title: Travel distance and home dialysis rates in the United States.
abstract: BACKGROUND
  Rural residence is associated with increased peritoneal dialysis (PD) utilization. The influence of travel distance on rates of home dialysis utilization has not been examined in the United States. The purpose of this study was to determine whether travel distances to the closest home and in-center hemodialysis (IHD) facilities are a barrier to home dialysis. ♢
  
  
  METHODS
  This was a retrospective cohort study of patients aged ≥ 18 years initiating dialysis between 2005 and 2011. Unadjusted PD and home hemodialysis (HHD) rates were compared by travel distances to both the closest home dialysis and closest IHD facilities. Adjusted PD and HHD utilization rates were examined using multivariable logistic regression models. ♢
  
  
  RESULTS
  There were 98,608 patients in the adjusted analyses. 55.5% of the dialysis facilities offered home dialysis. IHD, PD and HHD patients traveled median distances of 5.4, 3.5 and 6.6 miles respectively to their initial dialysis facilities. Unadjusted analyses showed an increase in PD rates and decrease in HHD rates with increased travel distances. Adjusted odds of PD and HHD were 1.6 and 1.2 respectively for a ten mile increase in distance to the closest home dialysis facility, while for distances to the closest IHD facility the odds ratios for both PD and HHD were 0.7 (all p < 0.01). ♢
  
  
  CONCLUSIONS
  In metropolitan areas, PD and HHD generally increased with increased travel distance to the closest home dialysis facility and decreased with greater distance to an IHD facility. Examination of travel distances to PD and HHD facilities separately may provide further insight on specific barriers to these modalities which can serve as targets for future studies examining expansion of home dialysis utilization.
authors: Case Western Reserve University,1 Cleveland, Ohio, USA;
authors: Suma
authors: S
authors: Prakash
authors: Rick
authors: R
authors: Coffin
authors: Jesse
authors: J
authors: Schold
authors: Steven A
authors: SA
authors: Lewis
authors: Douglas
authors: D
authors: Gunzler
authors: Susan
authors: S
authors: Stark
authors: Matthew
authors: M
authors: Howard
authors: Darlene
authors: D
authors: Rodgers
authors: Douglas
authors: D
authors: Einstadter
authors: Ashwini R
authors: AR
authors: Sehgal
mesh_terms: D000554:Ambulatory Care Facilities; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006437:Hemodialysis, Home / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data*; D014481:United States
keywords: Peritoneal dialysis; United States; home hemodialysis; predictors of home dialysis; travel distances