End stage renal disease as a symptom of health inequalities in French Guiana

Objectives
French Guiana attracts numerous migrants in search of a better life. They often live in very poor conditions, and may thus have difficulties in accessing care. The objective of the study was to look at differences between French and non-French ESRD patients in French Guiana.

Material and methods
Data from REIN registry in French Guiana was used between 1 January 2011 and 31 December 2016. Data from the population census was used to compare the prevalence of ESRD between French and foreign citizens. Longitudinal data was analyzed using survival analysis. Cox proportional hazards modelling was used.

Results
Half of patients on dialysis were of foreign origin. The odds ratio of ESRD was 2.2 (95% CI = 1.8-2.8, p < 0.0001) for foreigners relative to French citizens. When looking at adults only, immigrants were still more likely to have ESRD OR = 1.45 (95% CI = 1.2-1.7), p < 0.001. There was a significant age difference between foreign patients with ESRD and French patients with ESRD, 58.9 years (SD = 13.79) vs. 62.2 years (SD = 16.03), respectively, p = 0.02. No significant difference was found between French citizens and migrants regarding the underlying nephropathy, or mortality. However, when adjusting for age and looking at specific nationalities, patients from Guyana, Brazil, and the Dominican Republic, had a greater mortality.

Conclusions
Although there was no difference in prevalence between migrants and French citizens, the age at diagnosis of ESRD was lower in immigrants from neighboring countries Guyana, Suriname, and Brazil. Age-adjusted mortality was higher in some immigrant groups relative to French patients. Earlier detection of socially vulnerable patients with renal failure or with risk factors for renal failure should be a priority in French Guiana.