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Open Access 01-12-2021 | Chronic Kidney Disease | Research article

Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies

Authors: Tania Huria, Suzanne G. Pitama, Lutz Beckert, Jaquelyne Hughes, Nathan Monk, Cameron Lacey, Suetonia C. Palmer

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

To summarise the evidentiary basis related to causes of inequities in chronic kidney disease among Indigenous Peoples.

Methods

We conducted a Kaupapa Māori meta-synthesis evaluating the epidemiology of chronic kidney diseases in Indigenous Peoples. Systematic searching of MEDLINE, Google Scholar, OVID Nursing, CENTRAL and Embase was conducted to 31 December 2019. Eligible studies were quantitative analyses (case series, case-control, cross-sectional or cohort study) including the following Indigenous Peoples: Māori, Aboriginal and Torres Strait Islander, Métis, First Nations Peoples of Canada, First Nations Peoples of the United States of America, Native Hawaiian and Indigenous Peoples of Taiwan. In the first cycle of coding, a descriptive synthesis of the study research aims, methods and outcomes was used to categorise findings inductively based on similarity in meaning using the David R Williams framework headings and subheadings. In the second cycle of analysis, the numbers of studies contributing to each category were summarised by frequency analysis.

Completeness of reporting related to health research involving Indigenous Peoples was evaluated using the CONSIDER checklist.

Results

Four thousand three hundred seventy-two unique study reports were screened and 180 studies proved eligible. The key finding was that epidemiological investigators most frequently reported biological processes of chronic kidney disease, particularly type 2 diabetes and cardiovascular disease as the principal causes of inequities in the burden of chronic kidney disease for colonised Indigenous Peoples. Social and basic causes of unequal health including the influences of economic, political and legal structures on chronic kidney disease burden were infrequently reported or absent in existing literature.

Conclusions

In this systematic review with meta-synthesis, a Kaupapa Māori methodology and the David R Williams framework was used to evaluate reported causes of health differences in chronic kidney disease in Indigenous Peoples. Current epidemiological practice is focussed on biological processes and surface causes of inequity, with limited reporting of the basic and social causes of disparities such as racism, economic and political/legal structures and socioeconomic status as sources of inequities.

United Nations, United Nations Declaration on the Rights of Indigenous Peoples, U. Nations, Editor. 2007.

Anderson I, Robson B, Connolly M, al-Yaman F, Bjertness E, King A, et al. Indigenous and tribal peoples’ health (the lancet - Lowitja Institute global collaboration): a popluation study. Lancet. 2016;388(10040):131–57. https://doi.org/10.1016/S0140-6736(16)00345-7.CrossRefPubMed

Joshy G, Dunn P, Fisher M, Lawrenson R. Ethnic differences in the natural progression of nephropathy among diabetes patients in New Zealand: hospital admission rate for renal complications, and incidence of end-stage renal disease and renal death. Diabetologia. 2009;52(8):1474–8. https://doi.org/10.1007/s00125-009-1380-1.CrossRefPubMed

Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectices. Lancet. 2013;382(9888):260–72. https://doi.org/10.1016/S0140-6736(13)60687-X.CrossRefPubMed

Priest N, Williams D. In: Major JFDB, Link BG, editors. Racial discrimination and racial disparities in health., in Oxford library of psychology. The Oxford handbook of stigma, discrimination, and health: Oxford University Press; 2018. p. 163–82.

Williams DR. Race and health: basic questions, emerging directions. Ann Epidemiol. 1997;7(5):322–33.PubMedCrossRef

Reid P, Cormack D, Paine S. Colonial histories, racism and health - the experience of Māori and indigenous peoples. Public Health. 2019;172:119–24. https://doi.org/10.1016/j.puhe.2019.03.027.CrossRefPubMed

Williams D, Mohammed S. Racism and Health 1: Pathways and Scientific Evidence American Behavioural. Scientist. 2013;57(8):1152–73.

Yeates K, Tonelli M. Indigenous health: update on the impact of diabetes and chronic kidney disease. Curr Opin Nephrol Hypertens. 2006;15(6):588–92. https://doi.org/10.1097/01.mnh.0000247495.54882.e4.CrossRefPubMed

10.

