Socioeconomic differences in the uptake of home dialysis.
OBJECTIVE
Home dialysis creates fewer lifestyle disruptions while providing similar or better outcomes than in-center hemodialysis. Socioeconomically advantaged patients are more likely to commence home dialysis (peritoneal dialysis and home hemodialysis) in many developed countries. This study investigated associations between socioeconomic status and uptake of home dialysis in Australia, a country with universal access to health care and comparatively high rates of home dialysis.


METHODS
This study analyzed 23,281 non-Indigenous adult patients who commenced chronic RRT in Australia from 2000 to 2011 according to the Australia and New Zealand Dialysis and Transplant Registry in a retrospective cohort study. This study investigated the proportion of patients who were ever likely to use home dialysis using nonmixture cure models and followed patients until the end of 2011 (median follow-up time=3.0 years, interquartile range=1.3-5.5 years). The main predictor was area socioeconomic status from postcodes grouped into quartiles using standard indices.


RESULTS
Patients from the most advantaged quartile of areas were less likely to commence peritoneal dialysis (odds ratio, 0.63; 95% confidence interval, 0.58 to 0.69) and more likely to use in-center hemodialysis than patients from the most disadvantaged areas (odds ratio, 1.19; 95% confidence interval, 1.10 to 1.30). Socioeconomic status was not associated with uptake of home hemodialysis. Rural areas were more disadvantaged and had higher rates of peritoneal dialysis, and privately funded hospitals rarely used home dialysis. Patients from the most advantaged quartile of areas were more likely to use private hospitals than patients from the most disadvantaged quartile (odds ratio, 5.9; 95% confidence interval, 4.6 to 7.5).


CONCLUSIONS
The lower incidence of peritoneal dialysis among patients from advantaged areas seems to be multifactorial. Identifying and addressing barriers to home dialysis in Australia could improve patient quality of life and reduce costs.
Australia and New Zealand Dialysis and Transplant Registry, Royal Adelaide Hospital, Adelaide, South Australia, Australia;, †Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia;, ‡Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia;, §Sydney Medical School, University of Sydney, Sydney, Australia;, ‖Department of Renal Medicine, Nambour General Hospital, Nambour, Queensland, Australia, ¶University of Queensland, Sunshine Coast Clinical School, Nambour General Hospital, Nambour, Queensland, Australia.
Blair S
BS
Grace
Philip A
PA
Clayton
Nicholas A
NA
Gray
Stephen P
SP
McDonald
D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001315:Australia; D005260:Female; D006437:Hemodialysis, Home / Q000706:statistics & numerical data*; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D011204:Poverty Areas; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D019472:Universal Health Insurance
Epidemiology and outcomes; clinical epidemiology; peritoneal dialysis