SC PALMER1, SG PITAMA,2 V GRAY1, T KARA,3 JT HUGHES4,5
1 University of Otago Christchurch, Christchurch, Aotearoa/New Zealand; 2 Māori and Indigenous Health Institute, University of Otago Christchurch, Aotearoa/New Zealand; 3 Starship Hospital, Auckland District Health Board, Auckland, Aotearoa New Zealand; 4 Royal Darwin Hospital, Darwin, Northern Territories; 5 Menzies School of Health Research, Darwin, Northern Territories
Aim: To systematically document the research outputs related to Indigenous health outcomes arising from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).
Background: Treatment patterns for dialysis and kidney transplantation and clinical outcomes differ by Indigeneity in Australia and Aotearoa/New Zealand.
Methods: Electronic databases were searched for peer-reviewed studies reporting analyses according to Indigeneity in ANZDATA between 1977 and 2017. We mapped the purpose of including Indigeneity within the study, research foci, and involvement of Indigenous stakeholders in study conduct.
Results: 257 eligible study reports were identified. 120 (47%) reported Indigeneity as a variable in statistical analyses, 53 (44%) reported the primary study outcome(s) according to Indigenous status, and 21 (18%) were principally designed to evaluate health outcomes among Indigenous peoples. Among the 21 studies designed to examine Indigenous health outcomes (published 1999-2017), 20 reported outcomes among Aboriginal and Torres Strait Islanders and 4 reported outcomes among Māori resident in Aotearoa/New Zealand. Six studies evaluated end-stage kidney disease, 7 evaluated dialysis, 4 evaluated dialysis and transplantation, and 4 evaluated transplantation. Eleven studies evaluated practice patterns and 15 reported clinical outcomes. Five studies (24%) were explicitly designed to explore disparities in dialysis or transplantation practices and/or outcomes. None of the studies reported involvement of Indigenous stakeholders in developing the research question, study design, or dissemination. Two studies reported practice patterns among younger Indigenous patients.
Conclusions: The evidence base for Indigenous health outcomes derived from ANZDATA is dominated by the use of Indigeneity as an analytical variable. Few studies based on the ANZDATA registry explore the causes of inequitable practice patterns and clinical outcomes experienced by Indigenous peoples with end-stage kidney disease.