Association of Socio-Economic Position with Technique Failure and Mortality in Australian Non-Indigenous Peritoneal Dialysis Patients

Samuel Chan, Yeoungjee Cho, Yung H Koh, Neil C Boudville, Philip A Clayton, Stephen P McDonald, Elaine M Pascoe, Ross S Francis, David W Mudge, Monique Borlace, Sunil V Badve, Kamal Sud, Carmel M Hawley, David W Johnson

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Abstract

BACKGROUND: Few studies have examined the relationship between socio-economic position (SEP) and peritoneal dialysis (PD) outcomes, particularly at a country level. The aim of this study was to investigate the relationships between SEP, technique failure, and mortality in PD patients undertaking treatment in Australia.

METHODS: The study included all Australian non-indigenous incident PD patients between January 1, 1997, and December 31, 2014, using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data. The SEP was assessed by quartiles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Advantage and Disadvantage (IRSAD - primary index), Index of Relative Socio-economic Disadvantage (IRSD), Index of Economic Resources (IER), and Index of Education and Occupation (IEO). Technique and patient survival were evaluated by multivariable Cox proportional hazards survival analyses.

RESULTS: The study included 9,766 patients (mean age 60.6 ± 15 years, 57% male, 38% diabetic). Using multivariable Cox regression, no significant association was observed between quartiles of IRSAD and technique failure (30-day definitionp= 0.65, 180-day definitionp= 0.68). Similar results were obtained using competing risks regression. However, higher SEP, defined by quartiles of IRSAD, was associated with better patient survival (Quartile 1 reference; Quartile 2 adjusted hazards ratio [HR] 0.96, 95% confidence interval [CI] 0.86 - 1.06; Quartile 3 HR 0.87, 95% CI 0.77 - 0.99; Quartile 4 HR 0.86, 95% CI 0.76 - 0.97). Similar results were found when IRSD was analyzed, but results were no longer statistically significant for IER and IEO.

CONCLUSIONS: In Australia, where there is universal free healthcare, SEP was not associated with PD technique failure in non-indigenous PD patients. Higher SEP was generally associated with improved patient survival.

Original languageEnglish
Pages (from-to)397-406
Number of pages10
JournalPeritoneal Dialysis International
Volume37
Issue number4
DOIs
Publication statusPublished - 12 Feb 2017

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Peritoneal Dialysis
Economics
Mortality
Confidence Intervals
Occupations
Survival
Education
Survival Analysis
New Zealand
Registries
Dialysis
Delivery of Health Care
Transplants

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Chan, Samuel ; Cho, Yeoungjee ; Koh, Yung H ; Boudville, Neil C ; Clayton, Philip A ; McDonald, Stephen P ; Pascoe, Elaine M ; Francis, Ross S ; Mudge, David W ; Borlace, Monique ; Badve, Sunil V ; Sud, Kamal ; Hawley, Carmel M ; Johnson, David W. / Association of Socio-Economic Position with Technique Failure and Mortality in Australian Non-Indigenous Peritoneal Dialysis Patients. In: Peritoneal Dialysis International. 2017 ; Vol. 37, No. 4. pp. 397-406.
@article{ed221842b8814c9f82d203e4839dce87,
title = "Association of Socio-Economic Position with Technique Failure and Mortality in Australian Non-Indigenous Peritoneal Dialysis Patients",
abstract = "BACKGROUND: Few studies have examined the relationship between socio-economic position (SEP) and peritoneal dialysis (PD) outcomes, particularly at a country level. The aim of this study was to investigate the relationships between SEP, technique failure, and mortality in PD patients undertaking treatment in Australia.METHODS: The study included all Australian non-indigenous incident PD patients between January 1, 1997, and December 31, 2014, using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data. The SEP was assessed by quartiles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Advantage and Disadvantage (IRSAD - primary index), Index of Relative Socio-economic Disadvantage (IRSD), Index of Economic Resources (IER), and Index of Education and Occupation (IEO). Technique and patient survival were evaluated by multivariable Cox proportional hazards survival analyses.RESULTS: The study included 9,766 patients (mean age 60.6 ± 15 years, 57{\%} male, 38{\%} diabetic). Using multivariable Cox regression, no significant association was observed between quartiles of IRSAD and technique failure (30-day definitionp= 0.65, 180-day definitionp= 0.68). Similar results were obtained using competing risks regression. However, higher SEP, defined by quartiles of IRSAD, was associated with better patient survival (Quartile 1 reference; Quartile 2 adjusted hazards ratio [HR] 0.96, 95{\%} confidence interval [CI] 0.86 - 1.06; Quartile 3 HR 0.87, 95{\%} CI 0.77 - 0.99; Quartile 4 HR 0.86, 95{\%} CI 0.76 - 0.97). Similar results were found when IRSD was analyzed, but results were no longer statistically significant for IER and IEO.CONCLUSIONS: In Australia, where there is universal free healthcare, SEP was not associated with PD technique failure in non-indigenous PD patients. Higher SEP was generally associated with improved patient survival.",
author = "Samuel Chan and Yeoungjee Cho and Koh, {Yung H} and Boudville, {Neil C} and Clayton, {Philip A} and McDonald, {Stephen P} and Pascoe, {Elaine M} and Francis, {Ross S} and Mudge, {David W} and Monique Borlace and Badve, {Sunil V} and Kamal Sud and Hawley, {Carmel M} and Johnson, {David W}",
note = "Copyright {\circledC} 2017 International Society for Peritoneal Dialysis.",
year = "2017",
month = "2",
day = "12",
doi = "10.3747/pdi.2016.00209",
language = "English",
volume = "37",
pages = "397--406",
journal = "Peritoneal Dialysis International",
issn = "0896-8608",
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Chan, S, Cho, Y, Koh, YH, Boudville, NC, Clayton, PA, McDonald, SP, Pascoe, EM, Francis, RS, Mudge, DW, Borlace, M, Badve, SV, Sud, K, Hawley, CM & Johnson, DW 2017, 'Association of Socio-Economic Position with Technique Failure and Mortality in Australian Non-Indigenous Peritoneal Dialysis Patients' Peritoneal Dialysis International, vol. 37, no. 4, pp. 397-406. https://doi.org/10.3747/pdi.2016.00209

