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Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians

Cass, Alan, Cunningham, Joan, Snelling, Paul L., Wang, Zhiqiang and Hoy, Wendy (2004). Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians. Social Science and Medicine,58(4):767-785.

Document type: Journal Article
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Title Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians
Author Cass, Alan
Cunningham, Joan
Snelling, Paul L.
Wang, Zhiqiang
Hoy, Wendy
Journal Name Social Science and Medicine
Publication Date 2004
Volume Number 58
Issue Number 4
ISSN 0277-9536   (check CDU catalogue open catalogue search in new window)
Start Page 767
End Page 785
Total Pages 9
Place of Publication UK
Publisher Pergamon
Field of Research 1601 - Anthropology
1608 - Sociology
1117 - Public Health and Health Services
HERDC Category C1 - Journal Article (DEST)
Abstract Indigenous Australians are disadvantaged, relative to other Australians, over a range of socio-economic and health measures. The age- and sex-adjusted incidence of end-stage renal disease (ESRD)—the irreversible preterminal phase of chronic renal failure—is almost nine times higher amongst Indigenous than it is amongst non-indigenous Australians. A striking gradient exists from urban to remote regions, where the standardised ESRD incidence is from 20 to more than 30 times the national incidence. We discuss the profound impact of renal disease on Indigenous Australians and their communities. We explore the linkages between disadvantage, often accompanied by geographic isolation, and both the initiation of renal disease, and its progression to ESRD. Purported explanations for the excess burden of renal disease in indigenous populations can be categorised as: (1)primary renal disease explanations; (2)genetic explanations; (3)early development explanations; and (4)socio-economic explanations. We discuss the strengths and weaknesses of these explanations and suggest a new hypothesis which integrates the existing evidence. We use this hypothesis to illuminate the pathways between disadvantage and the human biological processes which culminate in ESRD, and to propose prevention strategies across the life-course of Indigenous Australians to reduce their ESRD risk. Our hypothesis is likely to be relevant to an understanding of patterns of renal disease in other high-risk populations, particularly indigenous people in the developed world and people in developing countries. Furthermore, analogous pathways might be relevant to other chronic diseases, such as diabetes and cardiovascular disease. If we are able to confirm the various pathways from disadvantage to human biology, we will be better placed to advocate evidence-based interventions, both within and beyond the scope of the health-care system, to address the excess burden of renal and other chronic diseases among affected populations.
Keywords Aboriginal health
Renal disease
Social determinants
Biological pathways
Prevention
Australia
DOI http://dx.doi.org/10.1016/S0277-9536(03)00243-0   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes 2601 (Journal)
 
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Created: Fri, 12 Sep 2008, 08:35:25 CST by Administrator