The incidence of treated end-stage renal disease in New Zealand Maori and Pacific Island people and in Indigenous Australians.

BACKGROUND: Although Indigenous Australians, New Zealand Maori and Pacific Island people comprise an unduly high proportion of patients treated for end-stage renal disease (ESRD) in the two countries, no population-based age- and disease-specific rates have been published. METHODS: From data provided to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), truncated age- and sex-standardized incidence rates were calculated for treated ESRD due to all causes and by primary renal disease, in four broad age groups of Maori, Pacific Island people and all 'other' New Zealanders and Indigenous and non-indigenous Australians, for the period 1992-2001. RESULTS: The incidence of ESRD did not differ in persons aged 0-14 years. In adults, Maori and Pacific Island people had similar rates of ESRD, a little more than half those of Indigenous Australians except in persons aged 65 years and over in whom the rates were nearly equal, but two to ten times the rates in 'other' New Zealanders and non-indigenous Australians. The excess of ESRD in Indigenous Australians was due principally to type II diabetic nephropathy and glomerulonephritis (all common types except lupus nephritis), but was seen also in respect of type I diabetic nephropathy, hypertensive renal disease and analgesic nephropathy, while the excess in Maori and Pacific Island people was confined to type II diabetic nephropathy, hypertensive renal disease and glomerulonephritis (especially lupus nephritis and type I mesangiocapillary glomerulonephritis, but not mesangial IgA disease). CONCLUSIONS: The incidence and pattern of treated ESRD differs quantitatively and qualitatively between Maori, Pacific Island people and other New Zealanders, and Indigenous and non-indigenous Australians.     

Incidence and treatment of ESRD among indigenous peoples of Australasia

Indigenous people in Australia and New Zealand experience rates of ESKD several times higher than non-indigenous people. This relative rate is highest among people aged 45 - 54 for Aboriginal Australians, and 65 - 74 years for Maori. The majority of this is driven by diabetic nephropathy. Both groups have lesser utilization of transplantation as a renal replacement therapy than non-indigenous comparators, and lesser utilization of home dialysis modalities.     

Current incidence, treatment patterns and outcome of end-stage renal disease among indigenous groups in Australia and New Zealand

SUMMARY: The changes in rates of treated end-stage renal disease (ESRD) among indigenous populations have profound consequences for those individuals affected and for health-care providers. By using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the current incidence, treatment and outcomes of ESRD among indigenous groups in Australia and New Zealand. All patients who began renal replacement therapy (RRT) in Australia or New Zealand between October 1991 and September 2000 were included. Rates of ESRD, RRT modalities, renal transplantation and mortality were the outcomes examined. End-stage renal disease rates among indigenous groups in Australia and New Zealand exceeded non-indigenous rates up to eightfold. The median age of indigenous ESRD patients was younger (51 vs 60 years, P  < 0.0001), and there was an excess of comorbidities, particularly diabetes. For Australian Aboriginal and Torres Strait Islanders, and New Zealand Maori patients, mortality rates across all modalities of RRT were 70% higher than non-indigenous rates. Indigenous people were less likely to receive a renal transplant prior to dialysis treatment, less likely to be accepted onto the cadaveric transplant waiting list, and less likely to receive a well-matched transplant. The poorer outcomes among Australian Aboriginal and Torres Strait Islanders, and New Zealand Maori patients did not appear to be explained by the different comorbid conditions or age. Whether the outcomes reflect unmeasured differences in disease burden or treatment differences is not known. Tackling this problem will involve a spectrum of people and approaches, from tertiary care providers and RRT to local staff and preventative programs.     

Burden of end-stage renal disease among indigenous peoples in Australia and New Zealand

Rates of end-stage renal disease (ESRD) among indigenous people in Australia and New Zealand are considerably higher than the non-indigenous population. This trend, apparent for several years, is described here using data from the Australia & New Zealand Dialysis and Transplant (ANZDATA) Registry. The average age at start of renal replacement therapy (RRT) is approximately 10 years less than non-indigenous people. Among those starting RRT, rates of "diabetic nephropathy" are higher among indigenous patients, reflecting higher rates of diabetes. The increased burden of illness extends to coronary artery disease and chronic lung disease, which are present at rates 1.5 to 2 times non-indigenous rates. Once dialysis treatment has commenced, indigenous people are less likely to be placed on the active cadaveric transplant waiting list, and less likely to receive a graft. Overall mortality outcomes are poorer for indigenous patients overall, and for each RRT modality. These outcomes are not simply due to increased frequency of co-morbid illness: for indigenous people receiving dialysis treatment the mortality rate adjusted for age and gender is around 11/2 times the non-indigenous rate. These data are consistent with studies showing increased rates of markers of early renal disease (in particular albuminuria) among both Australian and New Zealand indigenous groups, and reflect a broader health profile marked by high rates of diabetes, cardiovascular disease and chronic lung disease. Addressing these issues is a major challenge for health care providers in these regions.     

