MORTALITY OUTCOMES FOR MĀORI AND NON-MĀORI AFTER COMMENCING RENAL REPLACMENT THERAPY IN AOTEAROA/NEW ZEALAND: A KAUPAPA MĀORI APPROACH

T HURIA,1 S PALMER2, L BECKERT2, J WILLIMAN,3 S PITAMA1

1Māori and Indigenous Health Institute, University of Otago Christchurch, New Zealand; 2Department of Medicine, University of Otago Christchurch, New Zealand; 3Department of Population Health, University of Otago Christchurch

Aim:  To utilise indigenous approaches to explore disparities for Māori with end-stage kidney disease (ESKD).

Background: Inequitable health outcomes for indigenous peoples with ESKD persist despite considerable research and policy efforts.

Methods: We employed a kaupapa Māori approach in the conduct of a propensity score matched cohort analysis of mortality after commencement of renal replacement therapy. We included all adults commencing renal replacement therapy in Aotearoa/New Zealand (1/1/2002-31/12/2011) from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) linked to the New Zealand National Health Index.

Results: 1459 Māori and 3312 non-Māori were included. Non- Māori were older, had a lower BMI and were less likely to have smoked or have diabetes. Non-Māori were more likely to utilise peritoneal dialysis and kidney transplantation. Non-Māori were less likely to be referred late to specialist services or start dialysis with a vascular catheter.  Non-Māori were more likely to live in an urban setting and had markedly less socioeconomic deprivation. Propensity-score matching assembled Māori and non-Māori cohorts with similar clinical and sociodemographic characteristics. Despite matching, Māori were more likely to commence dialysis with a venous catheter (standardized difference 0.35) and live in a rural location (0.50). Within age standardised populations, the crude fatality rate ratio for Māori compared with New Zealand European patients at 5 years was 14.1 (95% CI 4.2-47.3) during 2002-2006 and 10.3 (3.5-30.0) in 2007-2011.

Conclusions: Non-Māori experienced markedly lower mortality rates than Māori during dialysis therapy even when socioeconomic and clinical factors were equivalent. Health services and policies that insufficiently consider indigenous status as a marker of adverse outcomes, independent of social and clinical indicators, may not effectively address disparities in Aotearoa/New Zealand.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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