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.