Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians

Abstract

Indigenous Australians are disadvantaged, relative to other Australians, over a range of socio-economic and health measures. The age-and sex-adjusted incidence of end-stage renal disease (ESRD) -the irreversible preterminal phase of chronic renal failure -is almost nine times higher amongst Indigenous than it is amongst non-indigenous Australians. A striking gradient exists from urban to remote regions, where the standardised ESRD incidence is from 20 to more than 30 times the national incidence. We discuss the profound impact of renal disease on Indigenous Australians and their communities. We explore the linkages between disadvantage, often accompanied by geographic isolation, and both the initiation of renal disease, and its progression to ESRD. Purported explanations for the excess burden of renal disease in indigenous populations can be categorised as:(1) primary renal disease explanations; (2) genetic explanations; (3) early development explanations; and (4) socio-economic explanations.We discuss the strengths and weaknesses of these explanations and suggest a new hypothesis which integrates the existing evidence. We use this hypothesis to illuminate the pathways between disadvantage and the human biological processes which culminate in ESRD, and to propose prevention strategies across the life-course of Indigenous Australians to reduce their ESRD risk.Our hypothesis is likely to be relevant to an understanding of patterns of renal disease in other high-risk populations, particularly indigenous people in the developed world and people in developing countries. Furthermore, analogous pathways might be relevant to other chronic diseases, such as diabetes and cardiovascular disease. If we are able to confirm the various pathways from disadvantage to human biology, we will be better placed to advocate evidence-based interventions, both within and beyond the scope of the health-care system, to address the excess burden of renal and other chronic diseases among affected populations.

Ethnicity and Renal Replacement Therapy

“…Socio-economic disadvantage is itself associated with an increased risk of ESRD [12] , a complex interaction that might directly influence renal damage, be associated with damaging health behaviours or influence the quality of health care of those with kidney disease.…”

Chronic Kidney Disease: A Life Course Health Development Perspective

“…These findings have been replicated in several populations in the USA (Shoham et al 2005), Canada (Zacharias et al 2012), and Australia (Cass et al 2004), although socioeconomically disadvantaged groups in the USA may be at greatest risk (White et al 2008). Although numerous studies have examined the association between adult socioeconomic status and CKD (Crews et al 2012;McClellan et al 2010;Volkova et al 2008;Cass et al 2002;Fored et al 2003;Martins et al 2006;Merkin et al 2005;Merkin et al 2007;Patzer and McClellan 2012;Perneger et al 1995), few have examined the contribution of early-life socioeconomic determinants of CKD (Shoham et al 2007;Shoham et al 2008).…”

Application of an integrated multidisciplinary economic welfare approach to improved wellbeing through Aboriginal caring for country

“…450;Zhao and Dempsey 2006). Although the factors affecting the high level of chronic disease among Aboriginal people are not fully understood (Cass et al 2004), the psychological and social (psychosocial) determinants of health are important (Carson et al 2007;Johnston et al 2007a;Putnis et al 2007;Marmot et al 2008). Therefore, addressing the psychosocial determinants is fundamental to closing the gap in health outcomes.…”