Online Program

Geographical disparities in mortality among the End Stage Renal Disease (ESRD) patients in United States

Monday, November 2, 2015

Fozia Ajmal, MBBS, MBA (Health Management), MSc (Epidemiology), Department of Health Service Policy & Managment, University of South Carolina, South Carolina Rural Health Research Center, University of South Carolina, Columbia, SC
Kevin Bennett, PhD, Family & Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC
Janice C. Probst, PhD, University of South Carolina, South Carolina Rural Health Research Center, Columbia, SC

Twenty six million people in the U.S. have chronic kidney disease (CKD) and approximately one million more are at increased risk. CKD causes End Stage Renal Disease (ESRD), a state of permanent and irreversible renal failure. The prevalence of ESRD has increased over the last three decades. The disease needs an ongoing and long term treatment. Distance and rurality may affect access to care.


We used 2008 United States Renal Data System (USRDS). Using mortality as the outcome, we used the Anderson model to select exposures, including, socio-demographic, laboratory results, comorbidities, body mass index, alcohol dependence and the straight line distance (centroids) between the patient and facility zip codes. The USRDS files were merged to extract the needed variables. After removing the missing fields, we had data for 657,992 patients.


The majority of patients were males (54.0%) and whites (64.8%). Hypertension (78.2%), diabetes (43.8%), and cardiac failure (32.5%) were the commonest comorbidities.  The logistic regression model showed a significant interaction between rurality and distance. The likelihood of mortality increased with increased travel distances, yet differentially across the levels of rurality.


Geographical disparities are associated with poor access to care and adverse outcomes among ESRD patients. The promotion of home dialysis, telemedicine-portals and coordinated satellite clinics can help reduce the urban-rural gap in access. The Accountable Care Organizations must devise strategies to cater ESRD patients living in remote-rural areas.

Learning Areas:

Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Evaluate the association between mortality, rurality, and distance from the treatment facility of the patients with ESRD.

Keyword(s): Health Disparities/Inequities, Rural Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working in the South Carolina Rural Health Research Center (SCRHRC), which focuses on addressing the geographical disparities in health in South Carolina. I am basically a physician with a research interest in disparities in healthcare access. I have been working on evaluating the impact, geographical disparities in clinical outcomes of ESRD patients. My focus is to evaluate alternative methods to increase the access to care for the people living in remote areas.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.