Geographic disparities in kidney replacement therapy and patient outcomes - does the place of living matter?
Geographic residence affects access to health services, and people living in remote areas may face barriers such as lower patient-physician ratio, lower quality of care, and poorer outcomes. In Norway, life expectancy, morbidity and mortality, as well as sociodemographic characteristics vary between the different counties According to data from Norwegian Cause of Death Registry, the northernmost County of Finnmark has the lowest life expectancy in the country.
A study from 2015 demonstrated that patients receiving kidney replacement therapy (KRT; dialysis and kidney transplantation), residing in Finnmark County, had poorer survival than those living in Troms and Nordland Counties. However, the study did not consider effect of the type of KRT, patients’ residence or socioeconomic factors. About 18 % of Norwegian inhabitants live in rural settlements. Still, little is known about how proximity to secondary health care affects quality of care and survival of Norwegian kidney transplant patients and patients treated with maintenance hemodialysis.
Whether the poor prognosis of patients in Finnmark is mainly due to health factors negatively associated with survival or by other, geography specific factors, is not clear.
Our study aims to investigate the geographic disparities in access to nephrology care in Norway. Factors potentially affecting survival and treatment quality of kidney transplant patients and hemodialysis patients, such as density of dialysis units and centers with onsite nephrologist, will be explored.
The results may reveal a need to evaluate and modify the organization of nephrology care in order to improve the outcomes of remotely living patients.
In this research project we use data from the Norwegian Renal Registry and Statistics Norway to study whether distance from individual patient’s residence to the nearest dialysis unit and/or nephrologist, can explain mortality and morbidity in people receiving KRT, or whether socioeconomic, demographic or comorbidity factors are more important.
We collaborate closely with Professor Aminu Bello and his group at the University of Alberta, Edmonton, Canada, and study similar associations in persons with CKD, persons on dialysis and transplanted patients registered in the Alberta Kidney Network Database.