Abstract: TH-PO816

Socioeconomic Status and Dialysis Quality of Care

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Krishnasamy, Rathika, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
  • Jegatheesan, Dev Krish, University of Queensland School of Medicine, Brisbane, Queensland, Australia
  • Lawton, Paul D., Menzies School of Health Research, Casuarina, Northern Territory, Australia
  • Gray, Nicholas A., Sunshine Coast University Hospital, Birtinya, Queensland, Australia
Background

Lower socioeconomic status (SES) has been associated with increased mortality in end stage kidney disease (ESKD) populations across USA, South America, Europe and Australasia. However, less is known about the association between SES and the quality of care (QOC) delivered to dialysis patients.

Methods

This study included all non-Indigenous adults commencing hemodialysis (HD) or peritoneal dialysis (PD) registered with Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry between 2002 and 2012 (n=16867). Each patient’s location at dialysis start was classified into SES quartiles of advantaged through to disadvantaged using Australian Bureau of Statistics socio-economic indexes for areas. National and international guidelines were used to set limits for QOC attainment. The association between area-level SES and attainment of QOC indicators at 6-18 months and 18-24 months after dialysis start were assessed using logistic regression models. QOC measures included pre-dialysis phosphate, calcium, hemoglobin, 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 lost to HD.

Results

The median age was 65 years (interquartile range 53-74), 62.2% were male and 85.1% were Caucasian. There were no significant differences in attainment of biochemical targets, PD or HD adequacy between the SES quartiles at 6-18 months after dialysis commencement. The least advantaged quartile were less likely to achieve hemoglobin target [Odds Ratio (OR) 0.89, 0.79-0.99, p=0.03] or to have a functioning fistula or graft (OR 0.75, 0.61-0.94, p=0.01] compared with the most advantaged group at 18-24 months.

Conclusion

Area-level SES has minimal impact on QOC attainment among non-Indigenous dialysis patients in Australia, where all residents have equal access to government funded healthcare. Increased mortality in lower SES groups is therefore likely due to pre-dialysis, other area-level and individual patient factors such as health-related behaviors, lifestyle and literacy, rather than disparities in QOC.

Funding

  • Government Support - Non-U.S.