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.
    @article{64866065b47d456abecca8b185e1e777,
    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 -