Renal transplantation for Indigenous Australians

Identifying the barriers to equitable access

Alan Cass, Joan Cunningham, Paul Snelling, Zhiqiang Wang, Wendy Hoy

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective. To assess Indigenous Australians' access to renal transplantation, compared with non-Indigenous Australians. To examine whether disparities are due to a lower rate of acceptance onto the waiting list and/or a lower rate of moving from the list to transplantation. Design. National cohort study using data from the Australian and New Zealand Dialysis and Transplant Registry. We included all end-stage renal disease (ESRD) patients under 65 years of age who started treatment in Australia between January 1993 and December 1998. We used survival analysis to examine the time from commencement of renal replacement therapy (RRT) to transplantation. We measured time from commencement of RRT to acceptance onto the waiting list (stage 1), and time from acceptance onto the waiting list to transplantation (stage 2). The main outcome measures were (1) acceptance onto the waiting list and (2) receipt of a transplant, before 31 March 2000. Results. Indigenous patients had a lower transplantation rate (adjusted Indigenous:non-Indigenous rate ratio 0.32, 95% CI 0.25-0.40). They had both a lower rate of acceptance onto the waiting list (adjusted rate ratio 0.50, 95% CI 0.44-0.57) and a lower rate of moving from the list to transplantation (adjusted rate ratio 0.50, 95% CI 0.38-0.65). The disparities were not explained by differences in age, sex, co-morbidities or cause of renal disease. Conclusions. Indigenous Australians face barriers to acceptance onto the waiting list and to moving from the list to transplantation. Further research to identify the causes could facilitate strategies to improve equity in transplantation.
Original languageEnglish
Pages (from-to)111-119
Number of pages9
JournalEthnicity and Health
Volume8
Issue number2
Publication statusPublished - 2003

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Waiting Lists
Kidney Transplantation
Transplantation
acceptance
Renal Replacement Therapy
Disease
cause
Transplants
comorbidity
chronic illness
Survival Analysis
New Zealand
equity
Chronic Kidney Failure
Registries
Dialysis
Cohort Studies
Acceptance
Outcome Assessment (Health Care)
Morbidity

Cite this

@article{26586afd76e74bcdad1c90cda0c650bf,
title = "Renal transplantation for Indigenous Australians: Identifying the barriers to equitable access",
abstract = "Objective. To assess Indigenous Australians' access to renal transplantation, compared with non-Indigenous Australians. To examine whether disparities are due to a lower rate of acceptance onto the waiting list and/or a lower rate of moving from the list to transplantation. Design. National cohort study using data from the Australian and New Zealand Dialysis and Transplant Registry. We included all end-stage renal disease (ESRD) patients under 65 years of age who started treatment in Australia between January 1993 and December 1998. We used survival analysis to examine the time from commencement of renal replacement therapy (RRT) to transplantation. We measured time from commencement of RRT to acceptance onto the waiting list (stage 1), and time from acceptance onto the waiting list to transplantation (stage 2). The main outcome measures were (1) acceptance onto the waiting list and (2) receipt of a transplant, before 31 March 2000. Results. Indigenous patients had a lower transplantation rate (adjusted Indigenous:non-Indigenous rate ratio 0.32, 95{\%} CI 0.25-0.40). They had both a lower rate of acceptance onto the waiting list (adjusted rate ratio 0.50, 95{\%} CI 0.44-0.57) and a lower rate of moving from the list to transplantation (adjusted rate ratio 0.50, 95{\%} CI 0.38-0.65). The disparities were not explained by differences in age, sex, co-morbidities or cause of renal disease. Conclusions. Indigenous Australians face barriers to acceptance onto the waiting list and to moving from the list to transplantation. Further research to identify the causes could facilitate strategies to improve equity in transplantation.",
keywords = "accessibility, equity, health care, health geography, indigenous population, age, Australia, cohort analysis, comorbidity, ethnic difference, health care access, human, kidney transplantation, New Zealand, outcomes research, register, review, sex difference, social class, Cohort Studies, Female, Health Services Accessibility, Humans, Kidney Failure, Chronic, Kidney Transplantation, Male, Oceanic Ancestry Group, Proportional Hazards Models, Registries, Waiting Lists",
author = "Alan Cass and Joan Cunningham and Paul Snelling and Zhiqiang Wang and Wendy Hoy",
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issn = "1355-7858",
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}

Renal transplantation for Indigenous Australians : Identifying the barriers to equitable access. / Cass, Alan; Cunningham, Joan; Snelling, Paul; Wang, Zhiqiang; Hoy, Wendy.

