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      Association of U.S. Dialysis Facility Neighborhood Characteristics with Facility-Level Kidney Transplantation

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          Background: Improving access to optimal healthcare may depend on the attributes of neighborhoods where patients receive healthcare services. We investigated whether the characteristics of dialysis facility neighborhoods - where most patients with end-stage renal disease are treated - were associated with facility-level kidney transplantation. Methods: We examined the association between census tract (neighborhood)-level sociodemographic factors and facility-level kidney transplantation rate in 3,983 U.S. dialysis facilities where kidney transplantation rates were high. Number of kidney transplants and total person-years contributed at the facility level in 2007-2010 were obtained from the Dialysis Facility Report and linked to the census tract data on sociodemographic characteristics from the American Community Survey 2006-2010 by dialysis facility location.We used multivariable Poisson models with generalized estimating equations to estimate the link between the neighborhood characteristics and transplant incidence. Results: Dialysis facilities in the United States were located in neighborhoods with substantially greater proportions of black and poor residents, relative to the national average. Most facility neighborhood characteristics were associated with transplant, with incidence rate ratios (95% CI) for standardized increments (in percentage) of neighborhood exposures of: living in poverty, 0.88 (0.84-0.92), black race, 0.83 (0.78-0.89); high school graduates, 1.22 (1.17-1.26); and unemployed, 0.90 (0.85-0.95). Conclusion: Dialysis facility neighborhood characteristics may be modestly associated with facility rates of kidney transplantation. The success of dialysis facility interventions to improve access to kidney transplantation may partially depend on reducing neighborhood-level barriers.

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          Most cited references 25

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          The quality of life of patients with end-stage renal disease.

          We assessed the quality of life of 859 patients undergoing dialysis or transplantation, with the goal of ascertaining whether objective and subjective measures of the quality of life were influenced by case mix or treatment. We found that 79.1 per cent of the transplant recipients were able to function at nearly normal levels, as compared with between 47.5 and 59.1 per cent of the patients treated with dialysis (depending on the type). Nearly 75 per cent of the transplant recipients were able to work, as compared with between 24.7 and 59.3 per cent of the patients undergoing dialysis. On three subjective measures (life satisfaction, well-being, and psychological affect) transplant recipients had a higher quality of life than patients on dialysis. Among the patients treated with dialysis, those undergoing treatment at home had the highest quality of life. All quality-of-life differences were found to persist even after the patient case mix had been controlled statistically. Finally, the quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the general population.
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            Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project.

            We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States. We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island. For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were substantially reduced. For half the outcomes, more than 50% of cases would not have occurred if population rates equaled those of persons in the least impoverished CTs. In the early 1990s, persons in the least impoverished CT were the only group meeting Healthy People 2000 objectives a decade ahead. Geocoding and use of the CT poverty measure permit routine monitoring of US socioeconomic inequalities in health, using a common and accessible metric.
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              On Economic Inequality


                Author and article information

                Am J Nephrol
                American Journal of Nephrology
                S. Karger AG
                September 2014
                02 September 2014
                : 40
                : 2
                : 164-173
                aDepartment of Epidemiology, Rollins School of Public Health, bLaney Graduate School, Emory University, cDivision of Renal Medicine, Department of Medicine, Emory University School of Medicine, dEmory Transplant Center, Emory Healthcare, eDivision of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Ga., fSoutheastern Kidney Council, ESRD Network 6, Raleigh, N.C., USA
                Author notes
                *Laura Plantinga, Department of Epidemiology, 1518 Clifton Road NE, Claudia Nance Rollins Building, Floor 3, Atlanta, GA 30322 (USA), E-Mail
                365596 PMC4175288 Am J Nephrol 2014;40:164-173
                © 2014 S. Karger AG, Basel

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                Page count
                Figures: 2, Tables: 2, Pages: 10
                Original Report: Patient-Oriented, Translational Research


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