Racial Disparities in Access to High Quality Dialysis Facilities in Chicago

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 racial groups differ in proximity and access to high quality dialysis facilities.

Methods.  We analyzed Chicago residents aged 18-65 initiating in-center hemodialysis between 2005- 2009 linked to data on neighborhood and 2007 dialysis facility quality measures.  In multivariable analyses, we examined the association between individual and neighborhood characteristics, and our outcomes: 1) distance from home zip code to nearest dialysis facility, 2) their current facility and, 3) the nearest high quality facility, as well as 4) likelihood of receiving dialysis in a high quality facility. We defined the nearest facility as the facility that was the shortest road network distance from patient’s home zip code.  High quality dialysis facilities were defined as those with a total performance score (TPS) greater than 26 (out of 30), based on the ESRD Quality Incentive Program scoring algorithm which gave a 1-10 rating for the proportion of patients with 1) a hemoglobin (Hgb)<10g/dL, 2) Hgb>12g/dL, and 3) urea reduction rate>65.

Results.  Chicago residents face significant racial and socioeconomic segregation; however, racial/ethnic groups do not differ significantly in distance to their own dialysis facility.  Across the multivariable models, other Whites, Hispanics and Asians live significantly farther from their dialysis facility (0.14-0.34 miles) and from a high quality facility (1.19-0.36 miles) than African Americans, all p<0.05.   Despite their proximity to high quality facilities, African Americans are not more likely than their non AA counterparts to receive dialysis in a high quality facility. In addition, Hispanics have a 1.92 greater odds of attending a high quality dialysis facility than African Americans, even though they live significantly farther from high quality facilities, all p<0.05.

Conclusions.   African Americans’ proximity to high quality facilities does not lead to receiving care there. Hispanics are more likely to receive dialysis at a high quality facility despite living farther away.  While proximity is important to access, institutional and social factors may also play an important role in where people receive dialysis.