Ritte Rebecca E, Lawton Paul, Hughes Jaquelyne T, Barzi Federica, Brown Alex, Mills Phillip, Hoy Wendy, O'Dea Kerin, Cass Alan, Maple-Brown Louise
Menzies School of Health Research, Casuarina, Australia.
The Indigenous Health Equity Unit, University of Melbourne, Melbourne, Australia.
Ethn Health. 2020 Jan;25(1):93-109. doi: 10.1080/13557858.2017.1395814. Epub 2017 Oct 31.
: This cross-sectional study investigated the relationship between individual-level markers of disadvantage, renal function and cardio-metabolic risk within an Indigenous population characterised by a heavy burden of chronic kidney disease and disadvantage.: Using data from 20 Indigenous communities across Australia, an aggregate socio-economic status (SES) score was created from individual-level socio-economic variables reported by participants. Logistic regression was used to assess the association of individual-level socio-economic variables and the SES score with kidney function (an estimated glomerular function rate (eGFR) cut-point of <60 ml/min/1.73 m) as well as clinical indicators of cardio-metabolic risk.: The combination of lower education and unemployment was associated with poorer kidney function and higher cardio-metabolic risk factors. Regression models adjusted for age and gender showed that an eGFR < 60 ml/min/1.73 m was associated with a low socio-economic score (lowest vs. highest 3.24 [95% CI 1.43-6.97]), remote living (remote vs. highly to moderately accessible 3.24 [95% CI 1.28-8.23]), renting (renting vs. owning/being purchased 5.76[95% CI 1.91-17.33]), unemployment (unemployed vs employed 2.85 [95% CI 1.31-6.19]) and receiving welfare (welfare vs. salary 2.49 [95% CI 1.42-4.37]). A higher aggregate socio-economic score was inversely associated with an eGFR < 60 ml/min/1.73 m (0.75 [95% CI 063-0.89]).: This study extends upon our understanding of associations between area-level markers of disadvantage and burden of end stage kidney disease amongst Indigenous populations to a detailed analysis of a range of well-characterised individual-level factors such as overall low socio-economic status, remote living, renting, unemployment and welfare. With the increasing burden of end-stage kidney disease amongst Indigenous people, the underlying socio-economic conditions and social and cultural determinants of health need to be understood at an individual as well as community-level, to develop, implement, target and sustain interventions.
这项横断面研究调查了在以慢性肾病和不利条件负担沉重为特征的原住民群体中，个体层面的不利因素、肾功能与心血管代谢风险之间的关系。
利用来自澳大利亚20个原住民社区的数据，根据参与者报告的个体层面社会经济变量创建了一个综合社会经济地位（SES）得分。采用逻辑回归来评估个体层面社会经济变量和SES得分与肾功能（估计肾小球滤过率（eGFR）切点<60 ml/min/1.73 m²）以及心血管代谢风险临床指标之间的关联。
较低的教育水平和失业相结合与较差的肾功能及较高的心血管代谢风险因素相关。经年龄和性别调整的回归模型显示，eGFR<60 ml/min/1.73 m²与低社会经济得分（最低与最高相比为3.24 [95% CI 1.43 - 6.97]）、居住在偏远地区（偏远与高度至中度可达地区相比为3.24 [95% CI 1.28 - 8.23]）、租房（租房与自有/正在购买相比为5.76 [95% CI 1.91 - 17.33]）、失业（失业与就业相比为2.85 [95% CI 1.31 - 6.19]）以及领取福利（领取福利与有薪资相比为2.49 [95% CI 1.42 - 4.37]）相关。较高的综合社会经济得分与eGFR<60 ml/min/1.73 m²呈负相关（0.75 [95% CI 0.63 - 0.89]）。
本研究在我们对原住民群体中地区层面不利因素与终末期肾病负担之间关联的理解基础上，进一步详细分析了一系列特征明确的个体层面因素，如总体社会经济地位低、居住在偏远地区、租房、失业和领取福利等。随着原住民中终末期肾病负担的增加，需要在个体以及社区层面了解潜在的社会经济状况以及健康的社会和文化决定因素，以制定、实施、针对并维持干预措施。
