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Trends in the incidence of renal failure in Australia

Trends in the incidence of renal failure in Australia. John Stewart, Margaret McCredie, Stephen McDonald. Background. The patterns of incident ESRD have changed substantially over recent years A variety of factors might contribute to this Altered disease incidence Altered disease outcomes

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Trends in the incidence of renal failure in Australia

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  1. Trends in the incidence of renal failure in Australia John Stewart, Margaret McCredie, Stephen McDonald

  2. Background • The patterns of incident ESRD have changed substantially over recent years • A variety of factors might contribute to this • Altered disease incidence • Altered disease outcomes • Altered referral and selection bias • Changes in the underlying popuation ANZDATA Registry, ANZSN 2003

  3. Methods • Treated ESRD (ANZDATA), Australia only • Only 90+ day survivors • Indirect standardisation to Australian population values (ABS) • Changes examined in 3 groups • Age • Disease • Country of birth ANZDATA Registry, ANZSN 2003

  4. Age at entry B A New patients per year, 1971-2001, Australia, treated ESRD only ANZDATA Registry, ANZSN 2003

  5. 95% CI Rate ratio Age-specific changes 15 3 Non-indigenous 10 Indigenous 2.5 5 2 Rate ratio Rate ratio 2 1.5 1 1 .5 0-14 15-24 25-34 35-44 45-54 55-64 65+ 0-14 15-24 25-34 35-44 45-54 55-64 65+ Age group Age group Incidence rate ratios for 1992-2001 compared to 1982-1991 ANZDATA Registry, ANZSN 2003

  6. Diseases over time • The changes in disease incidence rates from the period 1982-1991 to 1992-2001 was examined, stratified by age groups • Changes in most diseases are similar to the overall pattern, except • Diabetes • Hypertension / arteriopathy • Analgaesic nephropathy ANZDATA Registry, ANZSN 2003

  7. 95% CI Rate ratio Diabetic nephropathy 15 15 Type 1 diabetes Type 2 diabetes 10 10 5 5 Rate ratio Rate ratio 2 2 1 1 .5 .5 25-34 35-44 45-54 55-64 65+ 35-44 45-54 55-64 65+ Age group Age group ANZDATA Registry, ANZSN 2003

  8. 95% CI Rate ratio Hypertension / analgaesic 10 Analgaesic Hypertension / vascular 2 5 1 Rate ratio Rate ratio .5 2 1 .2 .1 .5 35-44 45-54 55-64 65+ 45-54 55-64 65+ Age group Age group ANZDATA Registry, ANZSN 2003

  9. Place of birth • Country of birth grouped by region • Australia, British Isles, Southern Europe, Rest of Europe, Middle East, Indian sub-continent, East / South East Asia, Pacific Island • Other than Pacific Island (23% Fijian Indians) and Middle East (15% European) there was little difference between country of birth and racial origin. • All RRT patients who survived 90 days, 1993-2001 ANZDATA Registry, ANZSN 2003

  10. S. Europe 1 1 1.4 British Isles .9 1.2 .8 .8 1 .7 Rate ratio Rate ratio Rate ratio .6 .8 .6 Rest of Europe .5 .6 .4 15-44 45-64 65 & over 15-44 45-64 65 & over 15-44 45-64 65 & over Age (years) Age (years) Age (years) Indian sub-cont East/SE Asia Mid East 3 2.5 2.5 2 2.5 2 1.5 2 Rate ratio Rate ratio Rate ratio 1 1.5 1.5 1 1 .5 15-44 45-64 65 & over 15-44 45-64 65 & over 15-44 45-64 65 & over Age (years) Age (years) Age (years) Incidence by country of birth ANZDATA Registry, ANZSN 2003

  11. Population Australian population and Australian ESRD patients, 1993-2001, by country of birth ANZDATA Registry, ANZSN 2003

  12. Specific diseases - 1 • Glomerulonephritis in 45-64 year group Country of birthRate ratio British Isles 0.8 [0.7-1.0] S.Europe 1.6 [1.4-1.8] Rest of Europe 0.7 [0.6-0.9] Middle Eastern 2.1 [1.5-2.8] Indian subcontinent 1.1 [0.6-1.8] East/SE Asia 2.2 [1.8-2.7] Pacific Islands 3.9 [2.5-5.9] ANZDATA Registry, ANZSN 2003

  13. Specific diseases – 2 • Hypertension / arteriopathic / renovascular disease among 65+ year group Country of birthRate ratio British Isles 0.9 [0.7-1.1] S. Europe 0.9 [0.8-1.2] Rest of Europe 1.0 [0.8-1.2] Middle Eastern 1.6 [1.0-2.5] Indian subcontinent 2.0 [1.2-3.2] East/SE Asia 1.5 [1.0-2.0] ANZDATA Registry, ANZSN 2003

  14. Issues • Selection bias • ANZDATA only collects treated ESRD • Most applicable to older age group • Will change over time • Competing risks • Patients may now be surviving to end-stage whereas previously they did not • Lead-time bias • Lessening level of creatinine at entry • Effect on survival analyses • Changing demography • Progressive increase in proportion of populations of Asian / Aboriginal / Maori / PI racial origin • Progressive ageing of the population. ANZDATA Registry, ANZSN 2003

  15. Issues 2 • Classification bias • Is the increase in type 1 diabetes actually type 2 in young people? • Changes in disease prevalence • Increasing population prevalence of diabetes • Changes in disease behaviours • ?beneficial effect of treatments • ACE inhibitors may reduce the number of diabetics reaching end-stage • But they may also affect the competing risk of cardiovascular disease ANZDATA Registry, ANZSN 2003

  16. Where to? • More detailed examination of trends in recent years, and types of GN • Comparison of these changes with elsewhere • Hence the 90 day exclusion • Associations with different treatment patterns ANZDATA Registry, ANZSN 2003

  17. Acknowledgements • All staff of contributing renal units • ANZDATA staff • Sheila Williams ANZDATA Registry, ANZSN 2003

  18. www.anzdata.org.au ANZDATA Registry, ANZSN 2003

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