Interpreting incidence trends for treated end-stage renal disease: implications for evaluating disease control in Australia

BACKGROUND: Five sources of change modify trends in incidence of treated end-stage renal disease (ESRD): (i) demography; (ii) disease control, comprising prevention and treatment of progressive kidney disease; (iii) competing risks, which encompass dying from untreated uraemia or non-renal comorbidity; (iv) lead-time bias; and (v) classification bias. Thus, rising crude incidence of treated ESRD may conceal effective disease control when there has been demographic change, lessening competing risks, or the introduction of bias. METHODS: Age-specific incidences of treated ESRD in Australia were calculated from Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data by indigenous/non-indigenous status (all causes) and by primary renal disease (non-indigenous only) for two successive decades, 1982-1991 and 1992-2001. RESULTS: We postulate that less competing risks explained much of the increase in treated ESRD in the elderly and Indigenous Australians. The increase in glomerulonephritic ESRD in non-indigenous Australians could be ascribed mainly to immigration from non-European countries. There was no significant change in incidence of treated ESRD in Indigenous or non-indigenous persons aged less than 25 years, in non-indigenous persons aged 25-64 years for ESRD caused by hereditary polycystic disease or hypertension, or in type 1 diabetics aged over 55 years. End-stage renal disease from analgesic nephropathy had declined. The increase in treated ESRD caused by type 2 diabetic nephropathy appeared to be multifactorial. Lead-time/length bias and less competing risks may have concealed a small favourable trend in other primary renal diseases. CONCLUSION: Whether recent disease control measures have had an impact on incidence of treated ESRD is not yet certain, but seems more likely than implied by previous reports.     

Prostate cancer outcomes disparities: Population survival analysis in an ethnically diverse nation

BackgroundProstate cancer represents a significant health burden on New Zealand men. There are increasing concerns regarding inequities in prostate cancer morbidity and mortality among the different ethnic groups in New Zealand. This study aims to assess ethnic differences in survival outcomes among men newly diagnosed with prostate cancer.Materials and methodsThe analyzed cohort included 42,563 men, 40 years or older, diagnosed with prostate cancer from January 1st, 2000 to January 1st, 2016. Overall and cancer-specific survivals were estimated for the main ethnic groups in New Zealand namely: Māori (indigenous), Pacific, Asian, and European. Hazard ratio (HR) of death from prostate cancer was calculated with Fine-Gray competing risk regression, while adjusting for age, socioeconomic deprivation, year of cancer diagnosis, residential status, presence of urology service, and cancer grade at diagnosis.ResultsAmong all ethnic groups, Māori participants consistently had worst survival outcomes. At 15-year follow-up, the overall cumulative survival probabilities were 39.8%, 43.6%, 63.3%, and 46.5%, for Māori, Pacific, Asian and European men, respectively. In the same order, cancer-specific survivals were 62.7%, 64.3%, 79.8% and 72.0%. Māori men had 43% higher risk of dying from prostate cancer when compared to Europeans. This persisted following adjustments in the multivariable model (adjusted HR = 1.44, [95% CI: 1.29–1.61], P< 0.001). Conversely, differences in sociodemographic and cancer characteristics between Pacific and European men could explain the higher mortality risk in the former group (adjusted HR = 1.00, [95% CI: 0.84–1.19], P= 0.990).ConclusionsSignificant ethnic disparities in prostate cancer survival outcomes are currently present in New Zealand. Several explanations have been proposed to account for this observation including differences in comorbidities, healthcare access and cancer grade at diagnosis.     

