title: Inequalities in rates of renal replacement therapy in England: does it matter who you are or where you live?
abstract: Introduction. This study explores the geographical variation in renal replacement therapy (RRT) incidence and prevalence after adjusting for general population socio-demographics, renal unit treatment patterns and travel times.
  
  
  METHODS
  The UK Renal Registry provided data on all patients in England commencing RRT in 2007 and receiving RRT on 31 December 2007. Multilevel Poisson regression models were constructed separately for incidence and prevalence. Geographical Information Systems software enabled estimation of road travel times and renal unit catchment areas. Small area estimates of RRT prevalence were produced for all 354 local authority districts.
  
  
  RESULTS
  Adjusted RRT incidence rates were 1.4 (95% confidence interval 1.2-1.6) times higher in the most deprived areas and 1.7 (1.5-2.0) and 1.5 (1.3-1.7) times higher in areas with most Black and South Asian inhabitants (10+%), respectively. The proportion of a centre's patients on haemodialysis or transplanted were positively associated with RRT incidence (not prevalence); numbers of satellite units were negatively associated with RRT incidence (not prevalence). While only 3% of patients lived >30 min from a dialysis unit, there was an effect of travel time on RRT rates; individuals living 45+ min from a dialysis unit were 20% less likely to commence or receive RRT than those living within 15 min (Ptrend=0.36 and Ptrend<0.001, respectively). A 4-fold variation in adjusted local authority district RRT prevalence rates could not be explained.
  
  
  CONCLUSIONS
  Expansion of renal unit facilities in England has reduced travel times in most areas though the possibility of inequitable geographic access to RRT persists.
authors: NIHR Musculoskeletal Biomedical Research Unit, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. andrew.judge@ndorms.ox.ac.uk
authors: Andy
authors: A
authors: Judge
authors: Fergus J
authors: FJ
authors: Caskey
authors: Nicky J
authors: NJ
authors: Welton
authors: David
authors: D
authors: Ansell
authors: Charles R V
authors: CR
authors: Tomson
authors: Paul J
authors: PJ
authors: Roderick
authors: Yoav
authors: Y
authors: Ben-Shlomo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D004739:England; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult