Geographic inequities in hemodialysis access: a call to reassess dialysis facility locations in Brazil.
Chronic kidney failure
Dialysis
Hemodialysis units
Spatial analysis
Journal
Journal of nephrology
ISSN: 1724-6059
Titre abrégé: J Nephrol
Pays: Italy
ID NLM: 9012268
Informations de publication
Date de publication:
25 Oct 2024
25 Oct 2024
Historique:
received:
15
06
2024
accepted:
17
09
2024
medline:
25
10
2024
pubmed:
25
10
2024
entrez:
25
10
2024
Statut:
aheadofprint
Résumé
Patients who travel more than 60 min to undergo hemodialysis may experience higher mortality and lower quality of life. The primary aim of this study was to calculate the travel distance between patient city areas and dialysis facility care locations in Brazil, to highlight barriers and need to optimize access to chronic dialysis. We conducted a retrospective cohort study using claims data from the Brazilian Public Health System's database, focusing on kidney replacement therapy (KRT) by hemodialysis. Our study population comprised all patients undergoing hemodialysis in Brazil between January 2023 and December 2023. For patients from different city areas, we calculated the Haversine distance between the patient city area and the dialysis facility. We evaluated 154,788 patients who received hemodialysis funded by the Brazilian Public Health System. Fifty-nine percent of the patients underwent dialysis in the same city area. Overall, patients traveled a median (IQR) distance of 35.9 [19.5 - 64.2] kilometers to the facilities, 48% traveled more than 40 km, with a maximum traveling distance of 353 km. Notably, the median distance traveled was shortest in the Southeast (27.6 km) and longest in the North (84.3 km). The number of patients that traveled more than 40 km was lower in the Southeast (32%) and higher in the North region (77%). The travel distance to the dialysis facility is an important inequity to KRT access in Brazil. In the South and Southeast, where there is a higher dialysis unit density, patients have greater regional availability of dialysis centers, and shorter traveling distances than in the North, Midwest, and Northeast regions.
Sections du résumé
BACKGROUND
BACKGROUND
Patients who travel more than 60 min to undergo hemodialysis may experience higher mortality and lower quality of life. The primary aim of this study was to calculate the travel distance between patient city areas and dialysis facility care locations in Brazil, to highlight barriers and need to optimize access to chronic dialysis.
METHODS
METHODS
We conducted a retrospective cohort study using claims data from the Brazilian Public Health System's database, focusing on kidney replacement therapy (KRT) by hemodialysis. Our study population comprised all patients undergoing hemodialysis in Brazil between January 2023 and December 2023. For patients from different city areas, we calculated the Haversine distance between the patient city area and the dialysis facility.
RESULTS
RESULTS
We evaluated 154,788 patients who received hemodialysis funded by the Brazilian Public Health System. Fifty-nine percent of the patients underwent dialysis in the same city area. Overall, patients traveled a median (IQR) distance of 35.9 [19.5 - 64.2] kilometers to the facilities, 48% traveled more than 40 km, with a maximum traveling distance of 353 km. Notably, the median distance traveled was shortest in the Southeast (27.6 km) and longest in the North (84.3 km). The number of patients that traveled more than 40 km was lower in the Southeast (32%) and higher in the North region (77%).
CONCLUSION
CONCLUSIONS
The travel distance to the dialysis facility is an important inequity to KRT access in Brazil. In the South and Southeast, where there is a higher dialysis unit density, patients have greater regional availability of dialysis centers, and shorter traveling distances than in the North, Midwest, and Northeast regions.
Identifiants
pubmed: 39453603
doi: 10.1007/s40620-024-02120-5
pii: 10.1007/s40620-024-02120-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.