Cancer in Māori: lessons from prostate,colorectal and gastric cancer and progress in hereditary stomach cancer in New Zealand

Persisting ethnic disparities in cancer incidence and outcomes exist between Māori and non‐Māori in Aotearoa/New Zealand. It is difficult to disentangle the complex interplay of environmental and genetic factors that contribute to the variation in cancer statistics between these two groups. In Māori, the sites of highest cancer incidence are the prostate in men, breast in women and lung in both – the next most common cancers in Māori are colorectal and stomach cancer. This paper discusses colorectal, prostate and stomach cancer in Māori to illustrate selected issues that impact on cancer care. Colorectal cancer is discussed to illustrate the importance of accurate cancer statistics to focus management strategies. Prostate cancer in Māori is reviewed – an area where cultural factors impact on care delivery. Sporadic stomach cancer in New Zealand is used to show how sub‐classification of different types of cancer can be important and illustrate the breadth of putative causal factors. Then follows an overview of developments in hereditary gastric cancer in New Zealand in the last 15 years, showing how successful clinical and research partnerships can improve patient outcomes. One example is the Kimi Hauora Clinic, which provides support to cancer patients, mutation carriers and their families, helping them navigate the interface with the many health‐care professionals involved in the multidisciplinary care of cancer patients in the 21st century.     

An expanded nationwide view of chronic kidney disease in Aboriginal Australians

We summarize new knowledge that has accrued in recent years on chronic kidney disease (CKD) in Indigenous Australians. CKD refers to all stages of preterminal kidney disease, including end‐stage kidney failure (ESKF), whether or not a person receives renal replacement therapy (RRT). Recently recorded rates of ESKF, RRT, non‐dialysis CKD hospitalizations and CKD attributed deaths were, respectively, more than sixfold, eightfold, eightfold and threefold those of non‐Indigenous Australians, with age adjustment, although all except the RRT rates are still under‐enumerated. However, the nationwide average Indigenous incidence rate of RRT appears to have stabilized. The median age of Indigenous people with ESKF was about 30 years less than for non‐Indigenous people, and 84% of them received RTT, while only half of non‐Indigenous people with ESKF did so. The first‐ever (2012) nationwide health survey data showed elevated levels of CKD markers in Indigenous people at the community level. For all CKD parameters, rates among Indigenous people themselves were strikingly correlated with increasing remoteness of residence and socio‐economic disadvantage, and there was a female predominance in remote areas. The burden of renal disease in Australian Indigenous people is seriously understated by Global Burden of Disease Mortality methodology, because it employs underlying cause of death only, and because deaths of people on RRT are frequently attributed to non‐renal causes. These data give a much expanded view of CKD in Aboriginal people. Methodologic approaches must be remedied for a full appreciation of the burden, costs and outcomes of the disease, to direct appropriate policy development.     

Frequency,etiology and treatment of childhood end-stage kidney disease in Australia and New Zealand

To describe the trends in end-stage kidney disease (ESKD) in children in Australia and New Zealand over time and across different ages, we analyzed data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). A total of 1,485 children aged less than 18 years received renal replacement therapy (RRT) during the period from 1963 to 2006, of which children 55.6% were male. The incidence of ESKD increased over the first two decades but has been stable at 8 per million since the mid-1980s. The prevalence of ESKD continues to increase in all age groups, especially among older children, and is currently 50 per million in those aged less than 18 years. The cause of ESKD over the entire cohort was one-third each for glomerulonephritis (32.5%), structural anomalies (hypoplasia/dysplasia, posterior urethral valves or reflux nephropathy, 35.8%), and cystic disease or other conditions (31.7%). Proportionately, glomerulonephritis is becoming less common. Overall, 50% of children were commenced on peritoneal dialysis as the initial RRT modality, 30% were started on hemodialysis, and 20% underwent transplantation pre-emptively. The proportion of children receiving transplants has not increased over time.     

Trends in colorectal cancer incidence rates in New Zealand, 1981-2004

Background: Incidence rates of colorectal cancer (CRC) in New Zealand rank among the highest worldwide. Internationally, there has been evidence of a shift in colon cancer from left‐ to right‐sided. The objective of this study was to determine trends in left‐ and right‐sided colon and rectal cancers incidence by sex, age and ethnicity. Methods: Using datasets created by linking data from the New Zealand Cancer Registry to the census data, we analysed a total of 47 694 CRCs from 1981 to 2004. Cancers were divided into right‐sided colon (cecum to the splenic flexure); left‐sided colon (descending and sigmoid colon); and rectal (rectosigmoid junction and rectum). Results: Left‐ and right‐sided colon, and rectal cancer incidence rates increased by 13–20% among men. In women, colon cancer rates increased by 25% for right‐sided cancers, decreased by 8% for left‐sided cancers and remained unchanged for rectal cancers. This corresponds with an increase in right‐sided cancers from 57% to 65% of total colon cancers in women. The incidence of all CRCs increased at a faster rate among Māori than non‐Māori. Conclusion: We identified a left‐ to right‐sided shift in colon cancer limited to women over the age of 65. While Māori trends in site distribution parallel those of their non‐Māori counterparts, the rapid increase in Māori incidence rates is noteworthy. It is unclear why such shifts in CRC site distribution are occurring.     

