Renal transplantation for Indigenous Australians: identifying the barriers to equitable access.
OBJECTIVE
To assess Indigenous Australians' access to renal transplantation, compared with non-Indigenous Australians. To examine whether disparities are due to a lower rate of acceptance onto the waiting list and/or a lower rate of moving from the list to transplantation.


METHODS
National cohort study using data from the Australian and New Zealand Dialysis and Transplant Registry. We included all end-stage renal disease (ESRD) patients under 65 years of age who started treatment in Australia between January 1993 and December 1998. We used survival analysis to examine the time from commencement of renal replacement therapy (RRT) to transplantation. We measured time from commencement of RRT to acceptance onto the waiting list (stage 1), and time from acceptance onto the waiting list to transplantation (stage 2). The main outcome measures were (1) acceptance onto the waiting list and (2) receipt of a transplant, before 31 March 2000.


RESULTS
Indigenous patients had a lower transplantation rate (adjusted Indigenous: non-Indigenous rate ratio 0.32, 95% CI 0.25-0.40). They had both a lower rate of acceptance onto the waiting list (adjusted rate ratio 0.50, 95% CI 0.44-0.57) and a lower rate of moving from the list to transplantation (adjusted rate ratio 0.50, 95% CI 0.38-0.65). The disparities were not explained by differences in age, sex, co-morbidities or cause of renal disease.


CONCLUSIONS
Indigenous Australians face barriers to acceptance onto the waiting list and to moving from the list to transplantation. Further research to identify the causes could facilitate strategies to improve equity in transplantation.
Cass
Alan
A
Menzies School of Health Research, Cooperative Research Centre for Aboriginal and Tropical Health, Casuarina, Northern Territory, Australia. alancass@menzies.edu.au
Cunningham
Joan
J
Snelling
Paul
P
Wang
Zhiqiang
Z
Hoy
Wendy
W
D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D014850:Waiting Lists