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Ethn Health. 2017 Oct 31:1-17. doi: 10.1080/13557858.2017.1395814. [Epub ahead of print]

Chronic kidney disease and socio-economic status: a cross sectional study.

Author information

1
a Menzies School of Health Research , Casuarina , Australia.
2
b The Indigenous Health Equity Unit , University of Melbourne , Melbourne , Australia.
3
c Division of Medicine , Royal Darwin Hospital , Darwin , Australia.
4
d Centre for Population Health Research , University of South Australia , Adelaide , Australia.
5
e South Australian Health and Medical Research Institute , Adelaide , Australia.
6
f Australian Institute of Tropical Health and Medicine , James Cook University , Cairns , Australia.
7
g Centre for Chronic Disease , The University of Queensland , Brisbane St Lucia , Australia.

Abstract

OBJECTIVE:

This cross-sectional study investigated the relationship between individual-level markers of disadvantage, renal function and cardio-metabolic risk within an Indigenous population characterised by a heavy burden of chronic kidney disease and disadvantage.

DESIGN:

Using data from 20 Indigenous communities across Australia, an aggregate socio-economic status (SES) score was created from individual-level socio-economic variables reported by participants. Logistic regression was used to assess the association of individual-level socio-economic variables and the SES score with kidney function (an estimated glomerular function rate (eGFR) cut-point of <60 ml/min/1.73 m2) as well as clinical indicators of cardio-metabolic risk.

RESULTS:

The combination of lower education and unemployment was associated with poorer kidney function and higher cardio-metabolic risk factors. Regression models adjusted for age and gender showed that an eGFR < 60 ml/min/1.73 m2 was associated with a low socio-economic score (lowest vs. highest 3.24 [95% CI 1.43-6.97]), remote living (remote vs. highly to moderately accessible 3.24 [95% CI 1.28-8.23]), renting (renting vs. owning/being purchased 5.76[95% CI 1.91-17.33]), unemployment (unemployed vs employed 2.85 [95% CI 1.31-6.19]) and receiving welfare (welfare vs. salary 2.49 [95% CI 1.42-4.37]). A higher aggregate socio-economic score was inversely associated with an eGFR < 60 ml/min/1.73 m2 (0.75 [95% CI 063-0.89]).

CONCLUSION:

This study extends upon our understanding of associations between area-level markers of disadvantage and burden of end stage kidney disease amongst Indigenous populations to a detailed analysis of a range of well-characterised individual-level factors such as overall low socio-economic status, remote living, renting, unemployment and welfare. With the increasing burden of end-stage kidney disease amongst Indigenous people, the underlying socio-economic conditions and social and cultural determinants of health need to be understood at an individual as well as community-level, to develop, implement, target and sustain interventions.

KEYWORDS:

Chronic kidney disease; aboriginal and torres strait islander peoples; disadvantage; indigenous peoples; socio-economic status

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