Nationwide survey of adolescents and young adults with end-stage kidney disease

Aim: To better understand the health‐care needs of adolescents and young adults (AYA) with end‐stage kidney disease (ESKD), we sought to describe the demographic characteristics of a national cohort. Methods: Data were retrieved from the Australia and New Zealand Dialysis and Transplant Registry. We included all patients aged 15–25 years, living in Australia and receiving renal replacement therapy (RRT) on 31 December 2009. Data included race, aetiology of kidney disease, postal code, transition and migration history. Results: A total of 495 AYA were receiving RRT in Australia giving a prevalence of 143 per million age‐related population. Sixty‐three per cent had a functioning transplant, 24% were receiving haemodialysis and 13% peritoneal dialysis. Median current age was 22 years (interquartile range (IQR) 19–24). The most prevalent cause of ESKD was glomerulonephritis (33%). The majority of patients lived in capital cities. Indigenous patients were more likely to live in more remote areas. Eighty‐five per cent of patients were currently receiving care at an adult unit and 35% of these patients had transitioned from a paediatric unit since starting RRT. The median number of patients per adult unit was 5 (IQR 3–10). Conclusions: The majority of Australian AYA with ESKD are managed in adult units; however, the number at any one unit is low. As most live in the capital cities there may be an opportunity to establish centralized services designed to cater for the needs of AYA patients. However, the needs of patients living in more remote areas, including a significant proportion of Indigenous patients, may not be met by such a model.     

Variation in publicly funded bariatric surgery in New Zealand by ethnicity: cohort study of 328,739 patients

BackgroundNew Zealand health services are responsible for equitable health service delivery, particularly for Māori, the Indigenous peoples of New Zealand. Recent research has indicated the presence of inequities in publicly funded bariatric surgery in New Zealand by ethnicity, but it is unclear whether these inequities persist after adjustment for co-morbidities.ObjectivesTo determine whether receipt of publicly funded bariatric surgery varies by ethnicity, after adjustment for co-morbidities.SettingNew Zealand primary care.MethodsA cohort study of New Zealanders aged 30–79 years who had cardiovascular risk assessment in primary care between January 1, 2010 and June 30, 2018. Data were collated and analyzed using an encrypted unique identifier with regional and national datasets. Cox proportional hazard modeling was performed to determine the likelihood of receipt of a primary publicly funded bariatric procedure up to December 31, 2018, after adjustment for sex, age, ethnicity, locality, socioeconomic deprivation, body mass index, diabetes status, smoking status, and co-morbidities.ResultsA total of 328,739 participants (44% female, median age 54 yr [interquartile range, IQR, 46–62], 54% European, 13% Māori, 13% Pacific, 20% Asian) were included in the study and followed up for a median of 5.6 years (IQR 4.1–6.9). The likelihood of receipt of bariatric surgery was lower for Māori and Pacific compared with Europeans (adjusted hazard ratio .82 [95% CI .69–.96] and .24 [.20–.29], respectively). The likelihood of receiving bariatric surgery was also inversely related with increasing socioeconomic deprivation and rurality.ConclusionsConsistent with data worldwide, there is evidence of unequal access to publicly funded bariatric surgery by ethnicity, locality as well as socioeconomic deprivation among New Zealanders who were cardiovascular risk assessed in primary care.     

