Socioeconomic status and dialysis quality of care

Rathika Krishnasamy, Dev Jegatheesan, Paul Lawton, Nicholas A. Gray

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aim: Lower socioeconomic status (SES) has been associated with increased dialysis mortality. This study aimed to determine if the quality of care (QOC) delivered to dialysis patients varied by SES.

Methods: All non-Indigenous adults commencing haemodialysis (HD) or peritoneal dialysis (PD) registered with the Australia and New Zealand Dialysis and Transplant Registry between 2002 and 2012 were included. Each patient's location at dialysis start was classified into SES quartiles of advantaged to disadvantaged. Guidelines were used to determine attainment of adequate QOC at 6–<18 months and 18–<30 months after dialysis start, using logistic regression models. QOC measures included pre-dialysis phosphate, calcium, haemoglobin, transferrin saturation and ferritin. HD-related parameters included single pool Kt/V and percentage with functioning arteriovenous fistula/graft. PD-related parameters included weekly Kt/V and percentage transferring to HD.

Results: Of 19 486 commencing dialysis, the median age was 65 years (interquartile range 53–74), 62.2% were male and 85.1% were Caucasian. At 6–<18 months after dialysis start, there were no significant differences by SES in attainment of biochemical targets, PD or HD adequacy. The disadvantaged quartile was less likely to achieve haemoglobin targets (odds ratio 0.88, 0.80–0.96, P = 0.01) or have a functioning arteriovenous fistula or graft (odds ratio 0.79, 0.68–0.92, P = 0.003) compared with the most advantaged group. Vascular access differences persisted at 18–<30 months.

Conclusion: Other than vascular access, area-level SES has minimal impact on QOC attainment among non-Indigenous dialysis patients in Australia. Increased mortality in lower SES groups may be due to pre-dialysis factors and other variables such as health-related behaviours, lifestyle and literacy.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalNephrology
DOIs
Publication statusE-pub ahead of print - 1 Jul 2019

Fingerprint

Quality of Health Care
Social Class
Dialysis
Renal Dialysis
Peritoneal Dialysis
Arteriovenous Fistula
Vulnerable Populations
Transplants
Blood Vessels
Hemoglobins
Logistic Models
Odds Ratio
Health Literacy
Mortality
Transferrin
Ferritins
New Zealand
Registries
Life Style
Guidelines

Cite this

Krishnasamy, Rathika ; Jegatheesan, Dev ; Lawton, Paul ; Gray, Nicholas A. / Socioeconomic status and dialysis quality of care. In: Nephrology. 2019 ; pp. 1-8.
@article{b863aee4ec76415dbfd7a126bff4b2d4,
title = "Socioeconomic status and dialysis quality of care",
abstract = "Aim: Lower socioeconomic status (SES) has been associated with increased dialysis mortality. This study aimed to determine if the quality of care (QOC) delivered to dialysis patients varied by SES. Methods: All non-Indigenous adults commencing haemodialysis (HD) or peritoneal dialysis (PD) registered with the Australia and New Zealand Dialysis and Transplant Registry between 2002 and 2012 were included. Each patient's location at dialysis start was classified into SES quartiles of advantaged to disadvantaged. Guidelines were used to determine attainment of adequate QOC at 6–<18 months and 18–<30 months after dialysis start, using logistic regression models. QOC measures included pre-dialysis phosphate, calcium, haemoglobin, transferrin saturation and ferritin. HD-related parameters included single pool Kt/V and percentage with functioning arteriovenous fistula/graft. PD-related parameters included weekly Kt/V and percentage transferring to HD. Results: Of 19 486 commencing dialysis, the median age was 65 years (interquartile range 53–74), 62.2{\%} were male and 85.1{\%} were Caucasian. At 6–<18 months after dialysis start, there were no significant differences by SES in attainment of biochemical targets, PD or HD adequacy. The disadvantaged quartile was less likely to achieve haemoglobin targets (odds ratio 0.88, 0.80–0.96, P = 0.01) or have a functioning arteriovenous fistula or graft (odds ratio 0.79, 0.68–0.92, P = 0.003) compared with the most advantaged group. Vascular access differences persisted at 18–<30 months. Conclusion: Other than vascular access, area-level SES has minimal impact on QOC attainment among non-Indigenous dialysis patients in Australia. Increased mortality in lower SES groups may be due to pre-dialysis factors and other variables such as health-related behaviours, lifestyle and literacy.",
keywords = "ANZDATA, dialysis, disadvantage, quality of care, socioeconomic status",
author = "Rathika Krishnasamy and Dev Jegatheesan and Paul Lawton and Gray, {Nicholas A.}",
year = "2019",
month = "7",
day = "1",
doi = "10.1111/nep.13629",
language = "English",
pages = "1--8",
journal = "Nephrology",
issn = "1320-5358",
publisher = "Wiley-Blackwell",

}

Socioeconomic status and dialysis quality of care. / Krishnasamy, Rathika; Jegatheesan, Dev; Lawton, Paul; Gray, Nicholas A.

