Author: Amandi Hiyare Hewage
Hiyare Hewage, Amandi, 2025 Chronic Kidney Disease in young Aboriginal and/or Torres Strait Islander peoples: understanding links between sociodemographic factors and healthcare use., Flinders University, College of Medicine and Public Health
Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact copyright@flinders.edu.au with the details.
Aboriginal and/or Torres Strait Islander peoples are the world's oldest living and continuing culture. For tens of thousands of years, they have lived self-determined lives by passing on their extensive knowledge about the environment, traditional lands, and their ways of being, knowing and doing over generations. (1) The impact of previous and ongoing colonising practices has caused socioeconomic disadvantage for Aboriginal and/or Torres Strait Islander peoples, which in turn has increased the risk of comorbidity and hospitalisations. Aboriginal and/or Torres Strait Islander peoples are twice as likely to have indicators of CKD and are four times more likely to die from CKD as a cause of death than the general population in Australia (2, 3) Furthermore, the rate of potentially preventable hospitalisations was nearly 3 times higher among Aboriginal and/or Torres Strait Islander peoples than the general public (66 compared with 23 per 1,000 based on age-standardised rates). (4)
CKD is a non-communicable and asymptomatic condition that is a significant public health concern in Australia. (3, 5) Kidney Health Australia reported that 1 in 3 adults is at risk for CKD. (5) Further statistics from the AIHW show that in 2017-18, approximately 1.8 million hospitalisations were recorded with CKD as the main or additional diagnosis. (3) Whilst CKD remains a growing public health problem in Australia, cases are often undiagnosed or underreported until the later stages of dialysis and transplant. Thus, early detection and intervention through screening from earlier ages and engagement with primary healthcare (PHC) services are important in reducing the burden of CKD and preventing high hospital use and preventable readmissions. (6) Understanding high hospital use hospitalisations and preventable readmission patterns among young people (those under 25 years old) at the formative stages of their lives and experiencing physical and psychosocial changes is important in early intervention and modifying healthcare use behaviours. (7) These findings also present opportunities to provide feedback on the results to communities so that self-determination can be fostered and health promotion materials tailored to individual communities' needs can be developed.
The current PhD study is part of the ARDAC study, established in 2002 as a community-based longitudinal cohort study by Aboriginal Health Education Officer Ms. Rita Williams. (8-10) The ARDAC study has monitored the kidney and heart health of young Aboriginal and non-Aboriginal peoples from New South Wales through repeated urine albumin and urine creatinine estimations (semi-quantitative) using random spot urinalysis, and anthropomorphic measurements over 14.5 years of follow-up. (11, 12) In 2023, the ARDAC biomedical data was linked to 20 administrative and national datasets (with over 800 variables) due to follow-up challenges. The ARDAC data linkage provides an opportunity to evaluate the kidney health trajectory better and understand the cohort's healthcare utilisation. (11)
Previous findings from the ARDAC suggest childhood health, early clinical markers and healthcare use may impact the development of CKD in Aboriginal and/or Torres Strait Islander young people (13) This PhD thesis builds upon this prior knowledge by utilising the ARDAC data linkage to determine the incidence of CKD, understand factors that are associated with the development of CKD and to investigate healthcare utilisation among the cohort through primary healthcare use, hospitalisations, specific health checks and hospital readmissions. Therefore, the overarching aim of this thesis is to understand the cumulative incidence of Chronic Kidney Disease among a cohort of young Aboriginal people and to examine sociodemographic factors associated with the development of CKD overtime. Then, this thesis aimed to investigate health service use (primary healthcare and hospital use) among the broader ARDAC cohort. To address these aims, a multi-method approach consisting of a systematic review, cox proportional hazards model, logistic regression, negative binomial regression and descriptive statistics were used. Across the thesis, three common factors were associated with the development of CKD and healthcare use, including Aboriginality, geographical remoteness and being female which will be discussed further.
Keywords: Chronic kidney disease, Aboriginal and/or Torres Strait Islander, Indigenous health, nephrology, epidemiology, healthcare use, pediatric health
Subject: Australian Studies thesis
Thesis type: Doctor of Philosophy
Completed: 2025
School: College of Medicine and Public Health
Supervisor: A/Prof Jacqueline Stephens