GEOGRAPHIC VARIATIONS IN THE EPIDEMIOLOGY OF KIDNEY FAILURE IN AOTEAROA NEW ZEALAND
Johanna Birrell1,2, Angela Webster2,3,4, Nicholas Cross1, Heather Dunckley5, Ben Beaglehole6, Ian Dittmer7, John Irvine1, Curtis Walker8, Merryn Jones9, Melanie Wyld2,3, Kate Wyburn10, Nicole De La Mata21Department of Nephrology, Te Whatu Ora – Waitaha Canterbury, Christchurch, New Zealand2Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia3Department of Renal and Transplantation Medicine, Westmead Hospital, Westmead, NSW, Australia4National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Autralia5New Zealand Transplantation and Immunogenetics Laboratory, New Zealand Blood Service, Auckland, New Zealand6Department of Psychological Medicine, University of Otago, Christchurch, New Zealand7Auckland City Hospital, Te Whatu Ora – Te Toka Tumai, Auckland, New Zealand8Internal Medicine, Medical Council of New Zealand, Te Whatu Ora – Te Pae Hauora o Ruahine o Tararua MidCentral, Palmerston North, New Zealand9Kidney Health New Zealand Tākihi Hauora Aotearoa, Christchurch, New Zealand10Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia
Abstract
Aim: To describe geographic variations in kidney failure epidemiology across Aotearoa New Zealand (NZ).
Background: Various health service delivery models are used to manage kidney failure around NZ, relating to differences in resourcing, remoteness and burden of disease. Understanding the unique regional epidemiology of kidney failure is necessary for effective national health resource allocation.
Methods: We used AcceSS and Equity in Transplantation (ASSET), a health-linked data platform, to include people commencing kidney replacement therapy (KRT) in NZ from 2006-2019. Residential domicile was categorised into the 20 former District Health Board (DHB) jurisdictions. Geographic Classification for Health was used for rurality and NZDep2018 for socioeconomic status. Stats NZ population data were used for age-standardised national and DHB-level incidence calculations.
Results: We included 7,739 people commencing KRT. Median age was 58 years (IQR:48-68). There was a male predominance (60%). By ethnicity, 39% were European, 31% Māori, 25% Pacific and 6% other ethnicities. 18% of our cohort had rural residential location.
The overall age-standardised incidence of KRT in NZ was 9.6-cases-per-100,000 (95%CI:9.4-9.8); this varied by socioeconomic status but not by rurality. Socioeconomic disadvantage was greatest in Tairawhiti DHB, with 83% of patients living in the highest-deprivation quintile, followed by Northland (69%) and Counties Manukau (68%). KRT incidence was also greatest among these three DHBs, at 18.5 cases-per-100,000 in Counties Manukau (95%CI:17.5-19.4), 15.7 in Tairawhiti (95%CI:13.1-18.8) and 12.7 in Northland (95%CI:11.4-14.1).
Conclusions: There is marked variation in the burden and socioeconomic profile of kidney failure across NZ. The establishment of a national health service, Te Whatu Ora – Health New Zealand, provides opportunities to direct resources for prevention and treatment of kidney failure towards populations at greatest need.
Biography
Jo is originally from Adelaide. She is a dual advanced trainee in adult general medicine and public health medicine, with an interest in rural health. Jo completed 3 years of basic physician training in Darwin, Australia followed by 3 years in regional New Zealand. This year she is working in a combined clinical and research position as the Ross Bailey Fellow in the Christchurch Hospital Nephrology Department.