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Geography Matters: Relationships among Urban Residential Segregation, Dialysis Facilities, and Patient Outcomes

Rudolph A. Rodriguez, MD; Saunak Sen, PhD; Kala Mehta, DSc; Sandra Moody-Ayers, BSN, MD; Peter Bacchetti, PhD; and Ann M. O'Hare, MD, MA
[+] Article and Author Information

From San Francisco General Hospital, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, and Veterans Affairs San Francisco Research Enhancement Award Program, San Francisco, California.


Note: This manuscript was presented in abstract form at the Renal Disease in Minority Populations and Developing Nations satellite meeting of the International Society of Nephrology, Singapore, 30 June–2 July 2005, and at the Veterans Affairs Health Services Research and Development meeting, Arlington, Virginia, 16–17 February 2006.

Acknowledgments: The authors thank the patients and staff of the dialysis unit at the San Francisco General Hospital for inspiring this study. They also thank Dr. Barbara Grimes for technical assistance in implementing the multiple imputation procedure.

Grant Support: Dr. O'Hare is supported by a Paul Beeson Career Development Award in Aging from the National Institute of Aging (K23 AG 028980-01). This research was also supported by Veterans Affairs Health Services Research and Development Career Development Awards to Drs. O'Hare and Moody-Ayers. Dr. Sen is supported in part by the Veterans Affairs San Francisco Health Services Research and Development Research Enhancement Award Program to Improve Care for Older Veterans.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Rudolph A. Rodriguez, MD, University of California, San Francisco, San Francisco General Hospital, Renal Center Building 100, Room 350, Box 1341, San Francisco, CA 94110; e-mail, rrodriguez@medsfgh.ucsf.edu.

Current Author Addresses: Dr. Rodriguez: University of California, San Francisco, San Francisco General Hospital, Renal Center Building 100, Room 350, Box 1341, San Francisco, CA 94110.

Drs. Sen and Bacchetti: University of California, 185 Berry Street, Suite 5700, San Francisco, San Francisco, CA 94107.

Dr. Mehta, MS. Moody-Ayers, and Dr. O'Hare: San Francisco Veterans Affairs Medical Center, 4150 Clement Street, Box 151G, San Francisco, CA 94121.

Author Contributions: Conception and design: R.A. Rodriguez, A.M. O'Hare.

Analysis and interpretation of the data: R.A. Rodriguez, S. Sen, P. Bacchetti, A.M. O'Hare.

Drafting of the article: R.A. Rodriguez, P. Bacchetti, A.M. O'Hare.

Critical revision of the article for important intellectual content: R.A. Rodriguez, S. Sen, K. Mehta, S. Moody-Ayers, P. Bacchetti, A.M. O'Hare.

Final approval of the article: R.A. Rodriguez, S. Sen, K. Mehta, S. Moody-Ayers, P. Bacchetti, A.M. O'Hare.

Provision of study materials or patients: R.A. Rodriguez, A.M. O'Hare.

Statistical expertise: S. Sen, P. Bacchetti, A.M. O'Hare.

Administrative, technical, or logistic support: R.A. Rodriguez, A.M. O'Hare.

Collection and assembly of data: R.A. Rodriguez, A.M. O'Hare.


Ann Intern Med. 2007;146(7):493-501. doi:10.7326/0003-4819-146-7-200704030-00005
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Published studies have emphasized the importance of patient, provider, and facility characteristics in understanding differences in mortality and transplantation rates among patients receiving dialysis (1011, 14, 2932). Our findings suggest that the residential location of patients receiving dialysis is associated with time to transplantation and that the location of dialysis facilities is associated with achievement of performance targets.

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Figures

Grahic Jump Location
Figure 1.
Kaplan–Meier curve for death, by percentage of black residents in each patient's ZIP code and the race of the patient.

P < 0.001 by log-rank test for both black and white patients living in ZIP codes with fewer than 10% black residents versus those with 75% or more black residents.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Kaplan–Meier curve for transplantation, by percentage of black residents in each patient's ZIP code and the race of the patient.

P < 0.001 by log-rank test for both black and white patients living in ZIP codes with fewer than 10% black residents versus those with 75% or more black residents.

Grahic Jump Location

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