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. 2014 Dec 1;1(4):291-299.
doi: 10.1007/s40615-014-0036-0.

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

Milda R Saunders  1 , Haena Lee  2 , Chieko Maene  3 , Todd Schuble  3 , Kathleen A Cagney  4
Affiliations

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

Milda R Saunders et al. J Racial Ethn Health Disparities. .

Abstract

Background: For patients receiving hemodialysis, distance to their dialysis facility may be particularly important due to the need for thrice weekly dialysis. We sought to determine whether African-Americans and Whites differ in proximity and access to high quality dialysis facilities.

Methods: We analyzed urban, Whites and African-Americans aged 18-65 receiving in-center hemodialysis linked to data on neighborhood and dialysis facility quality measures. In multivariable analyses, we examined the association between individual and neighborhood characteristics, and our outcomes: distance from home zip code to nearest dialysis facility, their current facility and the nearest high quality facility, as well as likelihood of receiving dialysis in a high quality facility.

Results: African-Americans lived a half mile closer to a dialysis facility (B=-0.52) but traveled the same distance to their own dialysis facility compared to Whites. In initial analysis, African-Americans are 14% less likely than their White counterparts to attend a high quality dialysis facility (OR 0.86); and those disparities persist, though are reduced, even after adjusting for region, neighborhood poverty and percent African-American. In predominately African-American neighborhoods, individuals lived closer to high quality facilities (B=--5.92), but were 53% less likely to receive dialysis there (OR 0.47, highest group versus lowest, p<0.05). Living in a predominately African-American neighborhood explains 24% of racial disparity in attending a high quality facility.

Conclusions: African-Americans' proximity to high quality facilities does not lead to receiving care there. Institutional and social barriers may also play an important role in where people receive dialysis.

Keywords: access; hemodialysis; quality of care; racial disparity.

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Conflict of interest statement

Ethical Standards: The authors (Dr. Saunders, Ms. Lee, Ms. Maene, Mr. Schuble, Dr. Cagney) declare that they have no conflict of interest. No animal or human studies were carried out by the authors for this article. This study was deemed exempt by the University of Chicago Institutional Review Board.

References

    1. Wolfe RA, Ashby VB, Milford EL, et al. Differences in access to cadaveric renal transplantation in the United States. Am J Kidney Dis. 2000;36(5):1025–33. - PubMed
    1. Ashby VB, Kalbfleisch JD, Wolfe RA, Lin MJ, Port FK, Leichtman AB. Geographic variability in access to primary kidney transplantation in the United States, 1996-2005. Am J Transplant. 2007;7(5 Pt 2):1412–23. - PubMed
    1. Navaneethan SD, Singh S. A systematic review of barriers in access to renal transplantation among African Americans in the United States. Clin Transplant. 2006;20(6):769–75. - PubMed
    1. Frankenfield DL, Rocco MV, Frederick PR, Pugh J, McClellan WM, Owen WF., Jr Racial/ethnic analysis of selected intermediate outcomes for hemodialysis patients: results from the 1997 ESRD Core Indicators Project. Am J Kidney Dis. 1999;34(4):721–30. - PubMed
    1. Reddan DN, Szczech LA, Klassen PS, Owen WF. Racial Inequity in America's ESRD Program. Seminars in Dialysis. 2000;13(6):399–403. - PubMed

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