End-stage renal disease in Aboriginals in New South Wales: a very different picture to the Northern Territory

Objectives: To compare the incidence of end-stage renal disease (ESRD) amon g Aboriginals in New South Wales with the incidence among Aboriginals in th e Northern Territory, and to compare the patterns of ESRD among Aboriginals and non-Aboriginals in NSW. Design: Secondary data analysis of information from unpublished and publish ed Australia and New Zealand Dialysis and Transplant Registry reports. Main outcome measures: Average annual incidence of ESRD (persons per millio n); form of renal replacement therapy; mortality at 31 March 1998; patient and graft survival one and five years after transplant. Results: Each year in NSW, 5-17 new Aboriginal patients are treated for ESR D. There was no increase in the average annual incidence of ESRD among NSW Aboriginals (118 per million in 1988-1989 and 111 per million in 1996-1997) , whereas incidence in the NT increased from 255 per million to 800 per mil lion. In NSW, ESRD was attributed to diabetes in 32% of Aboriginal patients , compared with 13% of non-Aboriginal patients (P<0.001). In NSW, Aborigina l patients were younger and more likely to be female, a pattern similar to that in the NT. The outcome of ESRD treatment is not significantly differen t between Aboriginals and non-Aboriginals in NSW. Conclusion: There is a different pattern of incidence of ESRD and of outcom es with treatment among Aboriginals in NSW compared with those in the Ni. A possible explanation is that the lower incidence in NSW reflects less prof ound socioeconomic disadvantage and better access to primary and specialist care.