title: Gender differences in the dialysis treatment of Indigenous and non-Indigenous Australians.
abstract: OBJECTIVE
  Access to dialysis treatment and the types of treatments employed in Australia differs by Indigenous status. We examined whether dialysis treatment utilisation in Indigenous and non-Indigenous Australians also differs by gender.
  
  
  METHODS
  Using registry data we evaluated 21,832 incident patients (aged ≥18 years) commencing dialysis, 2001-2013. Incidence rates were calculated and multivariate regression modelling used to examine differences in dialysis treatment (modality, location and vascular access creation) by race and gender.
  
  
  RESULTS
  Dialysis incidence was consistently higher in Indigenous women compared to all other groups. Compared to Indigenous women, both non-Indigenous women and men were more likely to receive peritoneal dialysis as their initial treatment (non-Indigenous women RR=1.91, 95%CI 1.55-2.35; non-Indigenous men RR=1.73, 1.40-2.14) and were more likely to commence initial treatment at home (non-Indigenous women RR=2.07, 1.66-2.59; non-Indigenous men RR=1.95, 1.56-2.45). All groups were significantly more likely than Indigenous women to receive their final treatment at home.
  
  
  CONCLUSIONS
  Contemporary dialysis treatment in Australia continues to benefit the dominant non-Indigenous population over the Indigenous population, with non-Indigenous men being particularly advantaged. Implications for Public Health: Treatment guidelines that incorporate a recognition of gender-based preferences and dialysis treatment options specific to Indigenous Australians may assist in addressing this disparity.
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania.
authors.forename: Charlotte
authors.initials: C
authors.lastname: McKercher
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania.|School of Medicine, University of Tasmania.|Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Jose
authors.affiliation: School of Population Health, University of Adelaide, South Australia.
authors.forename: Blair
authors.initials: B
authors.lastname: Grace
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Clayton
authors.affiliation: School of Social Sciences, University of Tasmania.
authors.forename: Maggie
authors.initials: M
authors.lastname: Walter
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D001315:Australia / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Indigenous population; dialysis; end-stage kidney disease; gender; inequalities