Survival of Indigenous Australians on Renal Replacement Therapy

Closing the Gap?

Paul Lawton, Joan Cunningham, Yuejen Zhao, N Gray, Mark Chatfield, P. Baade, Karumathil Murali, Matthew D. Jose

Research output: Contribution to journalMeeting AbstractResearch

Abstract

Aim: To compare mortality rates for Indigenous and non‐indigenous Australians commencing renal replacement therapy (RRT) over time periods and by categories of remoteness.

Background: Indigenous Australians have a high incidence of RRT, are less likely to receive a kidney transplant and many come from rural and remote areas. Previous studies have suggested that there has been a substantial “gap” in survival between non‐indigenous and Indigenous Australians commencing RRT that may have been narrowing.

Methods: Patients registered with ANZDATA who commenced RRT from 1st January 1995 to 31st December 2009 were included and followed until 31st December 2011. Five year all‐cause survival for Indigenous and non‐indigenous patients was compared for three cohorts (1995–99, 2000–04 and 2005–09) using Cox proportional hazards (PH) models including interaction terms for Indigenous status and time period, age and baseline variables (comorbidities, late referral and interaction terms for Indigenous status and remoteness category).

Results: Indigenous patients were younger, more likely to have diabetes, be late referred and be from a more remote area than non‐Indigenous patients. Age and comorbidities increased with successive cohorts for both ethnicities. Unadjusted analysis (using stratified log rank test) showed an increased risk of death for indigenous patients for the time periods 1995–99 (P = 0.022) and 2000–2004 (P = 0.029), but not 2005–09 (P = 0.656). A Cox PH model adjusted for covariates revealed the following hazard ratios (95%CI) for major capital cities (for example): Indigenous 1995–99 2.05 (1.69–2.50), 2000–04 1.66 (1.38–2.00), 2005–09 1.37 (1.14–1.66); non‐Indigenous 1995–99 1.40 (1.33–1.47), 2000–04 1.23 (1.17–1.29), 2005–09 1.0 (reference).

Conclusions:
Despite unadjusted analysis suggesting that the gap has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.
Original languageEnglish
Article number069
Pages (from-to)35-36
Number of pages2
JournalNephrology
Volume19
Issue numberSuppl. 4
DOIs
Publication statusPublished - 20 Jul 2014

Fingerprint

Renal Replacement Therapy
Survival
Proportional Hazards Models
Comorbidity
Referral and Consultation
Transplants
Kidney
Mortality
Incidence

Cite this

Lawton, P., Cunningham, J., Zhao, Y., Gray, N., Chatfield, M., Baade, P., ... Jose, M. D. (2014). Survival of Indigenous Australians on Renal Replacement Therapy: Closing the Gap? Nephrology, 19(Suppl. 4), 35-36. [069]. https://doi.org/10.1111/nep.12301
Lawton, Paul ; Cunningham, Joan ; Zhao, Yuejen ; Gray, N ; Chatfield, Mark ; Baade, P. ; Murali, Karumathil ; Jose, Matthew D. / Survival of Indigenous Australians on Renal Replacement Therapy : Closing the Gap?. In: Nephrology. 2014 ; Vol. 19, No. Suppl. 4. pp. 35-36.
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title = "Survival of Indigenous Australians on Renal Replacement Therapy: Closing the Gap?",
abstract = "Aim: To compare mortality rates for Indigenous and non‐indigenous Australians commencing renal replacement therapy (RRT) over time periods and by categories of remoteness.Background: Indigenous Australians have a high incidence of RRT, are less likely to receive a kidney transplant and many come from rural and remote areas. Previous studies have suggested that there has been a substantial “gap” in survival between non‐indigenous and Indigenous Australians commencing RRT that may have been narrowing.Methods: Patients registered with ANZDATA who commenced RRT from 1st January 1995 to 31st December 2009 were included and followed until 31st December 2011. Five year all‐cause survival for Indigenous and non‐indigenous patients was compared for three cohorts (1995–99, 2000–04 and 2005–09) using Cox proportional hazards (PH) models including interaction terms for Indigenous status and time period, age and baseline variables (comorbidities, late referral and interaction terms for Indigenous status and remoteness category).Results: Indigenous patients were younger, more likely to have diabetes, be late referred and be from a more remote area than non‐Indigenous patients. Age and comorbidities increased with successive cohorts for both ethnicities. Unadjusted analysis (using stratified log rank test) showed an increased risk of death for indigenous patients for the time periods 1995–99 (P = 0.022) and 2000–2004 (P = 0.029), but not 2005–09 (P = 0.656). A Cox PH model adjusted for covariates revealed the following hazard ratios (95{\%}CI) for major capital cities (for example): Indigenous 1995–99 2.05 (1.69–2.50), 2000–04 1.66 (1.38–2.00), 2005–09 1.37 (1.14–1.66); non‐Indigenous 1995–99 1.40 (1.33–1.47), 2000–04 1.23 (1.17–1.29), 2005–09 1.0 (reference).Conclusions: Despite unadjusted analysis suggesting that the gap has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.",
author = "Paul Lawton and Joan Cunningham and Yuejen Zhao and N Gray and Mark Chatfield and P. Baade and Karumathil Murali and Jose, {Matthew D.}",
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Lawton, P, Cunningham, J, Zhao, Y, Gray, N, Chatfield, M, Baade, P, Murali, K & Jose, MD 2014, 'Survival of Indigenous Australians on Renal Replacement Therapy: Closing the Gap?', Nephrology, vol. 19, no. Suppl. 4, 069, pp. 35-36. https://doi.org/10.1111/nep.12301

Survival of Indigenous Australians on Renal Replacement Therapy : Closing the Gap? / Lawton, Paul; Cunningham, Joan; Zhao, Yuejen; Gray, N; Chatfield, Mark; Baade, P.; Murali, Karumathil; Jose, Matthew D.

