Transportation Insecurity and Outcomes in Hemodialysis Patients: A Retrospective Cohort Study

Area of Science:

• Nephrology
• Public Health
• Health Services Research

Background:

• Transportation insecurity is a significant social risk for patients with end-stage kidney disease (ESKD) undergoing in-center hemodialysis (HD).
• Addressing transportation barriers may enhance dialysis access and reduce ESKD-related mortality and complications.

Purpose of the Study:

• To investigate the association between modes of transportation and missed dialysis treatments and mortality in adults with ESKD.
• To identify the impact of lacking private transportation on patient outcomes.

Main Methods:

• Retrospective national cohort study (April 2022-March 2023) including 115,982 adult ESKD patients on in-center HD.
• Primary outcomes: missed dialysis treatments and all-cause mortality.
• Primary exposure: mode of transportation to dialysis (private vs. non-private options).

Main Results:

• 27% of patients lacked private transportation (self-driven or friend/family).
• Non-private transportation (Medicaid, paratransit, NEMT, public transit) was associated with higher mortality and increased likelihood of missed dialysis treatments.
• Adjusted Incident Rate Ratios (aIRRs) for mortality ranged from 1.09 to 1.70; for missed dialysis, from 1.15 to 2.78, depending on the transportation mode.

Conclusions:

• A lack of private transportation is significantly linked to increased risks of missed dialysis treatments and mortality in ESKD patients.
• Transportation modality is a critical factor influencing treatment adherence and survival in the ESKD population.
• Interventions targeting transportation insecurity could improve health equity and outcomes for dialysis patients.