Report of renal failure treatment in Australia and New Zealand from the dialysis and transplant registry (ANZDATA)

Summary: The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) has recorded 15675 patients resident in Australia and 2909 patients in New Zealand who have been treated by dialysis and transplantation for end-stage renal failure. the majority of patients have a functioning transplant (51% Australia, 50% New Zealand). Cadaveric organs have been the mainstay of the transplant programme from 1963 to 1993 (91% Australia, 87% New Zealand). In recent years the early graft survival has dramatically improved; the 12 month graft survivals were 74 and 87% in Australia, and 68 and 78% in New Zealand in 1983 and 1992, respectively. A large majority of patients have dialysed at home (49% Australia, 84% New Zealand) or with low level assistance in facilities remote from tertiary level hospital renal units (21% Australia). While most patients use haemodialysis (64% Australia, 41% New Zealand), continuous ambulatory peritoneal dialysis is the predominant form of dialysis in the home (63% Australia, 70% New Zealand). the demographic analysis displays a slight predominance of males (55.5% Australia, 50.4% New Zealand), and a steadily increasing number of patients over 65 years old (31% Australia, 15% New Zealand), and of diabetics (16% Australia, 31% New Zealand). Aborigines, Maoris and Pacific Islanders have a strikingly higher rate of renal failure per million population than the Caucasoid/Europid population. Certain causes of renal failure such as excess analgesic ingestion and malignant hypertension have declined. Glomerulonephritis has been the most common cause of renal failure in Australia (33%), diabetic nephropathy the most common in New Zealand (31%).     

Incidence of end-stage renal disease in overseas-born, compared with Australian-born, non-indigenous Australians

BACKGROUND: Barriers to immigration from non-European sources were relaxed in the 1970s. As a result, more Australians are now of Middle Eastern, Asian or Pacific Islander origin, rather than British or European. Currently, overseas-born persons comprise one-third of non-indigenous Australians with end-stage renal disease (ESRD). METHODS: Using data recorded by the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, age-standardized incidence rates were calculated for ESRD due to all causes and to certain primary renal diseases for all non-indigenous Australians who were aged over 15 years when first treated for ESRD between 1993 and 2001. Truncated age-standardized incidence rates were calculated for ESRD due to glomerulonephritis by type. RESULTS: Immigrants from the British Isles and 'rest of Europe' had less, and those from the Pacific Island nations, East/South-East Asia, Indian subcontinent, Middle East and Southern Europe more ESRD from all causes than the Australian-born. Two diseases accounted for most of the excess: Type 2 diabetic nephropathy and glomerulonephritis (the latter not significant for the Indian-born). There was a small excess (not always significant) of hypertensive/arteriopathic renal disease in Asian- and Middle Eastern-born persons. The East/South-East Asian-born had the highest rates of ESRD due to mesangial immunoglobulin A (IgA) disease and lupus nephritis, and the Middle Eastern-born the highest rates from focal sclerosing glomerulonephritis. CONCLUSION: For Australians born in the Pacific Island nations, Asia, the Middle East or Southern Europe, excess prevalence of, and/or susceptibility to, diseases that cause ESRD has more than offset any 'healthy migrant' effect.     

Differences in the surgical admissions to hospital between the indigenous and non-indigenous populations of Australia

Background: The overall rate of admission to hospital for indigenous Australians is in general much higher than that for the non‐indigenous Australians. However, this result is not uniform for surgical and medical admissions. Previous studies in the Northern Territory have suggested a cultural aversion to surgery among indigenous Australians. In the present study the current data of admission to hospital are analysed to explore the pattern for surgical procedures in the indigenous population and to determine whether the disparity between indigenous and non‐indigenous populations still exists at this later period. Methods: Admission data for all acute public and private hospitals in New South Wales (NSW) for the 6‐year period 1989?1995 are used for this analysis. Results: It is shown that when adjustments have been made for the differing age composition of the two populations in NSW, the medical admission rate for the indigenous population is approximately double that for the non‐indigenous population. In contrast, the non‐indigenous admission rate for surgical procedure is approximately 1.3 times the indigenous surgical admission rate. In addition, while approximately one‐third of non‐indigenous admissions are for surgical procedure, this proportion is only one‐sixth of the indigenous admissions. Indigenous people are more likely to be admitted for emergency surgery rather than planned surgery. and while approximately 25% of the surgical admissions in the indigenous population are through emergency, this proportion is only 14% in the non‐indigenous population. Conclusions: It seems that the disparity between admission patterns for indigenous and non‐indigenous populations still exists in NSW at this later period, particularly in rural areas. There appears to be a need to find ways to overcome a possible bias within the indigenous population against surgery. It is possible that medical treatments are being substituted for surgical procedures.     