In: Nephrology, Vol. 19, No. Suppl. 4, 069, 20.07.2014, p. 35-36.

Research output: Contribution to journalMeeting AbstractResearch

TY - JOUR

T1 - Survival of Indigenous Australians on Renal Replacement Therapy

T2 - Closing the Gap?

AU - Lawton, Paul

AU - Cunningham, Joan

AU - Zhao, Yuejen

AU - Gray, N

AU - Chatfield, Mark

AU - Baade, P.

AU - Murali, Karumathil

AU - Jose, Matthew D.

PY - 2014/7/20

Y1 - 2014/7/20

N2 - Aim: To compare mortality rates for Indigenous and non‐indigenous Australians commencing renal replacement therapy (RRT) over time periods and by categories of remoteness.Background: Indigenous Australians have a high incidence of RRT, are less likely to receive a kidney transplant and many come from rural and remote areas. Previous studies have suggested that there has been a substantial “gap” in survival between non‐indigenous and Indigenous Australians commencing RRT that may have been narrowing.Methods: Patients registered with ANZDATA who commenced RRT from 1st January 1995 to 31st December 2009 were included and followed until 31st December 2011. Five year all‐cause survival for Indigenous and non‐indigenous patients was compared for three cohorts (1995–99, 2000–04 and 2005–09) using Cox proportional hazards (PH) models including interaction terms for Indigenous status and time period, age and baseline variables (comorbidities, late referral and interaction terms for Indigenous status and remoteness category).Results: Indigenous patients were younger, more likely to have diabetes, be late referred and be from a more remote area than non‐Indigenous patients. Age and comorbidities increased with successive cohorts for both ethnicities. Unadjusted analysis (using stratified log rank test) showed an increased risk of death for indigenous patients for the time periods 1995–99 (P = 0.022) and 2000–2004 (P = 0.029), but not 2005–09 (P = 0.656). A Cox PH model adjusted for covariates revealed the following hazard ratios (95%CI) for major capital cities (for example): Indigenous 1995–99 2.05 (1.69–2.50), 2000–04 1.66 (1.38–2.00), 2005–09 1.37 (1.14–1.66); non‐Indigenous 1995–99 1.40 (1.33–1.47), 2000–04 1.23 (1.17–1.29), 2005–09 1.0 (reference).Conclusions: Despite unadjusted analysis suggesting that the gap has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.

AB - Aim: To compare mortality rates for Indigenous and non‐indigenous Australians commencing renal replacement therapy (RRT) over time periods and by categories of remoteness.Background: Indigenous Australians have a high incidence of RRT, are less likely to receive a kidney transplant and many come from rural and remote areas. Previous studies have suggested that there has been a substantial “gap” in survival between non‐indigenous and Indigenous Australians commencing RRT that may have been narrowing.Methods: Patients registered with ANZDATA who commenced RRT from 1st January 1995 to 31st December 2009 were included and followed until 31st December 2011. Five year all‐cause survival for Indigenous and non‐indigenous patients was compared for three cohorts (1995–99, 2000–04 and 2005–09) using Cox proportional hazards (PH) models including interaction terms for Indigenous status and time period, age and baseline variables (comorbidities, late referral and interaction terms for Indigenous status and remoteness category).Results: Indigenous patients were younger, more likely to have diabetes, be late referred and be from a more remote area than non‐Indigenous patients. Age and comorbidities increased with successive cohorts for both ethnicities. Unadjusted analysis (using stratified log rank test) showed an increased risk of death for indigenous patients for the time periods 1995–99 (P = 0.022) and 2000–2004 (P = 0.029), but not 2005–09 (P = 0.656). A Cox PH model adjusted for covariates revealed the following hazard ratios (95%CI) for major capital cities (for example): Indigenous 1995–99 2.05 (1.69–2.50), 2000–04 1.66 (1.38–2.00), 2005–09 1.37 (1.14–1.66); non‐Indigenous 1995–99 1.40 (1.33–1.47), 2000–04 1.23 (1.17–1.29), 2005–09 1.0 (reference).Conclusions: Despite unadjusted analysis suggesting that the gap has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.

U2 - 10.1111/nep.12301

DO - 10.1111/nep.12301

M3 - Meeting Abstract

VL - 19

SP - 35

EP - 36

JO - Nephrology

JF - Nephrology

SN - 1320-5358

IS - Suppl. 4

M1 - 069

ER -