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

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Abstract

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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Author and article information

Journal

Journal ID (publisher-id): AJN

Journal ID (nlm-ta): Am J Nephrol

Journal ID (doi): 10.1159/issn.0250-8095

Title: American Journal of Nephrology

Publisher: S. Karger AG

ISSN (Print): 0250-8095

ISSN (Electronic): 1421-9670

Publication date Subscription-year: 2014

Publication date (Print): September 2014

Publication date (Electronic): 02 September 2014

Volume: 40

Issue: 2

Pages: 164-173

Affiliations

^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 laura.plantinga@emory.edu

Article

Publisher ID: 365596 Pmcid ID: PMC4175288 Other ID: Am J Nephrol 2014;40:164-173

DOI: 10.1159/000365596

PMC ID: PMC4175288

PubMed ID: 25196018

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