title: Association of U.S. Dialysis facility neighborhood characteristics with facility-level kidney transplantation.
abstract: BACKGROUND
  Improving access to optimal healthcare may depend on the attributes of neighborhoods where patients receive healthcare services. We investigated whether the characteristics of dialysis facility neighborhoods--where most patients with end-stage renal disease are treated--were associated with facility-level kidney transplantation.
  
  
  METHODS
  We examined the association between census tract (neighborhood)-level sociodemographic factors and facility-level kidney transplantation rate in 3,983 U.S. dialysis facilities where kidney transplantation rates were high. Number of kidney transplants and total person-years contributed at the facility level in 2007-2010 were obtained from the Dialysis Facility Report and linked to the census tract data on sociodemographic characteristics from the American Community Survey 2006-2010 by dialysis facility location. We used multivariable Poisson models with generalized estimating equations to estimate the link between the neighborhood characteristics and transplant incidence.
  
  
  RESULTS
  Dialysis facilities in the United States were located in neighborhoods with substantially greater proportions of black and poor residents, relative to the national average. Most facility neighborhood characteristics were associated with transplant, with incidence rate ratios (95% CI) for standardized increments (in percentage) of neighborhood exposures of: living in poverty, 0.88 (0.84-0.92), black race, 0.83 (0.78-0.89); high school graduates, 1.22 (1.17-1.26); and unemployed, 0.90 (0.85-0.95).
  
  
  CONCLUSIONS
  Dialysis facility neighborhood characteristics may be modestly associated with facility rates of kidney transplantation. The success of dialysis facility interventions to improve access to kidney transplantation may partially depend on reducing neighborhood-level barriers.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Atlanta, Ga., USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Plantinga
authors.forename: Stephen
authors.initials: S
authors.lastname: Pastan
authors.forename: Michael
authors.initials: M
authors.lastname: Kramer
authors.forename: Ann
authors.initials: A
authors.lastname: McClellan
authors.forename: Jenna
authors.initials: J
authors.lastname: Krisher
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000554:Ambulatory Care Facilities; D002391:Catchment Area, Health / Q000191:economics*; D004522:Educational Status; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D011203:Poverty; D006435:Renal Dialysis; D014478:Unemployment; D014481:United States