Association of Socio-Economic Position with Technique Failure and Mortality in Australian Non-Indigenous Peritoneal Dialysis Patients. / Chan, Samuel; Cho, Yeoungjee; Koh, Yung H; Boudville, Neil C; Clayton, Philip A; McDonald, Stephen P; Pascoe, Elaine M; Francis, Ross S; Mudge, David W; Borlace, Monique; Badve, Sunil V; Sud, Kamal; Hawley, Carmel M; Johnson, David W.

In: Peritoneal Dialysis International, Vol. 37, No. 4, 12.02.2017, p. 397-406.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of Socio-Economic Position with Technique Failure and Mortality in Australian Non-Indigenous Peritoneal Dialysis Patients

AU - Chan, Samuel

AU - Cho, Yeoungjee

AU - Koh, Yung H

AU - Boudville, Neil C

AU - Clayton, Philip A

AU - McDonald, Stephen P

AU - Pascoe, Elaine M

AU - Francis, Ross S

AU - Mudge, David W

AU - Borlace, Monique

AU - Badve, Sunil V

AU - Sud, Kamal

AU - Hawley, Carmel M

AU - Johnson, David W

N1 - Copyright © 2017 International Society for Peritoneal Dialysis.

PY - 2017/2/12

Y1 - 2017/2/12

N2 - BACKGROUND: Few studies have examined the relationship between socio-economic position (SEP) and peritoneal dialysis (PD) outcomes, particularly at a country level. The aim of this study was to investigate the relationships between SEP, technique failure, and mortality in PD patients undertaking treatment in Australia.METHODS: The study included all Australian non-indigenous incident PD patients between January 1, 1997, and December 31, 2014, using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data. The SEP was assessed by quartiles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Advantage and Disadvantage (IRSAD - primary index), Index of Relative Socio-economic Disadvantage (IRSD), Index of Economic Resources (IER), and Index of Education and Occupation (IEO). Technique and patient survival were evaluated by multivariable Cox proportional hazards survival analyses.RESULTS: The study included 9,766 patients (mean age 60.6 ± 15 years, 57% male, 38% diabetic). Using multivariable Cox regression, no significant association was observed between quartiles of IRSAD and technique failure (30-day definitionp= 0.65, 180-day definitionp= 0.68). Similar results were obtained using competing risks regression. However, higher SEP, defined by quartiles of IRSAD, was associated with better patient survival (Quartile 1 reference; Quartile 2 adjusted hazards ratio [HR] 0.96, 95% confidence interval [CI] 0.86 - 1.06; Quartile 3 HR 0.87, 95% CI 0.77 - 0.99; Quartile 4 HR 0.86, 95% CI 0.76 - 0.97). Similar results were found when IRSD was analyzed, but results were no longer statistically significant for IER and IEO.CONCLUSIONS: In Australia, where there is universal free healthcare, SEP was not associated with PD technique failure in non-indigenous PD patients. Higher SEP was generally associated with improved patient survival.

AB - BACKGROUND: Few studies have examined the relationship between socio-economic position (SEP) and peritoneal dialysis (PD) outcomes, particularly at a country level. The aim of this study was to investigate the relationships between SEP, technique failure, and mortality in PD patients undertaking treatment in Australia.METHODS: The study included all Australian non-indigenous incident PD patients between January 1, 1997, and December 31, 2014, using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data. The SEP was assessed by quartiles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Advantage and Disadvantage (IRSAD - primary index), Index of Relative Socio-economic Disadvantage (IRSD), Index of Economic Resources (IER), and Index of Education and Occupation (IEO). Technique and patient survival were evaluated by multivariable Cox proportional hazards survival analyses.RESULTS: The study included 9,766 patients (mean age 60.6 ± 15 years, 57% male, 38% diabetic). Using multivariable Cox regression, no significant association was observed between quartiles of IRSAD and technique failure (30-day definitionp= 0.65, 180-day definitionp= 0.68). Similar results were obtained using competing risks regression. However, higher SEP, defined by quartiles of IRSAD, was associated with better patient survival (Quartile 1 reference; Quartile 2 adjusted hazards ratio [HR] 0.96, 95% confidence interval [CI] 0.86 - 1.06; Quartile 3 HR 0.87, 95% CI 0.77 - 0.99; Quartile 4 HR 0.86, 95% CI 0.76 - 0.97). Similar results were found when IRSD was analyzed, but results were no longer statistically significant for IER and IEO.CONCLUSIONS: In Australia, where there is universal free healthcare, SEP was not associated with PD technique failure in non-indigenous PD patients. Higher SEP was generally associated with improved patient survival.

U2 - 10.3747/pdi.2016.00209

DO - 10.3747/pdi.2016.00209

M3 - Article

VL - 37

SP - 397

EP - 406

JO - Peritoneal Dialysis International

JF - Peritoneal Dialysis International

SN - 0896-8608

IS - 4

ER -