Geographic Disparities in Patient Travel for Dialysis in the United States

Abstract

Purpose: To estimate travel distance and time for US hemodialysis patients and to compare travel of rural versus urban patients.Methods: Dialysis patient residences were estimated from ZIP code-level patient counts as of February 2011 allocated within the ZIP code proportional to census tract-level population, obtained from the 2010 US Census. Dialysis facility addresses were obtained from Medicare public-use files. Patients were assigned to an "original" and "replacement" facility, assuming patients used the facility closest to home and would select the next closest facility as a replacement, if a replacement facility was required. Driving distances and times were calculated between patient residences and facility locations using GIS software. Findings:The mean one-way driving distance to the original facility was 7.9 miles; for rural patients average distances were 2.5 times farther than for urban patients (15.9 vs 6.2 miles). Mean driving distance to a replacement facility was 10.6 miles, with rural patients traveling on average 4 times farther than urban patients to a replacement facility (28.8 vs 6.8 miles). Conclusion:Rural patients travel much longer distances for dialysis than urban patients. Accessing alternative facilities, if required, would greatly increase rural patient travel, while having little impact on urban patients. Increased travel could have clinical implications as longer travel is associated with increased mortality and decreased quality of life.

Proximity Does Not Equal Access: Racial Disparities in Access to High Quality Dialysis Facilities

“…We found that patients live, on average, 4 miles from their chosen dialysis facility and less than 2 miles to the nearest dialysis facility. Our work was consistent with previous studies that showed urban patients on hemodialysis do not travel far to their dialysis centers [6, 7, 42]. Having dialysis facilities close to where patients need them is a significant accomplishment, yet to be attained in rural areas in the US and in many other countries.…”

“…For many patients with end-stage renal disease (ESRD), distance from their dialysis facility may be particularly important due to the thrice weekly hemodialysis treatment requirement. Two US studies have shown that most people in urban areas live within 30 minutes of their dialysis facility and that longer travel time was associated with greater mortality and worse health related quality of life [6, 7]. However, to our knowledge, no study has examined racial disparities in proximity to dialysis facilities.…”

Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

“…Distances between a patient’s home and primary care practice may be acceptable for occasional, intermittent visits; however long travel distances for a short 15 min MOB visit may be problematic, a barrier that can be compounded by weather-related concerns. Distance is known to be an important factor in seeking healthcare in rural veterans [37] and other populations [38–42], increasing the risk of not returning for care. Inequalities to access to care have even been observed elsewhere, including Japan [43].…”

Differences in Women's Use of Medical Help for Becoming Pregnant by the Level of Urbanization of County of Residence in Georgia

“…The small sample within each category of our exposure variable caused many of our estimates to be imprecise; however, we focused on an issue that has been sparsely addressed in the literature. Studies looking at geographic disparities in use of medical help have focused on other health outcomes or access to only specialized care for becoming pregnant . Another limitation was that we were constrained to women's place of residence at the time of the interview, which on average, was 9 years after the age at visiting a doctor for help getting pregnant.…”