Gender differences in the dialysis treatment of Indigenous and non‐Indigenous Australians

Abstract

Abstract Objective: Access to dialysis treatment and the types of treatments employed in Australia differs by Indigenous status. We examined whether dialysis treatment utilisation in Indigenous and non‐Indigenous Australians also differs by gender. Methods: Using registry data we evaluated 21,832 incident patients (aged ≥18 years) commencing dialysis, 2001–2013. Incidence rates were calculated and multivariate regression modelling used to examine differences in dialysis treatment (modality, location and vascular access creation) by race and gender. Results: Dialysis incidence was consistently higher in Indigenous women compared to all other groups. Compared to Indigenous women, both non‐Indigenous women and men were more likely to receive peritoneal dialysis as their initial treatment (non‐Indigenous women RR=1.91, 95%CI 1.55–2.35; non‐Indigenous men RR=1.73, 1.40–2.14) and were more likely to commence initial treatment at home (non‐Indigenous women RR=2.07, 1.66–2.59; non‐Indigenous men RR=1.95, 1.56–2.45). All groups were significantly more likely than Indigenous women to receive their final treatment at home. Conclusions: Contemporary dialysis treatment in Australia continues to benefit the dominant non‐Indigenous population over the Indigenous population, with non‐Indigenous men being particularly advantaged. Implications for Public Health: Treatment guidelines that incorporate a recognition of gender‐based preferences and dialysis treatment options specific to Indigenous Australians may assist in addressing this disparity.

Keywords

• dialysis
• end‐stage kidney disease
• gender
• Indigenous population
• inequalities