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

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 hemo dialysis linked to data on neighborhood and dialysis facility quality measures. In multi-variable analyses, we examined the association between individual and neighborhood characteristics, and our outcomes: distance from home ZIP code to the 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 (odds ratio (OR) 0.86) and those disparities persist, though are reduced, even after adjusting for region and neighborhood poverty and per-cent 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.