Geographic variation and neighborhood factors are associated with low rates of pre–end-stage renal disease nephrology care

• DOI: 10.1038/ki.2015.118
• Publication Date: 2015-04-22T15:42:33Z
• Authors: Hua Hao; Brendan P. Lovasik; Stephen O. Pastan; Howard H. Chang; Ritam Chowdhury; Rachel E. Patzer
• Keywords: Geographic variation; Nephrology

Geographic variation of pre-end-stage renal disease (pre-ESRD) nephrology care has not been studied across the United States. Here we sought to identify geographic differences in pre-ESRD care, assess for county-level and sociodemographic risk factors, correlate with patient outcomes using facility-level mortality. Patients from 5387 dialysis facilities States 2007 2010 were included Dialysis Facility Report. Marginal generalized estimating equations used modeling cluster analysis detect clusters low rates care. On average, 67% patients received but significant variability regions ranging 3 99%. Five metropolitan areas San Francisco, Los Angeles, Chicago, Miami, Baltimore, along Southern states Mississippi River. lowest more likely be located urban counties high African-American populations educational attainment. A 10% higher proportion receiving was associated 1.3% lower mortality as reflected by Thus, factors can design quality improvement initiatives increase access nationwide improve outcomes.