Socio-economic status and incidence of renal replacement therapy

A registry study of Australian patients

Blair Grace, Philip Clayton, Alan Cass, Stephen McDonald

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Socio-economic disadvantage has been linked to higher incidence of end-stage kidney disease in developed countries. Associations between socio-economic status (SES) and incidence of renal replacement therapy (RRT) have not been explored for different kidney diseases, genders or age groups in a country with universal access to healthcare.

    Methods: We investigated the incidence of non-indigenous patients commencing RRT in Australia in 2000–09, using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Patient postcodes were grouped into deciles using a standard SES index. We analysed incidence by five groups of kidney diseases, age groups, gender and geographic remoteness.

    Results: Incidence of RRT decreased with increasing area advantage. Differences were most evident for the most disadvantaged areas [markedly increased burden; incident rate ratio (IRR) 1.27; 95% confidence interval (CI) 1.18–1.38] and most advantaged decile (decreased burden, IRR 0.76; 95% CI 0.72–0.81), compared with decile 5. Patients with diabetic nephropathy showed the greatest disparities: residents of the most disadvantaged decile were 2.38 (95% CI 2.09–2.71) times more at risk than the most advantaged decile. Congenital and genetic kidney diseases showed lesser gradients—the most disadvantaged decile was 1.28 times (95% CI 0.98–1.68) more at risk. SES was not associated with incidence for patients older than 69 years.

    Discussion: These SES gradients existed, despite all Australians having access to healthcare. Diseases associated with lifestyle show the greatest gradients with SES.
    Original languageEnglish
    Pages (from-to)4173-4180
    Number of pages8
    JournalNephrology Dialysis Transplantation
    Volume27
    Issue number11
    DOIs
    Publication statusPublished - Nov 2012

    Fingerprint

    Renal Replacement Therapy
    Registries
    Economics
    Incidence
    Kidney Diseases
    Vulnerable Populations
    Confidence Intervals
    Age Groups
    Delivery of Health Care
    Inborn Genetic Diseases
    Diabetic Nephropathies
    New Zealand
    Developed Countries
    Chronic Kidney Failure
    Life Style
    Dialysis
    Transplants

    Cite this

    @article{174a682a656240278bc91789fafdf0d8,
    title = "Socio-economic status and incidence of renal replacement therapy: A registry study of Australian patients",
    abstract = "Background: Socio-economic disadvantage has been linked to higher incidence of end-stage kidney disease in developed countries. Associations between socio-economic status (SES) and incidence of renal replacement therapy (RRT) have not been explored for different kidney diseases, genders or age groups in a country with universal access to healthcare.Methods: We investigated the incidence of non-indigenous patients commencing RRT in Australia in 2000–09, using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Patient postcodes were grouped into deciles using a standard SES index. We analysed incidence by five groups of kidney diseases, age groups, gender and geographic remoteness.Results: Incidence of RRT decreased with increasing area advantage. Differences were most evident for the most disadvantaged areas [markedly increased burden; incident rate ratio (IRR) 1.27; 95{\%} confidence interval (CI) 1.18–1.38] and most advantaged decile (decreased burden, IRR 0.76; 95{\%} CI 0.72–0.81), compared with decile 5. Patients with diabetic nephropathy showed the greatest disparities: residents of the most disadvantaged decile were 2.38 (95{\%} CI 2.09–2.71) times more at risk than the most advantaged decile. Congenital and genetic kidney diseases showed lesser gradients—the most disadvantaged decile was 1.28 times (95{\%} CI 0.98–1.68) more at risk. SES was not associated with incidence for patients older than 69 years.Discussion: These SES gradients existed, despite all Australians having access to healthcare. Diseases associated with lifestyle show the greatest gradients with SES.",
    author = "Blair Grace and Philip Clayton and Alan Cass and Stephen McDonald",
    year = "2012",
    month = "11",
    doi = "10.1093/ndt/gfs361",
    language = "English",
    volume = "27",
    pages = "4173--4180",
    journal = "Nephrology Dialysis Transplantation",
    issn = "0931-0509",
    publisher = "Oxford University Press",
    number = "11",

    }

    Socio-economic status and incidence of renal replacement therapy : A registry study of Australian patients. / Grace, Blair; Clayton, Philip; Cass, Alan; McDonald, Stephen.

