Distance to Transplant Center and Referral for Transplant Evaluation within One Year among End-Stage Renal Disease Patientsin Georgia Open Access

Abstract

Background: To initiate the kidney transplantation process, dialysis patients often require a referral from a dialysis facility to a transplant center for eligibility evaluation. Prior studies have shown that greater distance to a transplant center is associated with lower rates of waitlisting and transplantation, but little is known about distance and referral for kidney transplant evaluation. Methods: We examined data on incident, adult (18-69 years) dialysis patients residing in Georgia from January 2005 to September 2011, followed until September 2012, using United States Renal Data System data linked with kidney transplant referral data from Georgia's three transplant centers. Tertiles of the straight-line distance from the center of patient residential ZIP code tabulation area to the nearest transplant center were calculated. Referral was defined as referral for evaluation within one year of dialysis start. Logistic regression was used to assess the association between distance and 1-year referral. Results: Data on a total of 11,993 dialysis patients were examined. The mean patient age was 55 years (IQR: 45 - 62), 67% were African American, and 55% were male. The median distance to transplant center was 39.4 miles (IQR: 13.2 - 91.0). A total of 3,454 (28.8%) patients were referred for transplant evaluation within one year of dialysis start. The adjusted odds ratio of 1-year referral for kidney transplant evaluation comparing farthest (≥75 miles) to closest (<19 miles) distance was 0.76 (95% CI: 0.67-0.85). Additionally, male sex, younger age, African American race and high socioeconomic status were positively associated with 1-year referral. Conclusion: Dialysis patients in Georgia who live farther (vs. closer) from a transplant center are 24% less likely to be referred for transplant evaluation within one year of dialysis start. Understanding the role of distance on referral could help define areas of greater need and guide interventions for increasing kidney transplantation access.

Table of Contents

Literature Review...................................................................................1

Introduction.........................................................................................10

Methods...............................................................................................11

Results.................................................................................................14

Discussion............................................................................................18

Appendix..............................................................................................22

Tables 1, 2

Figures 1 - 5

References............................................................................................30

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Surgery Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Distance Disparities ESRD Transplant
Committee Chair / Thesis Advisor	Patzer, Rachel Elizabeth, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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