Survival of indigenous australians receiving renal replacement therapy

Closing the gap?

Paul D. Lawton, Joan Cunningham, Yuejen Zhao, Nicholas A. Gray, Mark D. Chatfield, Peter D. Baade, Karumathil Murali, Matthew D. Jose

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objectives: To compare mortality rates for Indigenous and non-Indigenous Australians commencing renal replacement therapy (RRT) over time and by categories of remoteness of place of residence.

    Design, setting and participants: An observational cohort study of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data on Indigenous and non-Indigenous Australians registered with ANZDATA who commenced RRT from 1 January 1995 to 31 December 2009 and were followed until 31 December 2011.

    Main outcome measures: Five-year all-cause mortality for Indigenous and non-Indigenous patients in three cohorts (1995–1999, 2000–2004 and 2005–2009) and five remoteness (of place of residence) categories.

    Results: Indigenous patients were younger, more likely to have diabetes, be referred late and be from a more remote area than non-Indigenous patients. Age and comorbid conditions increased with successive cohorts for both groups. Unadjusted analysis (using the log-rank test) showed an increased risk of death for Indigenous patients in the 1995–1999 (P = 0.02) and 2000–2004 (P = 0.03) cohorts, but not for the 2005–2009 cohort (P = 0.7). However, a Cox proportional hazards model adjusted for covariates (age, sex, late referral and comorbid conditions [diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung disease], and body mass index < 18.5 kg/m2 and > 30 kg/m2) showed the following Indigenous:non-Indigenous hazard ratios (with 95% CIs) for major capital cities: 1995–1999, 1.47 (1.21–1.79); 2000–2004, 1.35 (1.12–1.63); and 2005–2009, 1.37 (1.14–1.66).

    Conclusions: Although unadjusted analysis suggests that the survival gap between Indigenous and non-Indigenous patients receiving RRT has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.

    Original languageEnglish
    Pages (from-to)200-205
    Number of pages6
    JournalMedical Journal of Australia
    Volume202
    Issue number4
    DOIs
    Publication statusPublished - 2015

    Fingerprint

    Renal Replacement Therapy
    Survival
    New Zealand
    Registries
    Dialysis
    Transplants
    Cerebrovascular Disorders
    Peripheral Vascular Diseases
    Mortality
    Survival Analysis
    Proportional Hazards Models
    Lung Diseases
    Observational Studies
    Coronary Artery Disease
    Body Mass Index
    Cohort Studies
    Referral and Consultation
    Outcome Assessment (Health Care)

    Cite this

    Lawton, Paul D. ; Cunningham, Joan ; Zhao, Yuejen ; Gray, Nicholas A. ; Chatfield, Mark D. ; Baade, Peter D. ; Murali, Karumathil ; Jose, Matthew D. / Survival of indigenous australians receiving renal replacement therapy : Closing the gap?. In: Medical Journal of Australia. 2015 ; Vol. 202, No. 4. pp. 200-205.
    @article{e27028ef94d048f69627e3c278b82d8e,
    title = "Survival of indigenous australians receiving renal replacement therapy: Closing the gap?",
    abstract = "Objectives: To compare mortality rates for Indigenous and non-Indigenous Australians commencing renal replacement therapy (RRT) over time and by categories of remoteness of place of residence. Design, setting and participants: An observational cohort study of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data on Indigenous and non-Indigenous Australians registered with ANZDATA who commenced RRT from 1 January 1995 to 31 December 2009 and were followed until 31 December 2011. Main outcome measures: Five-year all-cause mortality for Indigenous and non-Indigenous patients in three cohorts (1995–1999, 2000–2004 and 2005–2009) and five remoteness (of place of residence) categories. Results: Indigenous patients were younger, more likely to have diabetes, be referred late and be from a more remote area than non-Indigenous patients. Age and comorbid conditions increased with successive cohorts for both groups. Unadjusted analysis (using the log-rank test) showed an increased risk of death for Indigenous patients in the 1995–1999 (P = 0.02) and 2000–2004 (P = 0.03) cohorts, but not for the 2005–2009 cohort (P = 0.7). However, a Cox proportional hazards model adjusted for covariates (age, sex, late referral and comorbid conditions [diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung disease], and body mass index < 18.5 kg/m2 and > 30 kg/m2) showed the following Indigenous:non-Indigenous hazard ratios (with 95{\%} CIs) for major capital cities: 1995–1999, 1.47 (1.21–1.79); 2000–2004, 1.35 (1.12–1.63); and 2005–2009, 1.37 (1.14–1.66). Conclusions: Although unadjusted analysis suggests that the survival gap between Indigenous and non-Indigenous patients receiving RRT has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.",
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    author = "Lawton, {Paul D.} and Joan Cunningham and Yuejen Zhao and Gray, {Nicholas A.} and Chatfield, {Mark D.} and Baade, {Peter D.} and Karumathil Murali and Jose, {Matthew D.}",
    year = "2015",
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    language = "English",
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    Survival of indigenous australians receiving renal replacement therapy : Closing the gap? / Lawton, Paul D.; Cunningham, Joan; Zhao, Yuejen; Gray, Nicholas A.; Chatfield, Mark D.; Baade, Peter D.; Murali, Karumathil; Jose, Matthew D.