In: Nephrology, 01.07.2019, p. 1-8.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Socioeconomic status and dialysis quality of care

AU - Krishnasamy, Rathika

AU - Jegatheesan, Dev

AU - Lawton, Paul

AU - Gray, Nicholas A.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Aim: Lower socioeconomic status (SES) has been associated with increased dialysis mortality. This study aimed to determine if the quality of care (QOC) delivered to dialysis patients varied by SES. Methods: All non-Indigenous adults commencing haemodialysis (HD) or peritoneal dialysis (PD) registered with the Australia and New Zealand Dialysis and Transplant Registry between 2002 and 2012 were included. Each patient's location at dialysis start was classified into SES quartiles of advantaged to disadvantaged. Guidelines were used to determine attainment of adequate QOC at 6–<18 months and 18–<30 months after dialysis start, using logistic regression models. QOC measures included pre-dialysis phosphate, calcium, haemoglobin, transferrin saturation and ferritin. HD-related parameters included single pool Kt/V and percentage with functioning arteriovenous fistula/graft. PD-related parameters included weekly Kt/V and percentage transferring to HD. Results: Of 19 486 commencing dialysis, the median age was 65 years (interquartile range 53–74), 62.2% were male and 85.1% were Caucasian. At 6–<18 months after dialysis start, there were no significant differences by SES in attainment of biochemical targets, PD or HD adequacy. The disadvantaged quartile was less likely to achieve haemoglobin targets (odds ratio 0.88, 0.80–0.96, P = 0.01) or have a functioning arteriovenous fistula or graft (odds ratio 0.79, 0.68–0.92, P = 0.003) compared with the most advantaged group. Vascular access differences persisted at 18–<30 months. Conclusion: Other than vascular access, area-level SES has minimal impact on QOC attainment among non-Indigenous dialysis patients in Australia. Increased mortality in lower SES groups may be due to pre-dialysis factors and other variables such as health-related behaviours, lifestyle and literacy.

AB - Aim: Lower socioeconomic status (SES) has been associated with increased dialysis mortality. This study aimed to determine if the quality of care (QOC) delivered to dialysis patients varied by SES. Methods: All non-Indigenous adults commencing haemodialysis (HD) or peritoneal dialysis (PD) registered with the Australia and New Zealand Dialysis and Transplant Registry between 2002 and 2012 were included. Each patient's location at dialysis start was classified into SES quartiles of advantaged to disadvantaged. Guidelines were used to determine attainment of adequate QOC at 6–<18 months and 18–<30 months after dialysis start, using logistic regression models. QOC measures included pre-dialysis phosphate, calcium, haemoglobin, transferrin saturation and ferritin. HD-related parameters included single pool Kt/V and percentage with functioning arteriovenous fistula/graft. PD-related parameters included weekly Kt/V and percentage transferring to HD. Results: Of 19 486 commencing dialysis, the median age was 65 years (interquartile range 53–74), 62.2% were male and 85.1% were Caucasian. At 6–<18 months after dialysis start, there were no significant differences by SES in attainment of biochemical targets, PD or HD adequacy. The disadvantaged quartile was less likely to achieve haemoglobin targets (odds ratio 0.88, 0.80–0.96, P = 0.01) or have a functioning arteriovenous fistula or graft (odds ratio 0.79, 0.68–0.92, P = 0.003) compared with the most advantaged group. Vascular access differences persisted at 18–<30 months. Conclusion: Other than vascular access, area-level SES has minimal impact on QOC attainment among non-Indigenous dialysis patients in Australia. Increased mortality in lower SES groups may be due to pre-dialysis factors and other variables such as health-related behaviours, lifestyle and literacy.

KW - ANZDATA

KW - dialysis

KW - disadvantage

KW - quality of care

KW - socioeconomic status

UR - http://www.scopus.com/inward/record.url?scp=85069825578&partnerID=8YFLogxK

U2 - 10.1111/nep.13629

DO - 10.1111/nep.13629

M3 - Article

SP - 1

EP - 8

JO - Nephrology

JF - Nephrology

SN - 1320-5358

ER -