SAT-250 ARDAC KIDNEY HEALTH STUDY - SOCIAL DETERMINANTS SURVEY

Abstract

Chronic conditions are one of the key drivers behind the inequity in health outcomes for Aboriginal Australians. The ARDAC (Antecedents of Renal Disease in Aboriginal Children) Kidney Health Study is a New South Wales (NSW) based prospective cohort study which commenced in 2002. It aims to follow the early markers of chronic kidney and cardiovascular disease from childhood to early adulthood in urban, regional and remote Aboriginal and non-Aboriginal young people. The main outcome is to understand why the rate of kidney and cardiovascular disease in Aboriginal Australians is so high and help identify strategies to prevent it. Initially the focus of data collection was on 2 yearly measurements of height, weight, waist circumference, blood pressure, and urine albumin/creatinine ratio. Analysis of the data in 2013 showed risk factors for chronic disease were transient but not different in Aboriginal and non-Aboriginal participants. There was also no relationship between the biomedical risk factors and socio-economic status using their SEIFA scores. Based on these results and knowing social determinants influence health outcomes, a survey was initiated in Phase III of the study to address this gap. The survey was a voluntary, self-administered instrument which asked participants about family health history, level of education, employment, lifestyle, income and housing. Participants had the option to complete either a paper-based version or electronic application. Data were entered into an Excel spread-sheet and grouped according to Aboriginal status. Of the 354 surveys analysed 197 (56%) were completed by Aboriginal participants. There were 178 male and 176 female participants with an average age of 16-years (12 – 27 years). Just over half (55%) were still at high school while 72% of non-Aboriginal participants finished Year 12 compared to 53% of Aboriginal participants. For parents or main caregivers of the participant, 20% of non-Aboriginal and 3% of Aboriginal had completed Tertiary Education and 44% of non-Aboriginal and 30% Aboriginal were in full time employment. Housing showed Aboriginal households had similar number of bedrooms to non-Aboriginal households but more family members, potentially causing overcrowding and pressure on household net income. Variance in health was most striking in the number of participants or immediate family members who had been diagnosed with diabetes or chronic kidney disease (CKD). For instance, diabetes in an immediate relative was reported by 60% of Aboriginal compared to 44% of non-Aboriginal participants and CKD in an immediate relative was reported by 12% of Aboriginal compared to 8% of non-Aboriginal participants. Slightly more non-Aboriginal participants had visited a health service in the past 12 months (86% vs 74%) and 78% saw their GP or family doctor whereas 47% of Aboriginal participants went to an Aboriginal Medical Service. This survey provides unique data and strengthens the evidence for inclusion of the socio-economic determinates of health. These results suggest Aboriginal people can be more disadvantaged in education and employment and this affects their income, housing and use of primary health services.