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 language | English |
|---|---|
| Pages (from-to) | 200-205 |
| Number of pages | 6 |
| Journal | Medical Journal of Australia |
| Volume | 202 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 2015 |
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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 journal › Article › Research › peer-review
TY - JOUR
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
Y1 - 2015
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.
KW - adult
KW - Article
KW - body mass
KW - cause of death
KW - cerebrovascular disease
KW - cohort analysis
KW - comorbidity
KW - controlled study
KW - coronary artery disease
KW - diabetes mellitus
KW - female
KW - human
KW - Indigenous Australian
KW - lung disease
KW - major clinical study
KW - male
KW - middle aged
KW - mortality
KW - observational study
KW - peripheral vascular disease
KW - post treatment survival
KW - renal replacement therapy
KW - Australia
KW - clinical trial
KW - epidemiology
KW - ethnology
KW - follow up
KW - Kidney Failure, Chronic
KW - multicenter study
KW - New Zealand
KW - population group
KW - proportional hazards model
KW - register
KW - retrospective study
KW - survival rate
KW - time
KW - trends
KW - Cause of Death
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Population Groups
KW - Proportional Hazards Models
KW - Registries
KW - Renal Replacement Therapy
KW - Retrospective Studies
KW - Survival Rate
KW - Time Factors
UR - http://www.scopus.com/inward/record.url?scp=84923881915&partnerID=8YFLogxK
U2 - 10.5694/mja14.00664
DO - 10.5694/mja14.00664
M3 - Article
VL - 202
SP - 200
EP - 205
JO - Medical Journal of Australia
JF - Medical Journal of Australia
SN - 0025-729X
IS - 4
ER -