    In: Medical Journal of Australia, Vol. 202, No. 4, 2015, p. 200-205.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Survival of indigenous australians receiving renal replacement therapy

    T2 - Closing the gap?

    AU - Lawton, Paul D.

    AU - Cunningham, Joan

    AU - Zhao, Yuejen

    AU - Gray, Nicholas A.

    AU - Chatfield, Mark D.

    AU - Baade, Peter D.

    AU - Murali, Karumathil

    AU - Jose, Matthew D.

    PY - 2015

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    N2 - Objectives: To compare mortality rates for Indigenous and non-Indigenous Australians commencing renal replacement therapy (RRT) over time and by categories of remoteness of place of residence. Design, setting and participants: An observational cohort study of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data on Indigenous and non-Indigenous Australians registered with ANZDATA who commenced RRT from 1 January 1995 to 31 December 2009 and were followed until 31 December 2011. Main outcome measures: Five-year all-cause mortality for Indigenous and non-Indigenous patients in three cohorts (1995–1999, 2000–2004 and 2005–2009) and five remoteness (of place of residence) categories. Results: Indigenous patients were younger, more likely to have diabetes, be referred late and be from a more remote area than non-Indigenous patients. Age and comorbid conditions increased with successive cohorts for both groups. Unadjusted analysis (using the log-rank test) showed an increased risk of death for Indigenous patients in the 1995–1999 (P = 0.02) and 2000–2004 (P = 0.03) cohorts, but not for the 2005–2009 cohort (P = 0.7). However, a Cox proportional hazards model adjusted for covariates (age, sex, late referral and comorbid conditions [diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung disease], and body mass index < 18.5 kg/m2 and > 30 kg/m2) showed the following Indigenous:non-Indigenous hazard ratios (with 95% CIs) for major capital cities: 1995–1999, 1.47 (1.21–1.79); 2000–2004, 1.35 (1.12–1.63); and 2005–2009, 1.37 (1.14–1.66). Conclusions: Although unadjusted analysis suggests that the survival gap between Indigenous and non-Indigenous patients receiving RRT has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.

    AB - Objectives: To compare mortality rates for Indigenous and non-Indigenous Australians commencing renal replacement therapy (RRT) over time and by categories of remoteness of place of residence. Design, setting and participants: An observational cohort study of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data on Indigenous and non-Indigenous Australians registered with ANZDATA who commenced RRT from 1 January 1995 to 31 December 2009 and were followed until 31 December 2011. Main outcome measures: Five-year all-cause mortality for Indigenous and non-Indigenous patients in three cohorts (1995–1999, 2000–2004 and 2005–2009) and five remoteness (of place of residence) categories. Results: Indigenous patients were younger, more likely to have diabetes, be referred late and be from a more remote area than non-Indigenous patients. Age and comorbid conditions increased with successive cohorts for both groups. Unadjusted analysis (using the log-rank test) showed an increased risk of death for Indigenous patients in the 1995–1999 (P = 0.02) and 2000–2004 (P = 0.03) cohorts, but not for the 2005–2009 cohort (P = 0.7). However, a Cox proportional hazards model adjusted for covariates (age, sex, late referral and comorbid conditions [diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung disease], and body mass index < 18.5 kg/m2 and > 30 kg/m2) showed the following Indigenous:non-Indigenous hazard ratios (with 95% CIs) for major capital cities: 1995–1999, 1.47 (1.21–1.79); 2000–2004, 1.35 (1.12–1.63); and 2005–2009, 1.37 (1.14–1.66). Conclusions: Although unadjusted analysis suggests that the survival gap between Indigenous and non-Indigenous patients receiving RRT has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.

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