Norris K, Agodoa L. Unraveling the racial disparities associated with kidney disease 1. Kidney Int. 2005;68(3):914–24. https://doi.org/10.1111/j.1523-1755.2005.00485.x.CrossRefPubMed

11.

Simmons D, Schaumkel J, Cecil A, Scott DJ, Kenealy T. High impact of nephropathy on five-year mortality rates among patients with type 2 diabetes mellitus from a multi-ethnic population in New Zealand. Diabet Med. 1999;16(11):926–31. https://doi.org/10.1046/j.1464-5491.1999.00187.x.CrossRefPubMed

12.

Walter M. Using the 'power of the data' within Indigenous research practice. Aust Aborig Stud. 2005:2(27).

13.

Paradies Y. Colonisation, racism and indigenous health. J Popul Res. 2016;33(1):83–96. https://doi.org/10.1007/s12546-016-9159-y.CrossRef

14.

Walter M. The Politics of the Data: How the Australian Statistical Indigene is Constructed. Int J Critical Indigenous Stud. 2010;3(2).

15.

Smith Tuhiwai L. Decolonizing methodologies: Research and indigenous peoples: Zed Books Ltd; 2013.

16.

Huria T, Palmer SC, Pitama S, Beckert L, Lacey C, Ewen S, et al. Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement. BMC Med Res Methodol. 2019;19(1):173. https://doi.org/10.1186/s12874-019-0815-8.CrossRefPubMedPubMedCentral

17.

Komenda P, Lavallee B, Ferguson TW, Tangri N, Chartrand C, McLeod L, et al. The prevalence of CKD in rural Canadian indigenous peoples: results from the first nations community based screening to improve kidney health and prevent Dialysis (FINISHED) screen, triage, and treat program. Am J Kidney Dis. 2016;68(4):582–90. https://doi.org/10.1053/j.ajkd.2016.04.014.CrossRefPubMed

18.

Thomas D, et al. A Retrospective Study of Chronic Kideny Disease Burden in Saskatchewan’s First Nations People. Can J Kidney Health Dis. 2018;5.

19.

Walker RC, et al. Experiences, perspectives and values of Indigenous peoples regarding kidney transplantation: systematic review and thematic synthesis of qualitative studies. Int J Equity Health. 2019;18(1):204.PubMedPubMedCentralCrossRef

20.

Thomas DP, et al. Long-term trends in Indigenous deaths from chronic diseases in the Northern Territory: a foot on the brake, a foot on the accelerator. Med J Aust. 2006;185(3):145–9.PubMedCrossRef

21.

Marley JV, et al. Peritoneal dialysis outcomes of Indigenous Australian patients of remote Kimberley origin. Aust J Rural Health. 2014;22(3):101–8.PubMedPubMedCentralCrossRef

22.

Marley JV, et al. Haemodialysis outcomes of Aboriginal and Torres Strait Islander patients of remote Kimberley region origin. Med J Aust. 2010;193(9):516–20.PubMedCrossRef

23.

Lawton PD, et al. Survival of Indigenous Australians receiving renal replacement therapy: closing the gap? Med J Aust. 2015;202(4**):200–4.PubMedCrossRef

24.

Kim S, et al. Beginning the trajectory to ESKD in adult life: albuminuria in Australian aboriginal children and adolescents. Pediatr Nephrol. 2017;32(1):119–29.PubMedCrossRef

25.

Kelly L, et al. Prevalence of chronic kidney disease and cardiovascular comorbidities in adults in First Nations communities in northwest Ontario: a retrospective observational study. CMAJ Open. 2019;7(3).

26.

Walker R, et al. Māori patients’ experiences and perspectives of chronic kidney disease: a New Zealand qualitative interview study. BMJ Open. 2017;7(1):e01382.CrossRef

27.

Ritte R, Luke J, Nelson C, Brown A, O’Dea K, Jenkins A, et al. Clinical outcomes associated with albuminuria in Central Australia: a cohort study. BMC Nephrol. 2016;17(1):113. https://doi.org/10.1186/s12882-016-0328-1.CrossRefPubMedPubMedCentral

28.

