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Socioeconomic status and dialysis quality of care
Author(s) -
Krishnasamy Rathika,
Jegatheesan Dev,
Lawton Paul,
Gray Nicholas A
Publication year - 2020
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.13629
Subject(s) - medicine , dialysis , interquartile range , odds ratio , quartile , hemodialysis , socioeconomic status , peritoneal dialysis , dialysis adequacy , logistic regression , confidence interval , demography , population , environmental health , sociology
Aim Lower socioeconomic status (SES) has been associated with increased dialysis mortality. This study aimed to determine if the quality of care (QOC) delivered to dialysis patients varied by SES. Methods All non‐Indigenous adults commencing haemodialysis (HD) or peritoneal dialysis (PD) registered with the Australia and New Zealand Dialysis and Transplant Registry between 2002 and 2012 were included. Each patient's location at dialysis start was classified into SES quartiles of advantaged to disadvantaged. Guidelines were used to determine attainment of adequate QOC at 6–<18 months and 18–<30 months after dialysis start, using logistic regression models. QOC measures included pre‐dialysis phosphate, calcium, haemoglobin, transferrin saturation and ferritin. HD‐related parameters included single pool Kt/V and percentage with functioning arteriovenous fistula/graft. PD‐related parameters included weekly Kt/V and percentage transferring to HD. Results Of 19 486 commencing dialysis, the median age was 65 years (interquartile range 53–74), 62.2% were male and 85.1% were Caucasian. At 6–<18 months after dialysis start, there were no significant differences by SES in attainment of biochemical targets, PD or HD adequacy. The disadvantaged quartile was less likely to achieve haemoglobin targets (odds ratio 0.88, 0.80–0.96, P = 0.01) or have a functioning arteriovenous fistula or graft (odds ratio 0.79, 0.68–0.92, P = 0.003) compared with the most advantaged group. Vascular access differences persisted at 18–<30 months. Conclusion Other than vascular access, area‐level SES has minimal impact on QOC attainment among non‐Indigenous dialysis patients in Australia. Increased mortality in lower SES groups may be due to pre‐dialysis factors and other variables such as health‐related behaviours, lifestyle and literacy.