title: Rural Versus Urban Health Service Utilization and Outcomes for Renal Patients in New South Wales: Protocol for a Data Linkage Study.
abstract: BACKGROUND
  Kidney disease is a significant burden on health systems globally, with the rising prevalence of end stage kidney disease in Australia mirrored in many other countries. Approximately 25% of the Australian population lives in regional and rural areas and accessing complex tertiary services is challenging.
  
  
  OBJECTIVE
  We aim to compare the burden and outcomes of chronic kidney disease and end stage kidney disease in rural and urban regions of New South Wales (Australia's most populous state) using linked health data.
  
  
  METHODS
  This is a retrospective cohort study and we have defined two cohorts: one with end stage kidney disease and one with chronic kidney disease. The end stage kidney disease cohort was defined using the Australia and New Zealand Dialysis and Transplant Registry, identifying all patients living in NSW receiving renal replacement therapy at any time between 01/07/2000 and 31/07/2010. The chronic kidney disease cohort used the NSW Admitted Patient Data Collection (APDC) to identify patients with a diagnostic code relating to chronic renal failure during any admission between 01/07/2000 and 31/07/2010. Both cohorts were linked to the NSW APDC, the Registry of Births, Deaths and Marriages, and the Central Cancer Registry allowing derivation of outcomes by categories of geographical remoteness.
  
  
  RESULTS
  To date, we have identified 10,505 patients with 2,384,218 records in the end stage kidney disease cohort and 159,033 patients with 1,599,770 records in the chronic kidney disease cohort.
  
  
  CONCLUSIONS
  This study will define the geographical distribution of end stage and chronic kidney disease and compare the health service utilization between rural and urban renal populations.
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia. skotwal@georgeinstitute.org.au.
authors.forename: Sradha
authors.identifier: http://orcid.org/0000-0002-3294-4087
authors.initials: S
authors.lastname: Kotwal
authors.forename: Angela
authors.identifier: http://orcid.org/0000-0001-7509-0512
authors.initials: A
authors.lastname: Webster
authors.forename: Alan
authors.identifier: http://orcid.org/0000-0002-3923-3173
authors.initials: A
authors.lastname: Cass
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0001-9187-6187
authors.initials: M
authors.lastname: Gallagher
keywords: chronic kidney disease; cohort study; data linkage; dialysis; end stage kidney disease; kidney transplant; rural health care