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Inequalities in rates of renal replacement therapy in England: does it matter who you are or where you live?

Inequalities in rates of renal replacement therapy in England: does it matter who you are or where you live?
Inequalities in rates of renal replacement therapy in England: does it matter who you are or where you live?
Introduction. This study explores the geographical variation in renal replacement therapy (RRT) incidence and prevalence after adjusting for general population socio-demographics, renal unit treatment patterns and travel times.

Methods. The UK Renal Registry provided data on all patients in England commencing RRT in 2007 and receiving RRT on 31 December 2007. Multilevel Poisson regression models were constructed separately for incidence and prevalence. Geographical Information Systems software enabled estimation of road travel times and renal unit catchment areas. Small area estimates of RRT prevalence were produced for all 354 local authority districts.

Results. Adjusted RRT incidence rates were 1.4 (95% confidence interval 1.2–1.6) times higher in the most deprived areas and 1.7 (1.5–2.0) and 1.5 (1.3–1.7) times higher in areas with most Black and South Asian inhabitants (10+%), respectively. The proportion of a centre’s patients on haemodialysis or transplanted were positively associated with RRT incidence (not prevalence); numbers of satellite units were negatively associated with RRT incidence (not prevalence). While only 3% of patients lived >30 min from a dialysis unit, there was an effect of travel time on RRT rates; individuals living 45+ min from a dialysis unit were 20% less likely to commence or receive RRT than those living within 15 min (Ptrend = 0.36 and Ptrend < 0.001, respectively). A 4-fold variation in adjusted local authority district RRT prevalence rates could not be explained.

Conclusion. Expansion of renal unit facilities in England has reduced travel times in most areas though the possibility of inequitable geographic access to RRT persists.
dialysis, inequalities, renal replacement therapy, travel times
0931-0509
1598-607
Judge, Andy
a7b98e8c-fd10-42be-a35a-ca6359038f95
Caskey, Fergus J.
028fef54-dffa-460a-98ff-99e90a0d2f56
Welton, Nicky J.
0af4518d-a999-469c-a46c-4a77fea140aa
Ansell, David
9c009488-5612-4d05-9389-15dd3e238a7c
Tomson, Charles R.V.
becceeb5-d43f-478f-b848-5ce30fd8caad
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Ben-Shlomo, Yoav
df80bd02-a908-4296-b293-825d42203729
Judge, Andy
a7b98e8c-fd10-42be-a35a-ca6359038f95
Caskey, Fergus J.
028fef54-dffa-460a-98ff-99e90a0d2f56
Welton, Nicky J.
0af4518d-a999-469c-a46c-4a77fea140aa
Ansell, David
9c009488-5612-4d05-9389-15dd3e238a7c
Tomson, Charles R.V.
becceeb5-d43f-478f-b848-5ce30fd8caad
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Ben-Shlomo, Yoav
df80bd02-a908-4296-b293-825d42203729

Judge, Andy, Caskey, Fergus J., Welton, Nicky J., Ansell, David, Tomson, Charles R.V., Roderick, Paul J. and Ben-Shlomo, Yoav (2012) Inequalities in rates of renal replacement therapy in England: does it matter who you are or where you live? Nephrology, Dialysis, Transplantation, 27 (4), 1598-607. (doi:10.1093/ndt/gfr466). (PMID:21878474)

Record type: Article

Abstract

Introduction. This study explores the geographical variation in renal replacement therapy (RRT) incidence and prevalence after adjusting for general population socio-demographics, renal unit treatment patterns and travel times.

Methods. The UK Renal Registry provided data on all patients in England commencing RRT in 2007 and receiving RRT on 31 December 2007. Multilevel Poisson regression models were constructed separately for incidence and prevalence. Geographical Information Systems software enabled estimation of road travel times and renal unit catchment areas. Small area estimates of RRT prevalence were produced for all 354 local authority districts.

Results. Adjusted RRT incidence rates were 1.4 (95% confidence interval 1.2–1.6) times higher in the most deprived areas and 1.7 (1.5–2.0) and 1.5 (1.3–1.7) times higher in areas with most Black and South Asian inhabitants (10+%), respectively. The proportion of a centre’s patients on haemodialysis or transplanted were positively associated with RRT incidence (not prevalence); numbers of satellite units were negatively associated with RRT incidence (not prevalence). While only 3% of patients lived >30 min from a dialysis unit, there was an effect of travel time on RRT rates; individuals living 45+ min from a dialysis unit were 20% less likely to commence or receive RRT than those living within 15 min (Ptrend = 0.36 and Ptrend < 0.001, respectively). A 4-fold variation in adjusted local authority district RRT prevalence rates could not be explained.

Conclusion. Expansion of renal unit facilities in England has reduced travel times in most areas though the possibility of inequitable geographic access to RRT persists.

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More information

e-pub ahead of print date: 30 August 2011
Published date: 4 April 2012
Keywords: dialysis, inequalities, renal replacement therapy, travel times
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 335410
URI: http://eprints.soton.ac.uk/id/eprint/335410
ISSN: 0931-0509
PURE UUID: ea7b7863-3824-438a-aa34-65cad436999e
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 13 Mar 2012 11:16
Last modified: 26 Nov 2021 02:37

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Contributors

Author: Andy Judge
Author: Fergus J. Caskey
Author: Nicky J. Welton
Author: David Ansell
Author: Charles R.V. Tomson
Author: Yoav Ben-Shlomo

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