Shephard MD, Gill JP. An innovative Australian point-of-care model for urine albumin: creatinine ratio testing that supports diabetes management in indigenous medical services and has international application. Ann Clin Biochem. 2005;42(Pt 3):208–15. https://doi.org/10.1258/0004563053857806.CrossRefPubMed

29.

Cass A, et al. Renal transplantation for indigenous Australians: identifying the barriers to equitable access. Ethn Health. 2003;8(2):111–9. https://doi.org/10.1080/13557850303562.CrossRefPubMed

30.

Zhang Y, et al. Insulin resistance, incident cardiovascular diseases, and decreased kidney function among nondiabetic American Indians: the Strong Heart Study. Diabetes Care. 2013;36(10):3195–200.PubMedPubMedCentralCrossRef

31.

Zacharias JM, et al. Prevalence, risk factors and awareness of albuminuria on a Canadian First Nation: a community-based screening study. BMC Public Health. 2012;12:290.PubMedPubMedCentralCrossRef

32.

Yeates KE, et al. Indigenous people in Australia, Canada, New Zealand and the United States are less likely to receive renal transplantation. Kidney Int. 2009;76(6):659–64.PubMedCrossRef

33.

Walker RC, et al. Māori patients experiences and perspectives of chronic kidney disease: A New Zealand qualitative review. BMJ Open. 2017;7(1, e013829).

34.

Xu J, et al. A longitudinal study of risk factors for incident albuminuria in diabetic American Indians: the Strong Heart Study. Am J Kidney Dis. 2008;51(3):415–24.PubMedPubMedCentralCrossRef

35.

Shultis WA, et al. Effect of periodontitis on overt nephropathy and end-stage renal disease in type 2 diabetes. Diabetes Care. 2007;30(2):306–11.PubMedCrossRef

36.

Hoy WE, et al. Quantifying the excess risk for proteinuria, hypertension and diabetes in Australian Aborigines: Comparison of profiles in three remote communities in the Northern Territory with those in the AusDiab study. Aust N Z J Public Health. 2007;31(2):177–83.PubMedCrossRef

37.

Rix EF, et al. ‘Beats the alternative but it messes up your life’: aboriginal people’s experience of haemodialysis in rural Australia. BMJ Open. 2014;4(9):e005945.PubMedPubMedCentralCrossRef

38.

Rix EF, et al. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study. Hemodial Int. 2015;19(1):80–9.PubMedCrossRef

39.

Samuel SM, et al. Incidence and causes of end-stage renal disease among Aboriginal children and young adults. CMAJ. 2012;184(14):E758–64.PubMedPubMedCentralCrossRef

40.

Mottl AK, et al. Linkage analysis of glomerular filtration rate in American Indians. Kidney Int. 2008;74(9):1185–91.PubMedPubMedCentralCrossRef

41.

Mau MK, et al. Epidemiologic and clinical factors associated with chronic kidney disease among Asian Americans and Native Hawaiians. Ethn Health. 2007;12(2):111–27.PubMedCrossRef

42.

Anderson K, et al. The IMPAKT study: Using qualitative research to explore the impact of end-stage kidney disease and its treatments on aboriginal and Torres Strait Islander Australians. Kidney Int Suppl. 2013;3(2):223–6.CrossRef

43.

Anderson K, et al. “All they said was my kidneys were dead”: Indigenous Australian patients’ understanding of their chronic kidney disease. Med J Aust. 2008;189(9):499–503.PubMedCrossRef

44.

Anderson K, et al. If you can’t comply with dialysis, how do you expect me to trust you with transplantation? Australian nephrologists’ views on indigenous Australians’ ‘non-compliance’ and their suitability for kidney transplantation. Int J Equity Health. 2012;11:21.PubMedPubMedCentralCrossRef

45.

Ward DRR, et al. Assessment of the Siksika chronic disease nephropathy-prevention clinic. Can Fam Physician. 2013;59(1):e19–25.PubMedPubMedCentral

46.

