title: Proximity Does Not Equal Access: Racial Disparities in Access to High Quality Dialysis Facilities.
abstract: BACKGROUND
  For patients receiving hemodialysis, distance to their dialysis facility may be particularly important due to the need for thrice weekly dialysis. We sought to determine whether African-Americans and Whites differ in proximity and access to high quality dialysis facilities.
  
  
  METHODS
  We analyzed urban, Whites and African-Americans aged 18-65 receiving in-center hemodialysis linked to data on neighborhood and dialysis facility quality measures. In multivariable analyses, we examined the association between individual and neighborhood characteristics, and our outcomes: distance from home zip code to nearest dialysis facility, their current facility and the nearest high quality facility, as well as likelihood of receiving dialysis in a high quality facility.
  
  
  RESULTS
  African-Americans lived a half mile closer to a dialysis facility (B=-0.52) but traveled the same distance to their own dialysis facility compared to Whites. In initial analysis, African-Americans are 14% less likely than their White counterparts to attend a high quality dialysis facility (OR 0.86); and those disparities persist, though are reduced, even after adjusting for region, neighborhood poverty and percent African-American. In predominately African-American neighborhoods, individuals lived closer to high quality facilities (B=--5.92), but were 53% less likely to receive dialysis there (OR 0.47, highest group versus lowest, p<0.05). Living in a predominately African-American neighborhood explains 24% of racial disparity in attending a high quality facility.
  
  
  CONCLUSIONS
  African-Americans' proximity to high quality facilities does not lead to receiving care there. Institutional and social barriers may also play an important role in where people receive dialysis.
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois ; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.
authors.forename: Milda R
authors.initials: MR
authors.lastname: Saunders
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois ; Department of Sociology, University of Chicago, Chicago, Illinois.
authors.forename: Haena
authors.initials: H
authors.lastname: Lee
authors.affiliation: Social Science Computing Center, GIS Services.
authors.forename: Chieko
authors.initials: C
authors.lastname: Maene
authors.affiliation: Social Science Computing Center, GIS Services.
authors.forename: Todd
authors.initials: T
authors.lastname: Schuble
authors.affiliation: Department of Sociology, University of Chicago, Chicago, Illinois ; Population Research Center, NORC at the University of Chicago, Chicago, Illinois.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Cagney
keywords: access; hemodialysis; quality of care; racial disparity