Abstract: SA-PO1046
Rural vs. Urban Residence and Survival on Chronic Maintenance Dialysis in US Veterans
Session Information
- Hemodialysis and Frequent Dialysis - VI
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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 ±12 | 71±11 | 65±11 | 65±10 |
Male (%) | 91 | 93 | 96 | 97 |
White (%) | 69 | 82 | 54 | 62 |
Atherosclerosis (%) | 19 | 23 | 20 | 18 |
ESRD due to DM (%) | 36 | 38 | 44 | 40 |
Means Tested Status (%) | 18 | 21 | 25 | 27.2 |
Traumatic Brain Injury (%) | 1.2 | 1.3 | 2.5 | 2.4 |
PTSD (%) | 11.0 | 10.9 | 17.0 | 17.5 |
Residence, VA care and 5 year mortality
Funding
- Veterans Affairs Support