Connelly PW, et al. Association of the novel cardiovascular risk factors paraoxonase 1 and cystatin C in type 2 diabetes. J Lipid Res. 2009;50(6):1216–22.PubMedPubMedCentralCrossRef

47.

Hayward JS, et al. Kidney Disease Among Registered Metis Citizens of Ontario: A Population-Based Cohort Study. Can J Kidney Health Dis. 2017;4:2054358117703071.PubMedPubMedCentralCrossRef

48.

Bailie RS, et al. Investigating the sustainability of outcomes in a chronic disease treatment programme. Soc Sci Med. 2006;63(6):1661–70.PubMedCrossRef

49.

Dannenbaum D, et al. Prevalence of diabetes and diabetes-related complications in first nations communities in Northern Quebec (Eeyou Istchee), Canada. Can J Diabetes. 2008;32(1):46–52.CrossRef

50.

Kandasamy Y, et al. Reduced nephron endowment in the neonates of Indigenous Australian peoples. J Dev Orig Health Dis. 2014;5(1):31–5.PubMedCrossRef

51.

Oster RT, et al. Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta. Can Fam Physician. 2009;55(4):386–93.PubMedPubMedCentral

52.

McDermott RA, et al. Diabetes in the Torres Strait Islands of Australia: better clinical systems but significant increase in weight and other risk conditions among adults, 1999–2005. Med J Aust. 2007;186(10):505–8.PubMedCrossRef

53.

Looker HC, et al. Homocysteine and vitamin B(12) concentrations and mortality rates in type 2 diabetes. Diabetes Metab Res Rev. 2007;23(3):193–201.PubMedCrossRef

54.

Lucove J, et al. Metabolic syndrome and the development of CKD in American Indians: the Strong Heart Study. Am J Kidney Dis. 2008;51(1):21–8.PubMedCrossRef

55.

Le DS, et al. The association of plasma fibrinogen concentration with diabetic microvascular complications in young adults with early-onset of type 2 diabetes. Diabetes Res Clin Pract. 2008;82(3):317–23.PubMedCrossRef

56.

Haysom L, et al. Risk of CKD in Australian indigenous and nonindigenous children: a population-based cohort study. Am J Kidney Dis. 2009;53(2):229–37.PubMedCrossRef

57.

Haysom L, et al. Early chronic kidney disease in Aboriginal and non-Aboriginal Australian children: remoteness, socioeconomic disadvantage or race? Kidney Int. 2007;71(8):787–94.PubMedCrossRef

58.

Haysom L, et al. Natural history of chronic kidney disease in Australian Indigenous and non-Indigenous children: a 4-year population-based follow-up study. Med J Aust. 2009;190(6):303–6.PubMedCrossRef

59.

Shara NM, et al. Decreased GFR estimated by MDRD or Cockcroft-Gault equation predicts incident CVD: the strong heart study. J Nephrol. 2009;22(3):373–80.PubMedPubMedCentral

60.

Lim S, et al. Low prevalence of retinopathy, but high prevalence of nephropathy among Maori with newly diagnosed diabetes-Te Wai o Rona: Diabetes Prevention Strategy. Diabetes Res Clin Pract. 2008;80(2):271–4.PubMedCrossRef

61.

Cho Y, et al. Outcomes of nephrologist-inserted peritoneal catheters in indigenous patients from Far North Queensland. Perit Dial Int. 2014;34(6):663–7.PubMedPubMedCentralCrossRef

62.

Hochman ME, et al. The prevalence and incidence of end-stage renal disease in Native American adults on the Navajo reservation. Kidney Int. 2007;71(9):931–7.PubMedCrossRef

63.

Haswell-Elkins M, et al. Striking association between urinary cadmium level and albuminuria among Torres Strait Islander people with diabetes. Environ Res. 2008;106(3):379–83.PubMedCrossRef

64.

Maple-Brown LJ, et al. High rates of albuminuria but not of low eGFR in urban indigenous Australians: the DRUID study. BMC Public Health. 2011;11:346.PubMedPubMedCentralCrossRef

65.

