Effects of health service geographic accessibility in patients with treated end stage kidney disease: Cohort study 2000–2010

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The number of people requiring renal replacement therapy (RRT) continues to rise globally.1 RRT provision is expensive – the cost in the United States was USD$47.5b in 2010, while in Australia, costs are expected to rise to almost AUD$12.3b by 2019.3 Provision of RRT requires coordinated comprehensive care. The large landmass, low population density and a sizable rural population makes countries such as USA, Canada and Australia, especially vulnerable to the challenges in service provision.
Rural residents have a different experience of health services. Rurality has been associated with higher mortality and, in Australia, inferior access to preventive and acute health services.5 Rurality also impacts upon patterns of renal service use, as rural residents use a lower proportion of dialysis care compared with their urban counterparts.9
Patients receiving RRT are frequent users of healthcare services especially inpatient services. However, hospitalization rates and length of hospital stay have not been compared, and other differences in renal care are less clear. For example, there has not been adjustment for the differing comorbid burden and socio‐economic status in rural patients nor measurement of differences in hospitalization rates.12 An understanding of the differing patterns of healthcare utilization for people living in rural areas is therefore necessary to inform renal service planning.
We aimed to compare health service utilization and survival between rural and urban patients in receipt of RRT by linking administrative datasets with the Australia and New Zealand Dialysis and Transplant Registry – ANZDATA).
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