End-stage renal disease in Indigenous Australians: A disease of disadvantage

Objective: To determine the relation between area level indicators of socioeconomic disadvantage and the regional incidence of end-stage renal disease (ESRD) in indigenous Australians. Design: Ecological Study. 

Setting: The 36 Aboriginal and Torres Strait Islander Commission regions of Australia. 

Main Outcome Measures: The relation between area-based measures of disadvantage and the standardized incidence of ESRD for 36 Australian regions was examined using non-parametric tests of correlation. 

Results: Area-based measures of disadvantage showed a significant association with regional incidence of ESRD in indigenous Australians. (Early school leavers r=0.68, P<.001, unemployment rate r=0.72, P<.001, median household income r=-0.71, P<.001, number of persons per bedroom r=0.84, P<.001, and low birthweight r=.49, P=.003). If it were possible to improve the health of all indigenous Australians to the level of that of the general Australian population, 87% of cases of ESRD could be avoided. 

Conclusions: Socioeconomic factors appear to be strongly associated with rates of ESRD among indigenous Australians. Therefore, reducing the burden of renal disease in indigenous Australians is likely to require interventions addressing socioeconomic disadvantage in conjunction with biomedical interventions.