ASSOCIATION OF SOCIO-ECONOMIC POSITION WITH TECHNIQUE FAILURE AND MORTALITY IN AUSTRALIAN NON-INDIGENOUS PERITONEAL DIALYSIS PATIENTS Dr Samuel Chan Nephrology.

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Presentation transcript:

ASSOCIATION OF SOCIO-ECONOMIC POSITION WITH TECHNIQUE FAILURE AND MORTALITY IN AUSTRALIAN NON-INDIGENOUS PERITONEAL DIALYSIS PATIENTS Dr Samuel Chan Nephrology Advanced Trainee Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia Princess Alexandra Hospital, Brisbane, Queensland, Australia The University of Queensland, School of Medicine, Brisbane, Queensland

GLOBAL TECHNIQUE SURVIVAL Jose, Johnson et al Nephrology 16:19-29, 2011

IMPETUS FOR STUDY Socio-economic position may influence technique survival Socio-economic position is an important public health issue Changes in models of health care Changes to resource allocation

AIM To investigate the association between socio-economic position with technique failure and mortality in all non-indigenous peritoneal dialysis patients in Australia

METHODOLOGY All non-indigenous Australian adult patients who commenced PD 01/01/1994 to 31/12/2014 (ANZDATA Registry) Outcome measures Technique failure (30-day and 180-day) Patient survival Socio-economic position based on Socio-Economic Index for Areas (SEIFA) Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) Index of Relative Socio-Economic Disadvantage (IRSD) Index of Education and Occupation (IEO) Index of Economic Resources (IER)

PATIENT CHARACTERISTICS IRSAD Total Population (n=9766) Quartile 1 (n=2844) Quartile 2 (n= 3166) Quartile 3 (n=1819) Quartile 4 (n=1937) P-value Age (years) 61 ± 15 61 ± 14 60 ± 15 0.04 Gender Male 5536 (57%) 1553 (55%) 1774 (56%) 1051 (58%) 1158 (60%) 0.003 Racial origin Caucasian 7982 (82%) 2318 (82%) 2625 (83%) 1515 (83%) 1524 (79%) Asian 1170 (12%) 314 (11%) 343 (11%) 207 (11%) 306 (16%) Maori/Pacific Islander 224 (2%) 81 (3%) 77 (2%) 39 (2%) 27 (1%) Other 390 (4%) 131 (5%) 121 (4%) 58 (3%) 80 (4%) <0.001 Body Mass Index (kg/m2) <20 862 (9%) 239 (8%) 271 (9%) 167 (9%) 185 (10%) 20-25 3403 (35%) 930 (33%) 1079 (34%) 656 (36%) 738 (38%) >25-30 3355 (35%) 981 (35%) 1099 (35%) 628 (35%) 647 (34%) >30 2091 (22%) 679 (24%) 700 (22%) 359 (20%) 353 (18%) Co-morbidities Current smoking status 1038 (11%) 343 (12%) 359 (11%) 151 (8%) Chronic lung disease 1305 (13%) 436 (15%) 427 (14%) 230 (13%) 212 (11%) Ischaemic heart disease 3640 (37%) 1127 (40%) 1167 (37%) 675 (37%) 671 (35%) 0.006 Peripheral vascular disease 2407 (25%) 734 (26%) 811 (26%) 437 (24%) 425 (22%) 0.009 Cerebrovascular accident 1101 (12%) 338 (13%) 377 (12%) 188 (11%) 198 (10%) 0.05 Diabetes mellitus 3707 (38%) 1135 (40%) 1221 (39%) 665 (37%) 686 (35%) 0.008

TECHNIQUE FAILURE 30 DAYS – IRSAD 30 DAYS - IRSD HR CI Q1 Ref. Q2 0.96 0.90-1.02 Q3 0.97 0.90-2.04 Q4 1.00 0.93-1.07 HR CI Q1 Ref. Q2 1.07 1.00-1.15 Q3 0.99 0.93-1.06 Q4 1.04 0.96-1.12

TECHNIQUE FAILURE 30 DAYS – IER 30 DAYS – IEO HR CI Q1 Ref. Q2 1.00 0.94-1.07 Q3 1.01 0.93-1.08 Q4 0.98 0.92-1.06 HR CI Q1 Ref. Q2 0.93 0.87-1.00 Q3 0.97 0.91-1.04 Q4 1.00 0.94-1.08

TECHNIQUE FAILURE 180 DAYS – IRSAD 180 DAYS – IRSD HR CI Q1 Ref. Q2 0.96 0.90-1.02 Q3 0.97 0.90-1.05 Q4 0.90-1.04 HR CI Q1 Ref. Q2 1.04 0.97-1.12 Q3 0.96 0.92-1.05 Q4 1.00 0.93-1.08

TECHNIQUE FAILURE 180 DAYS – IER 180 DAYS – IEO HR CI Q1 Ref. Q2 0.98 0.92-1.05 Q3 0.99 0.91-1.07 Q4 0.96 0.89-1.03 HR CI Q1 Ref. Q2 0.94 0.87-1.01 Q3 0.96 0.90-1.03 Q4 1.01 0.94-1.08

MORTALITY IRSAD IRSD HR CI Q1 Ref. Q2 0.96 0.86-1.06 Q3 0.87 0.77-0.99 0.76-0.97 HR CI Q1 Ref. Q2 1.02 0.91-1.14 Q3 0.94 0.84-1.04 Q4 0.85 0.74-0.96

MORTALITY IER IEO HR CI Q1 Ref. Q2 0.99 0.88-1.10 Q3 0.97 0.86-1.10 Q4 0.89 0.80-1.01 HR CI Q1 Ref. Q2 0.94 0.83-1.06 Q3 0.85-1.05 Q4 0.85 0.75-0.96

CONCLUSIONS Socio-economic position was not associated with technique failure Higher socio-economic position was associated with better patient survival Future studies should examine the relationship between socio-economic position and technique failure in indigenous patients

ACKNOWLEDGEMENTS ANZDATA Registry – Stephen P McDonald and Philip A Clayton Project supervisors – Prof David W Johnson, A/Prof Carmel M Hawley, Dr Yeoungjee Cho, A/Prof David W Mudge, Dr Ross S Francis Australian Kidney Trials Network (AKTN) and Elaine Pascoe