Availability and Quality of Dialysis in Rural Counties with a High Diabetes Burden

Research center:
Lead researcher:
Project funded:
September 2022
Project completed:
March 2024

This project examined the degree to which counties with a high population risk for end stage renal disease, defined by high diabetes prevalence, are served by dialysis providers. It assessed the accessibility and quality of services for end stage renal disease looking for disparities associated with rural residence and racial/ethnic population composition.

We conducted a quantitative cross-sectional analysis of dialysis facility availability at the county level linked to potential community need.

  • Facility addresses were geocoded and assigned to counties for linkage to county-level population data.
  • Facilities were linked to information regarding quality scores using facility identification numbers.
  • As many counties contained multiple facilities, mean and median values were calculated as necessary.
  • Comparisons were made based on level rurality as measured by Urban Influence Codes and across community need and racial composition of counties.
  • Community need was characterized as "high" if the county was in the top quartile for estimated diabetes or chronic kidney disease prevalence; otherwise, low.
  • Need was calculated separately for rural and urban counties as population and disease distributions varied.
  • Availability was measured by count of facilities, count of stations, and the proportion of facilities offering in-center hemodialysis, in-center peritoneal dialysis, and home dialysis training.
  • Quality of ESRD services was assessed by whether the center offered after-hours services (greater patient flexibility), the percent of present patients waitlisted for a transplant (indicates encouragement of this option), the overall CMS star ranking (4-5 v lower), and the Consumer Assessment of Healthcare Providers and Systems Star ranking (4-5 v lower).