Survival of Indigenous Australians receiving renal replacement therapy: closing the gap?

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Author(s)
Lawton, Paul D
Cunningham, Joan
Zhao, Yuejen
Gray, Nicholas A
Chatfield, Mark D
Baade, Peter D
Murali, Karumathil
Jose, Matthew D
Griffith University Author(s)
Year published
2015
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Show full item recordAbstract
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, ...
View more >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.
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View more >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.
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Journal Title
Medical Journal of Australia
Volume
202
Issue
4
Copyright Statement
Lawton PD, Cunningham J, Zhao Y, et al. Survival of Indigenous Australians receiving renal replacement therapy: closing the gap? Med J Aust 2015; 202 (4): 200-204. © Copyright 2015 The Medical Journal of Australia – reproduced with permission.
Subject
Biomedical and clinical sciences
Oncology and carcinogenesis not elsewhere classified
Psychology