Maple-Brown L, et al. Progression of Kidney Disease in Indigenous Australians: The eGFR Follow-up Study. Clin J Am Soc Nephrol. 2016;11(6):993–1004.PubMedPubMedCentralCrossRef

66.

McKercher C, Jose MD, Grace B, Clayton PA, Walter M. Gender differences in the dialysis treatment of indigenous and non-indigenous Australians. Aust N Z J Public Health. 2017;41(1):15–20. https://doi.org/10.1111/1753-6405.12621.CrossRefPubMed

67.

Samuel SM, Palacios-Derflingher L, Tonelli M, Manns B, Crowshoe L, Ahmed SB, et al. Association between first nations ethnicity and progression to kidney failure by presence and severity of albuminuria. CMAJ. 2014;186(2):E86–94. https://doi.org/10.1503/cmaj.130776.CrossRefPubMedPubMedCentral

68.

Samuel SM, et al. Dialysis and transplantation among Aboriginal children with kidney failure. CMAJ. 2011;183(10):E665–72.PubMedPubMedCentralCrossRef

69.

Gao S, et al. Access to health care among status Aboriginal people with chronic kidney disease. CMAJ. 2008;179(10):1007–12.PubMedPubMedCentralCrossRef

70.

McKercher C, Chan HW, Clayton PA, McDonald S, Jose MD. Dialysis outcomes of elderly indigenous and non-indigenous Australians. Nephrology. 2014;19(10):610–6. https://doi.org/10.1111/nep.12317.CrossRefPubMed

71.

Harasemiw O, Milks S, Oakley L, Lavallee B, Chartrand C, McLeod L, et al. Remote dwelling location is a risk factor for CKD among indigenous Canadians. Kidney Int Rep. 2018;3(4):825–32. https://doi.org/10.1016/j.ekir.2018.02.002.CrossRefPubMedPubMedCentral

72.

Anderson K, et al. They really want to go back home, they hate it here: the importance of place in Canadian health professionals’ views on the barriers facing Aboriginal patients accessing kidney transplants. Health Place. 2009;15(1):390–3.PubMedCrossRef

73.

Sood MM, et al. Association of modality with mortality among Canadian Aboriginals. Clin J Am Soc Nephrol. 2012;7(12):1988–95.PubMedPubMedCentralCrossRef

74.

Kenealy T, et al. Increased prevalence of albuminuria among non-European peoples with type 2 diabetes. Nephrol Dial Transplant. 2012;27(5):1840–6.PubMedCrossRef

75.

Gardiner FW, et al. Poor access to kidney disease management services in susceptible patient populations in rural Australia is associated with increased aeromedical retrievals for acute renal care. Intern Med J. 2019;10.

76.

Tobe SW, et al. Preventing Cardiovascular and Renal Disease in Canada’s Aboriginal Populations. Can J Cardiol. 2015;31(9):1124–9.PubMedCrossRef

77.

Zrim S, F.T, Grace BS, Meade A. Body mass index and postoperative complications in kidney transplant recipients. Nephrology. 2012;17(6):582–7.PubMedCrossRef

78.

Huria T, Palmer S, Beckert L, Williman J, Pitama S. Inequity in dialysis related practices and outcomes in Aotearoa/New Zealand: a Kaupapa Māori analysis. Int J Equity Health. 2018;17(1):27. https://doi.org/10.1186/s12939-018-0737-9.CrossRefPubMedPubMedCentral

79.

Walker J, Lovett R, Kukutai T, Jones C, Henry D. Indigenous health data and the path to healing. Lancet. 2017;390(10107):2022–3. https://doi.org/10.1016/S0140-6736(17)32755-1.CrossRefPubMed

80.

Ekinci E, et al. Is Hyperfiltration associated with higher urine albumin to creatinine ratio at follow up among indigenous Australians? The eGFR follow-up study. J Diabetes Complicat. 2019;33(5):343–9. https://doi.org/10.1016/j.jdiacomp.2019.02.005.CrossRef

81.

Young RJ, Hoy WE, Kincaid-Smith P, Seymour AE, Bertram JF. Glomerular size and glomerulosclerosis in Australian aborigines. Am J Kidney Dis. 2000;36(3):481–9. https://doi.org/10.1053/ajkd.2000.9788.CrossRefPubMed

82.