Références
Barra ABL, da Silva APR, Canziani MEF et al (2023) Survival in hemodialysis in Brazil according to the source of payment for the treatment: Public Healthcare System (SUS) versus private insurance. J Bras Nefrol 45:302–309. https://doi.org/10.1590/2175-8239-JBN-2022-0131en
doi: 10.1590/2175-8239-JBN-2022-0131en
pubmed: 36662571
pmcid: 10697161
Nerbass FB, Lima H, do N, Thomé FS, et al (2023) Brazilian Dialysis Survey 2021. J Bras Nefrol 45:192–198. https://doi.org/10.1590/2175-8239-JBN-2022-0083en
doi: 10.1590/2175-8239-JBN-2022-0083en
pubmed: 36345998
Coube M, Nikoloski Z, Mrejen M, Mossialos E (2023) Inequalities in unmet need for health care services and medications in Brazil: a decomposition analysis. Lancet Reg Health Am 19:100426. https://doi.org/10.1016/j.lana.2022.100426
doi: 10.1016/j.lana.2022.100426
pubmed: 36950032
pmcid: 10025415
Paim J, Travassos C, Almeida C et al (2011) The Brazilian health system: history, advances, and challenges. Lancet 377:1778–1797. https://doi.org/10.1016/S0140-6736(11)60054-8
doi: 10.1016/S0140-6736(11)60054-8
pubmed: 21561655
Moist LM, Bragg-Gresham JL, Pisoni RL et al (2008) Travel time to dialysis as a predictor of health-related quality of life, adherence, and mortality: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 51:641–650. https://doi.org/10.1053/j.ajkd.2007.12.021
doi: 10.1053/j.ajkd.2007.12.021
pubmed: 18371540
DATASUS – Ministério da Saúde. https://datasus.saude.gov.br/ . Accessed 21 Jul 2022
Robert J. Hijmans (2022) geosphere: Spherical Trigonometry. R package version 1.5–18. https://CRAN.R-project.org/package=geosphere . Accessed 21 July 2022
2022 Census | IBGE. https://www.ibge.gov.br/en/statistics/social/labor/22836-2022-census-3.html . Accessed 17 Feb 2024
IBGE | Portal do IBGE | IBGE. https://www.ibge.gov.br/en/about-us/about-the-ibge/15312-geographical-divisions.html . Accessed 24 July 2024
Estimates of resident population for Municipalities and Federation Units | IBGE. https://www.ibge.gov.br/en/statistics/social/population/18448-estimates-of-resident-population-for-municipalities-and-federation-units.html?=&t=resultados . Accessed 21 July 2022
Sesso R, Lugon JR (2020) Global dialysis perspective: Brazil. Kidney 360(1):216–219. https://doi.org/10.34067/KID.0000642019
doi: 10.34067/KID.0000642019
McDonald SP, Ullah S, Dansie K et al (2023) The burden of travel-time and distance traveled for hemodialysis patients in Australian major city areas. Kidney Int Rep 8:1105–1108. https://doi.org/10.1016/j.ekir.2023.02.1077
doi: 10.1016/j.ekir.2023.02.1077
pubmed: 37180500
pmcid: 10166733
de Oliveira Soares AC, Cattafesta M, Paixão MPCP et al (2022) Determinants of access to hemodialysis services in a metropolitan region of Brazil. BMC Public Health 22:1868. https://doi.org/10.1186/s12889-022-14258-7
doi: 10.1186/s12889-022-14258-7
pubmed: 36207731
pmcid: 9541085
Lewis RA, Bohm C, Fraser F et al (2023) Transportation Burden Associated With Hemodialysis in Canada: A Qualitative Study of Stakeholders. Kidney Med 5:100571. https://doi.org/10.1016/j.xkme.2022.100571
doi: 10.1016/j.xkme.2022.100571
pubmed: 36686595
Yazawa M, Omae K, Shibagaki Y et al (2020) The effect of transportation modality to dialysis facilities on health-related quality of life among hemodialysis patients: results from the Japanese Dialysis Outcomes and Practice Pattern Study. Clin Kidney J 13:640–646. https://doi.org/10.1093/ckj/sfz110
doi: 10.1093/ckj/sfz110
pubmed: 32897276
Hemmige V, Deshpande P, Norris KC et al (2024) Geographic dialysis facility density and early dialysis initiation. JAMA Netw Open 7:e2350009. https://doi.org/10.1001/jamanetworkopen.2023.50009
doi: 10.1001/jamanetworkopen.2023.50009
pubmed: 38170525
pmcid: 10765261