Barriers to access by Indigenous Australians to kidney transplantation: The IMPAKT study

SUMMARY:   Although Indigenous Australians represent less than 2% of the national population, they account for 8–10% of new patients commencing treatment for end-stage renal disease (ESRD). Almost half come from remote regions lacking renal disease treatment services. In those regions, their incidence of ESRD is up to 30 times the incidence for all Australians.
Kidney transplantation is the optimal treatment for ESRD. Compared with long-term dialysis, it results in better quality of life, longer life expectancy and lower costs of health care. Indigenous Australians with ESRD receive transplants at approximately one-third the rate of non-Indigenous patients. There are similar disparities in access to kidney transplants for Native Americans, Aboriginal Canadians and New Zealander Maori. The reasons for such disparities have not been studied in any detail.
IMPAKT (Improving Patient Access to Kidney Transplantation) is an NHMRC-funded study, involving eight major renal units. It aims to identify the reasons for Indigenous Australians' poor access to transplantation. It will systematically examine each of the steps a new dialysis patient must negotiate in order to receive a transplant. Each of these steps can become a barrier.     

Racial disparities in paediatric kidney transplantation

Background

Transplantation is the preferred treatment for children with end-stage kidney disease (ESKD). Pre-emptive transplants, those from live donors and with few human leukocyte antigen (HLA) mismatches provide the best outcomes. Studies into disparities in paediatric transplantation to date have not adequately disentangled different transplant types.

Methods

We studied a retrospective cohort of 823 patients aged <18 years who started renal replacement therapy (RRT) in Australia 1990–2011, using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The primary outcomes were time to first kidney transplant and kidney donor type (deceased or living), analysed using competing risk regression.

Results

Caucasian patients were most likely to receive any transplant, due largely to disparities in live donor transplantation. No Indigenous patients received a pre-emptive transplant. Indigenous patients were least likely to receive a transplant from a live donor (sub-hazard ratio 0.41, 95 % confidence interval 0.20–0.82, compared to Caucasians). Caucasian recipients had fewer HLA mismatches, were less sensitised and were more likely to have kidney diseases that could be diagnosed early or progress slowly.

Conclusions

Caucasian paediatric patients are more likely to receive optimum treatment—a transplant from a living donor and fewer HLA mismatches. Further work is required to identify and address barriers to live donor transplantation among minority racial groups.     

Vasculitis in New Zealand

Background

The Asia Pacific Meeting for Vasculitis and ANCA Workshop was held in Tokyo in May 2012. This review of vasculitis in New Zealand (NZ) was prepared for the meeting.

Methods

A review of significant NZ demographic and health data is presented with information from relevant studies on vasculitis originating from NZ.

Results

Giant cell arteritis occurs in older adults, and has an annual incidence of 12.7/100,000 adults over the age of 50 years in NZ. Kawasaki disease, a rare cause of acquired cardiac disease primarily affecting young children, has an annual incidence of 8.0/100,000 children aged less than 5 years. The prevalence of granulomatosis with polyangiitis varies within NZ, with a 5-year prevalence varying from 29 to 75 cases per million people. Dual anti-glomerular basement membrane disease and ANCA-associated systemic vasculitis is rare, with an annual incidence estimated at 0.47 cases per million people.

Conclusions

Vasculitis is an uncommon but a significant cause of morbidity and mortality in NZ.     

Barriers to access by Indigenous Australians to kidney transplantation: the IMPAKT study

Although Indigenous Australians represent less than 2% of the national population, they account for 8-10% of new patients commencing treatment for end-stage renal disease (ESRD). Almost half come from remote regions lacking renal disease treatment services. In those regions, their incidence of ESRD is up to 30 times the incidence for all Australians. Kidney transplantation is the optimal treatment for ESRD. Compared with long-term dialysis, it results in better quality of life, longer life expectancy and lower costs of health care. Indigenous Australians with ESRD receive transplants at approximately one-third the rate of non-Indigenous patients. There are similar disparities in access to kidney transplants for Native Americans, Aboriginal Canadians and New Zealander Maori. The reasons for such disparities have not been studied in any detail. IMPAKT (Improving Patient Access to Kidney Transplantation) is an NHMRC-funded study, involving eight major renal units. It aims to identify the reasons for Indigenous Australians' poor access to transplantation. It will systematically examine each of the steps a new dialysis patient must negotiate in order to receive a transplant. Each of these steps can become a barrier.     

Racial disparity in an outreach pediatric surgical service

Aim

The aim of this study was to investigate whether racial disparities in healthcare exist within a New Zealand pediatric surgical outreach service in a high indigenous Māori population.