McDonald S. Indigenous transplant outcomes in Australia: what the ANZDATA registry tells us. Nephrology. 2004;9(Suppl 4):S138–43. https://doi.org/10.1111/j.1440-1797.2004.00350.x.CrossRefPubMed

83.

Hoy W, Mcdonald SP. Albuminuria: marker or target in indigenous populations. Kidney International. 2004;66:S25-31.

84.

Eggers PW. Effect of transplantation on the Medicare end-stage renal disease program. N Engl J Med. 1988;318(4):223–9. https://doi.org/10.1056/NEJM198801283180406.CrossRefPubMed

85.

Thomson R, et al. New Genetic Loci Associated With Chronic Kidney Disease in an Indigenous Australian Population. Front Genet. 2019;10(330).

86.

Kukutai T, Walter M. Indigenous Statistics. Handbook of Research Methods in Health Social Sciences, in Handbook of Research Methods in Health Social Sciences; 2017, Springer. p. 1–16.CrossRef

87.

King M, Smith A, Gracey M. Indigenous health part 2: the underlying causes of the health gap. Lancet. 2009;374(9683):76–85. https://doi.org/10.1016/S0140-6736(09)60827-8.CrossRefPubMed

88.

Smith LT. Decolonising methodologies: Research and indigenous peoples: Z.B. Ltd; 2013.

89.

Smith LT, et al. Indigenous knowledge, methodology and mayhem: what is the role of methodology in producing indigenous insights? A discussion from mātauranga Māori. J Knowledge Cultures. 2016;4(3):131–56.

90.

Prussing E. Critical epidemiology in actio: research for and by indigenous peoples. SSM Popul Health. 2018;6:98–106. https://doi.org/10.1016/j.ssmph.2018.09.003.CrossRefPubMedPubMedCentral

91.

Anderson I, Crengle S, Leialoha Kamaka M, Chen TH, Palafox N, Jackson-Pulver L. Indigenous health in Australia, New Zealand, and the Pacific. Lancet. 2006;367(9524):1775–85. https://doi.org/10.1016/S0140-6736(06)68773-4.CrossRefPubMed

92.

Grosfoguel R. The structure of knowledge in westernized universities: epistemic racism/sexism and the four genocides/epistemicides of the long 16th century. Hum Architecture. 2013;11(1):73.

93.

Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104. https://doi.org/10.1016/S0140-6736(05)71146-6.CrossRefPubMed

94.

Curtis E. Indigenous positioning in health research: the importance of Kaupapa Māori theory-informed practice. AlterNative Int J Indigenous Peoples. 2016;12(4):396–410. https://doi.org/10.20507/AlterNative.2016.12.4.5.CrossRef

95.

Knight J, et al. Indigenous research: a commitment to walking the talk. The Gudaga Study - an Australian case study. J Bioethical Inquiry. 2009;6(4):467.CrossRef

96.

Hyett, S., S. Marjerrison, And C. Gabel, Improving health research among Indigenous Peoples in Canada CMAJ, 2018. 190(20): p. E616–E621, DOI: https://doi.org/10.1503/cmaj.171538.CrossRefPubMedPubMedCentral

97.

Jones J, Cunsolo A, Harper S. Who is research serving? A sytematic realist review of circumpolar environment-related Indigenous health literature. PLoS One. 2018;13(5):e0196090.PubMedPubMedCentralCrossRef

98.

Reid P, P.S, Curtis E, Jones R, Anderson A, Willing E, et al. Achieving health equity in Aotearoa: strengthening responsiveness to Māori in health research. N Z Med J (Online). 2017;130(1465):96–103.

99.

Boyd, R., et al., ON racism: a new standard for publishing on racial health inequities, in Health Affairs Blog. 2020.

Title: Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies
Authors: Tania Huria
Suzanne G. Pitama
Lutz Beckert
Jaquelyne Hughes
Nathan Monk
Cameron Lacey
Suetonia C. Palmer
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Chronic Kidney Disease
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-11180-2

At a glance: The STEP trials

Springer Medicine

Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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