.
Results: Indigenous patients were younger, more likely to have diabetes, be referred late and be from a more remote area than non-Indigenous patients. Age and comorbid conditions increased with successive cohorts for both groups. Unadjusted analysis (using the log-rank test) showed an increased risk of death for Indigenous patients in the 1995–1999 (P = 0.02) and 2000–2004 (P = 0.03) cohorts, but not for the 2005–2009 cohort (P = 0.7). However, a Cox proportional hazards model adjusted for covariates (age, sex, late referral and comorbid conditions [diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung disease], and body mass index < 18.5 kg/m2 and > 30 kg/m2) showed the following Indigenous:non-Indigenous hazard ratios (with 95% CIs) for major capital cities: 1995–1999, 1.47 (1.21–1.79); 2000–2004, 1.35 (1.12–1.63); and 2005–2009, 1.37 (1.14–1.66).
Conclusions: Although unadjusted analysis suggests that the survival gap between Indigenous and non-Indigenous patients receiving RRT has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.
|Item Type:||Refereed Article|
|Keywords:||indigenous, kidney disease, dialysis|
|Research Division:||Medical and Health Sciences|
|Research Group:||Clinical Sciences|
|Research Field:||Nephrology and Urology|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Urogenital System and Disorders|
|Author:||Jose, MD (Professor Matthew Jose)|
|Deposited By:||Medicine (Discipline)|
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