title: Pre-end-stage renal disease care not associated with dialysis facility neighborhood poverty in the United States.
abstract: BACKGROUND
  Receipt of nephrology care prior to end-stage renal disease (ESRD) is a strong predictor of decreased mortality and morbidity, and neighborhood poverty may influence access to care. Our objective was to examine whether neighborhood poverty is associated with lack of pre-ESRD care at dialysis facilities.
  
  
  METHODS
  In a multi-level ecological study using geospatially linked 2007-2010 Dialysis Facility Report and 2006-2010 American Community Survey data, we examined whether high neighborhood poverty (≥20% of households in census tract living below poverty) was associated with dialysis facility-level lack of pre-ESRD care (percentage of patients with no nephrology care prior to dialysis start) in mixed-effects models, adjusting for facility and neighborhood confounders and allowing for neighborhood and regional random effects.
  
  
  RESULTS
  Among the 5,184 facilities examined, 1,778 (34.3%) were located in a high-poverty area. Lack of pre-ESRD care was similar in poverty areas (30.8%) and other neighborhoods (29.6%). With adjustment, the absolute increase in percentage of patients at a facility with no pre-ESRD care associated with facility location in a poverty area versus other neighborhood was only 0.08% (95% CI -1.32, 1.47; p = 0.9). Potential effect modification by race and income inequality was detected.
  
  
  CONCLUSIONS
  Despite previously reported detrimental effects of neighborhood poverty on health, facility neighborhood poverty was not associated with receipt of pre-ESRD care, suggesting no need to target interventions to increase access to pre-ESRD care at facilities in poorer geographic areas.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Atlanta, Ga., USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Min
authors.initials: M
authors.lastname: Kim
authors.forename: Margarethe
authors.initials: M
authors.lastname: Goetz
authors.forename: David G
authors.initials: DG
authors.lastname: Kleinbaum
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000379:methods*; D012111:Residence Characteristics; D014481:United States