Eric L. Wallace *,Russell L. Griffin ,Kelly L. Koenig ,Lauren A. Crain
Objectives: Studies evaluating geographic barriers to home dialysis utilization in the United States have shown increased rates of utilization of home therapies in rural areas and increased distance to a home dialysis unit (HDU). These large studies may not capture unique regional variation in access to home dialysis. We performed this study to evaluate geographic barriers to home dialysis in the rural Southeastern US.
Methods: We extracted residential zip code and dialysis modality on point-prevalent dialysis patients living in Alabama, Mississippi, and Tennessee. Facility location was identified as well. Data were stratified by patient zip code using Rural Urban Continuum Codes (RUCC) and by circumferential zones differentiated by distance around existing (HDU). 2010 U.S. census data was used for socioeconomic characteristics of each zone. Poisson regression was used to compare prevalence of home dialysis by circumferential zone and RUCC.
Results: Patients more rural or remote from a HDU had higher end-stage renal disease rates, lower median per capita income, higher poverty levels, and were older compared to those within 20 miles of a HDU or urban (all p values <0.001). The adjusted prevalence ratio of home modalities (PD and HHD) was 1.14(95%CI 1.03-1.26) in RUCC codes 4-7, and 1.00 (95%CI, 0.80-1.24) for RUCC code 8-9 when compared to the most urban (RUCC 1-3).There was no difference in adjusted prevalence ratio of home modality utilization regardless of distance to the closest HDU (1.02; 95%CI 0.90-1.16, 0.87; 95% CI 0.72-1.05, and 0.96; 95% CI 0.69-1.34 for 20-30,30-40, and >40 miles respectively) when compared to patients within 20 miles of an HDU.
Conclusions: Prevalence ratio of home dialysis did not differ with distance from an HDU and did not increase in rural areas versus metropolitan areas. Further studies are needed to address if regional variation exists in access to home dialysis care.
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