title: Neighborhood socioeconomic status and barriers to peritoneal dialysis: a mixed methods study.
abstract: OBJECTIVE
  The objective of this study was to evaluate the association between neighborhood socioeconomic status and barriers to peritoneal dialysis eligibility and choice.
  
  
  METHODS
  This study was a mixed methods parallel design study using quantitative and qualitative data from a prospective clinical database of ESRD patients. The eligibility and choice cohorts were assembled from consecutive incident chronic dialysis patients entering one of five renal programs in the province of Ontario, Canada, between January 1, 2004 and December 31, 2010. Socioeconomic status was measured as median household income and percentage of residents with at least a high school education using Statistics Canada dissemination area-level data. Multivariable models described the relationship between socioeconomic status and likelihood of peritoneal dialysis eligibility and choice. Barriers to peritoneal dialysis eligibility and choice were classified into qualitative categories using the thematic constant comparative approach.
  
  
  RESULTS
  The peritoneal dialysis eligibility and choice cohorts had 1314 and 857 patients, respectively; 65% of patients were deemed eligible for peritoneal dialysis, and 46% of eligible patients chose peritoneal dialysis. Socioeconomic status was not a significant predictor of peritoneal dialysis eligibility or choice in this study. Qualitative analyses identified 16 barriers to peritoneal dialysis choice. Patients in lower- versus higher-income Statistics Canada dissemination areas cited built environment or space barriers to peritoneal dialysis (4.6% versus 2.7%) and family or social support barriers (8.3% versus 3.5%) more frequently.
  
  
  CONCLUSIONS
  Peritoneal dialysis eligibility and choice were not associated with socioeconomic status. However, socioeconomic status may influence specific barriers to peritoneal dialysis choice. Additional studies to determine the effect of targeting interventions to specific barriers to peritoneal dialysis choice in low socioeconomic status patients on peritoneal dialysis use are needed.
authors: Department of Medicine, Case Western Reserve University, Cleveland, Ohio;, †Deartment of Medicine, MetroHealth Medical Center, Cleveland, Ohio;, ‡Institute for Clinical Evaluative Sciences;, §Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;, ‖Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;, ¶Department of Medicine, University of Toronto, Toronto, Ontario, Canada, *Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Suma
authors: S
authors: Prakash
authors: Adam T
authors: AT
authors: Perzynski
authors: Peter C
authors: PC
authors: Austin
authors: C Fangyun
authors: CF
authors: Wu
authors: Mary Ellen
authors: ME
authors: Lawless
authors: J Michael
authors: JM
authors: Paterson
authors: Rob R
authors: RR
authors: Quinn
authors: Ashwini R
authors: AR
authors: Sehgal
authors: Matthew James
authors: MJ
authors: Oliver
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D012923:Social Class
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