Chen Namimi-Halevi, Lital Keinan-Boker, Rita Dichtiar, Pazit Beckerman, Michal Bromberg
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引用次数: 0
Abstract
Evidence on the association between dialysis facility accessibility and mortality in small countries is limited. This study evaluated the association between travel distance and one- and two-year mortality among Israeli end-stage renal disease (ESRD) patients. Data were obtained from the National Renal Replacement Therapy Registry, encompassing all Israeli ESRD patients aged ≥ 45 years who initiated hemodialysis in 2010-2021. Sociodemographic (age, sex, population group), treatment-related (hospital/community treatment, primary renal disease, incident-year cohort), and geographic (residency socioeconomic and peripherality indices) data were collected. Travel distances from the most recent address to the initial treating facility were categorized into three groups based on the 50th and 90th percentiles, excluding outliers (> 100 km). Adjusted Cox regressions assessed associations between travel distances and mortality, with incident-year cohort-specific models evaluating temporal hazard variations. Analyses included 15,606 patients. The long-distance group (> 26.39 km) was characterized by younger age, Arab ethnicity, peripheral residence, and lower socioeconomic status. Compared to the short-distance group (≤ 6.80 km), the hazard ratios (HRs) in the intermediate-distance group (> 6.80 and ≤ 26.39 km) were 1.216 (1.106-1.337) for one-year and 1.181 (1.093-1.275) for two-year mortality. In the long-distance group, the HRs were 1.718 (1.460-2.021) for one-year and 1.554 (1.351-1.787) for two-year mortality (P-for-trend between travel distances <.001). Sensitivity and temporal analyses confirmed consistent associations across incident-year cohorts, alternative cut-offs, and outlier inclusion. The association between travel distance and mortality highlights the need to improve geographic accessibility to healthcare to reduce inequities, especially for life-sustaining chronic treatments such as hemodialysis.
期刊介绍:
The Journal of Community Health is a peer-reviewed publication that offers original articles on research, teaching, and the practice of community health and public health. Coverage includes public health, epidemiology, preventive medicine, health promotion, disease prevention, environmental and occupational health, health policy and management, and health disparities. The Journal does not publish articles on clinical medicine. Serving as a forum for the exchange of ideas, the Journal features articles on research that serve the educational needs of public and community health personnel.