title: The association between geographic proximity to a dialysis facility and use of dialysis catheters.
abstract: BACKGROUND
  Residing remotely from health care resources appears to impact quality of care delivery. It remains unclear if there are differences in vascular access based on distance of one's residence to dialysis centre at time of dialysis initiation, and whether region or duration of pre-dialysis care are important effect modifiers.
  
  
  METHODS
  We studied the association of distance from a patients' residence to the nearest dialysis centre and central venous catheter (CVC) use in an observational study of 26,449 incident adult dialysis patients registered in the Canadian Organ Replacement Registry between 2000-2009. Multivariate logistic regression was used to assess the association between distance in tertiles and CVC use, adjusted for patient demographics and comorbidities. Geographic region and duration of pre-dialysis care were examined as potential effect modifiers.
  
  
  RESULTS
  Eighty percent of patients commenced dialysis with a CVC. Incident CVC use was highest among those living > 20 km from the dialysis centre (OR 1.29 (1.24-1.34)) compared to those living < 5 km from centre. The length of pre-dialysis care and geographic region were significant effect modifiers; among patients residing in the furthest tertile (>20 km) from the nearest dialysis centre, incident CVC use was more common with shorter length of pre-dialysis care (< 1 year) and residence in central regions of the country.
  
  
  CONCLUSIONS
  Residing further from a dialysis centre is associated with increased CVC use, an effect modified by shorter pre-dialysis care and the geographic region of the country. Efforts to reduce geographical disparities in pre dialysis care may decrease CVC use.
authors.affiliation: Health Science Centre, Winnipeg, MB, Canada. lmiller@hsc.mb.ca.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Miller
authors.forename: Lavern M
authors.initials: LM
authors.lastname: Vercaigne
authors.forename: Louise
authors.initials: L
authors.lastname: Moist
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Julie
authors.initials: J
authors.lastname: Mojica
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D002170:Canada / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D062905:Central Venous Catheters / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000628:therapy*; D062211:Spatio-Temporal Analysis; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014600:Utilization Review