In: Ethnicity and Health, Vol. 8, No. 2, 2003, p. 111-119.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Renal transplantation for Indigenous Australians

T2 - Identifying the barriers to equitable access

AU - Cass, Alan

AU - Cunningham, Joan

AU - Snelling, Paul

AU - Wang, Zhiqiang

AU - Hoy, Wendy

PY - 2003

Y1 - 2003

N2 - Objective. To assess Indigenous Australians' access to renal transplantation, compared with non-Indigenous Australians. To examine whether disparities are due to a lower rate of acceptance onto the waiting list and/or a lower rate of moving from the list to transplantation. Design. National cohort study using data from the Australian and New Zealand Dialysis and Transplant Registry. We included all end-stage renal disease (ESRD) patients under 65 years of age who started treatment in Australia between January 1993 and December 1998. We used survival analysis to examine the time from commencement of renal replacement therapy (RRT) to transplantation. We measured time from commencement of RRT to acceptance onto the waiting list (stage 1), and time from acceptance onto the waiting list to transplantation (stage 2). The main outcome measures were (1) acceptance onto the waiting list and (2) receipt of a transplant, before 31 March 2000. Results. Indigenous patients had a lower transplantation rate (adjusted Indigenous:non-Indigenous rate ratio 0.32, 95% CI 0.25-0.40). They had both a lower rate of acceptance onto the waiting list (adjusted rate ratio 0.50, 95% CI 0.44-0.57) and a lower rate of moving from the list to transplantation (adjusted rate ratio 0.50, 95% CI 0.38-0.65). The disparities were not explained by differences in age, sex, co-morbidities or cause of renal disease. Conclusions. Indigenous Australians face barriers to acceptance onto the waiting list and to moving from the list to transplantation. Further research to identify the causes could facilitate strategies to improve equity in transplantation.

AB - Objective. To assess Indigenous Australians' access to renal transplantation, compared with non-Indigenous Australians. To examine whether disparities are due to a lower rate of acceptance onto the waiting list and/or a lower rate of moving from the list to transplantation. Design. National cohort study using data from the Australian and New Zealand Dialysis and Transplant Registry. We included all end-stage renal disease (ESRD) patients under 65 years of age who started treatment in Australia between January 1993 and December 1998. We used survival analysis to examine the time from commencement of renal replacement therapy (RRT) to transplantation. We measured time from commencement of RRT to acceptance onto the waiting list (stage 1), and time from acceptance onto the waiting list to transplantation (stage 2). The main outcome measures were (1) acceptance onto the waiting list and (2) receipt of a transplant, before 31 March 2000. Results. Indigenous patients had a lower transplantation rate (adjusted Indigenous:non-Indigenous rate ratio 0.32, 95% CI 0.25-0.40). They had both a lower rate of acceptance onto the waiting list (adjusted rate ratio 0.50, 95% CI 0.44-0.57) and a lower rate of moving from the list to transplantation (adjusted rate ratio 0.50, 95% CI 0.38-0.65). The disparities were not explained by differences in age, sex, co-morbidities or cause of renal disease. Conclusions. Indigenous Australians face barriers to acceptance onto the waiting list and to moving from the list to transplantation. Further research to identify the causes could facilitate strategies to improve equity in transplantation.

KW - accessibility

KW - equity

KW - health care

KW - health geography

KW - indigenous population

KW - age

KW - Australia

KW - cohort analysis

KW - comorbidity

KW - ethnic difference

KW - health care access

KW - human

KW - kidney transplantation

KW - New Zealand

KW - outcomes research

KW - register

KW - review

KW - sex difference

KW - social class

KW - Cohort Studies

KW - Female

KW - Health Services Accessibility

KW - Humans

KW - Kidney Failure, Chronic

KW - Kidney Transplantation

KW - Male

KW - Oceanic Ancestry Group

KW - Proportional Hazards Models

KW - Registries

KW - Waiting Lists

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M3 - Article

VL - 8

SP - 111

EP - 119

JO - Ethnicity and Health

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SN - 1355-7858

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