Ethnicity, age and incidence rates for renal replacement therapy (RRT) in Birmingham, UK: 1990-2004

Abstract

Birmingham is a densely populated, industrial city with a high social deprivation index and large black (B) and Indo-Asian (I) populations. End stage renal failure is known to be more common in ethnic minorities and urban communities. Workforce planning requires accurate epidemiological data but most studies of the effect of ethnicity in the UK are from the early 1990s. RRT acceptance rates for adults (>16 years) in Birmingham were calculated for the 5-year periods 1990-5 and 1999-2004 using the 1991 and 2001 UK population census datasets and local programmes data. The adult population of Birmingham Health Authority increased slightly (961,041 in 1991 v 977,099 in 2001) but the proportion of W fell (82.7% to 74.3%) while B (5.3% to 7.0%) and I (10.4% to 17.2%) both increased.Median age was lower for I (33.5 1991, 32.9 2001) than B(33.8 1991, 37.4 2001) and W (45.1 1991, 45.9 2001).Numbers of new patients increased by 29% in W, 98% in B and 109% in I. There was also a substantial increase in acceptance rates (W 92 to 129 pmp, I 175 to 243 pmp, B 191 to 278 pmp) but the proportional increase in I (26.9%) was less than in W (41.5%) or B (48.2%). This is because almost all the increase in RRT acceptance rates for all ethnic groups was seen in the over 55 age group (256 pmp 1991, 481 pmp 2001) but 85% of the population growth for I was in the under 55 age group. In all ethnic groups there was a striking increase in acceptance rates for the over 70's (W 177 to 440 pmp, I 536 to 1711 pmp, B 301 to 1858 pmp). All acceptance rates were equivalent to the highest previously described in the UK. This may be due to local factors including social deprivation, availability of care and physicians attitudes. The increase in patient numbers was due to rising ethnic minority populations and increasing acceptance rates, especially in the elderly.The take-on rate is likely to rise disproportionately for I as the population ages over the next 10 years. This indicates that the future need for RRT in UK inner city areas, especially those with a large elderly ethnic population, will be greater than previously estimated.