Nephrology Workforce Distribution and Chronic Kidney Disease Burden in Georgia: A Statewide Analysis

Healthcare disparities between rural and urban regions highlight barriers to care, yet access to nephrology services in nonmetropolitan areas remains poorly characterized. This study evaluates the distribution of nephrologists and dialysis centers across Georgia and examines how these patterns relate to county-level chronic kidney disease (CKD) prevalence.

The Georgia All-Payer Claims Database estimated CKD prevalence, the Centers for Medicare & Medicaid Services Dialysis Facility Care Compare database identified dialysis centers, and the Georgia Composite Medical Board Physician Workforce Database located nephrologists. Using 2023 Rural-Urban Continuum Codes, counties were classified as metropolitan (codes 1-3) or nonmetropolitan (codes 4-9). Physician and facility density were calculated per population and land area, and travel burden was estimated using distances from county centroids to the nearest nephrology resource.

A total of 347 nephrologists and 360 dialysis centers were identified across Georgia. Nonmetropolitan counties had higher CKD prevalence than did metropolitan counties (7.02% vs. 6.26%, P=0.002) and lower nephrologist density per 100,000 residents (0.7 vs. 1.8, P<0.001) and per 100 mi² (0.06 vs. 1.29, P<0.001). In addition, nonmetropolitan counties had fewer dialysis centers per 100 mi² (0.22 vs. 1.25, P<0.001). Nonmetropolitan counties experienced longer travel distances to the nearest nephrologist (15.85 vs. 8.19 miles, P<0.001) and dialysis center (9.30 vs. 6.46 mi, P=0.011).

There are significant disparities in CKD burden and access to nephrology care in Georgia. Rural counties experience higher disease prevalence but a reduced availability of specialist services.