    In: Nephrology Dialysis Transplantation, Vol. 27, No. 11, 11.2012, p. 4173-4180.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Socio-economic status and incidence of renal replacement therapy

    T2 - A registry study of Australian patients

    AU - Grace, Blair

    AU - Clayton, Philip

    AU - Cass, Alan

    AU - McDonald, Stephen

    PY - 2012/11

    Y1 - 2012/11

    N2 - Background: Socio-economic disadvantage has been linked to higher incidence of end-stage kidney disease in developed countries. Associations between socio-economic status (SES) and incidence of renal replacement therapy (RRT) have not been explored for different kidney diseases, genders or age groups in a country with universal access to healthcare.Methods: We investigated the incidence of non-indigenous patients commencing RRT in Australia in 2000–09, using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Patient postcodes were grouped into deciles using a standard SES index. We analysed incidence by five groups of kidney diseases, age groups, gender and geographic remoteness.Results: Incidence of RRT decreased with increasing area advantage. Differences were most evident for the most disadvantaged areas [markedly increased burden; incident rate ratio (IRR) 1.27; 95% confidence interval (CI) 1.18–1.38] and most advantaged decile (decreased burden, IRR 0.76; 95% CI 0.72–0.81), compared with decile 5. Patients with diabetic nephropathy showed the greatest disparities: residents of the most disadvantaged decile were 2.38 (95% CI 2.09–2.71) times more at risk than the most advantaged decile. Congenital and genetic kidney diseases showed lesser gradients—the most disadvantaged decile was 1.28 times (95% CI 0.98–1.68) more at risk. SES was not associated with incidence for patients older than 69 years.Discussion: These SES gradients existed, despite all Australians having access to healthcare. Diseases associated with lifestyle show the greatest gradients with SES.

    AB - Background: Socio-economic disadvantage has been linked to higher incidence of end-stage kidney disease in developed countries. Associations between socio-economic status (SES) and incidence of renal replacement therapy (RRT) have not been explored for different kidney diseases, genders or age groups in a country with universal access to healthcare.Methods: We investigated the incidence of non-indigenous patients commencing RRT in Australia in 2000–09, using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Patient postcodes were grouped into deciles using a standard SES index. We analysed incidence by five groups of kidney diseases, age groups, gender and geographic remoteness.Results: Incidence of RRT decreased with increasing area advantage. Differences were most evident for the most disadvantaged areas [markedly increased burden; incident rate ratio (IRR) 1.27; 95% confidence interval (CI) 1.18–1.38] and most advantaged decile (decreased burden, IRR 0.76; 95% CI 0.72–0.81), compared with decile 5. Patients with diabetic nephropathy showed the greatest disparities: residents of the most disadvantaged decile were 2.38 (95% CI 2.09–2.71) times more at risk than the most advantaged decile. Congenital and genetic kidney diseases showed lesser gradients—the most disadvantaged decile was 1.28 times (95% CI 0.98–1.68) more at risk. SES was not associated with incidence for patients older than 69 years.Discussion: These SES gradients existed, despite all Australians having access to healthcare. Diseases associated with lifestyle show the greatest gradients with SES.

    U2 - 10.1093/ndt/gfs361

    DO - 10.1093/ndt/gfs361

    M3 - Article

    VL - 27

    SP - 4173

    EP - 4180

    JO - Nephrology Dialysis Transplantation

    JF - Nephrology Dialysis Transplantation

    SN - 0931-0509

    IS - 11

    ER -