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Abstract: SA-PO1046

Rural vs. Urban Residence and Survival on Chronic Maintenance Dialysis in US Veterans

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Rathi, Naveen, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Boucher, Robert E., University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Greene, Tom, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Hartsell, Sydney Elizabeth, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Gribbin, Karen H., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Bair, Byron, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Eleazer, G Paul, Salt Lake City VAMC, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

Most of the VA dialysis centers are urban. Veterans receiving maintenance hemodialysis (MHD) care in non-VA rural facilities may have ↑ mortality. Hence, rural and urban disparities might explain the better survival of veterans initiating MHD within the VA.

Methods

We examined a national cohort of veterans who initiated MHD from May 2012 to May 2016 by combining United States Renal Data System data obtained from VA Information Resource Center and VA Corporate Data Warehouse data obtained via VA Informatics and Computing Infrastructure. We defined rural and urban residence by zip codes. We used USRDS data to define VA and non-VA dialysis facilities, dialysis quality metrics and time to death.

Results

46,470 veterans were included. VA veterans were younger, less likely to be white, had lower income and higher prevalence of traumatic brain injury and PTSD. However, irrespective of rural or urban residence, veterans who received dialysis care within the VA had better 5-year survival than veterans who received care outside the VA (Fig).

Conclusion

Veterans who received dialysis care within the VA had better survival compared to those who received care outside of the VA regardless of rural or urban residence.

Baseline Characteristics
 Non-VA-care (N=43,900)VA-care (N=2,570)
Urban (N=33,784)Rural (N=10,116)Urban (N=2,150)Rural (N=420)
Age (yr)70 ±1271±1165±1165±10
Male (%)91939697
White (%)69825462
Atherosclerosis (%)19232018
ESRD due to DM (%)36384440
Means Tested Status (%)18212527.2
Traumatic Brain Injury (%)1.21.32.52.4
PTSD (%)11.010.917.017.5

Residence, VA care and 5 year mortality

Funding

  • Veterans Affairs Support