Travel Distance to Dialysis and Mortality Among Hemodialysis Patients in a Geographically Small Country.

IF 3.9 3区 医学 Q1 HEALTH POLICY & SERVICES
Chen Namimi-Halevi, Lital Keinan-Boker, Rita Dichtiar, Pazit Beckerman, Michal Bromberg
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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.

一个地理位置小的国家血液透析患者的透析距离和死亡率。
关于小国透析设施可及性与死亡率之间关系的证据有限。本研究评估了旅行距离与以色列终末期肾病(ESRD)患者1年和2年死亡率之间的关系。数据来自国家肾脏替代治疗登记处,包括所有在2010-2021年开始血液透析的年龄≥45岁的以色列ESRD患者。收集了社会人口学(年龄、性别、人口群体)、治疗相关(医院/社区治疗、原发性肾脏疾病、事件年队列)和地理(居住地、社会经济和周边指数)数据。从最近的地址到初始处理设施的旅行距离根据第50和第90百分位数分为三组,不包括异常值(100公里)。调整后的Cox回归评估了旅行距离和死亡率之间的关系,使用事件年队列特定模型评估了时间风险变化。分析包括15606例患者。长距离组(> 26.39 km)的特点是年龄较小,阿拉伯民族,居住在周边地区,社会经济地位较低。与短距离组(≤6.80 km)相比,中距离组(> 6.80,≤26.39 km) 1年死亡率风险比为1.216(1.106 ~ 1.337),2年死亡率风险比为1.181(1.093 ~ 1.275)。长途旅行组1年死亡率HRs为1.718(1.460 ~ 2.021),2年死亡率HRs为1.554 (1.351 ~ 1.787)
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来源期刊
CiteScore
10.80
自引率
1.70%
发文量
113
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.
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