• Open Access

Geographic Disparities in Patient Travel for Dialysis in the United States


  • This study was sponsored by Amgen Inc. Employees of Amgen participated in the study design and interpretation of the data, and in reviewing, revising, and providing final approval of this manuscript. Stephan C. Dunning has received research and consulting fees from Amgen Inc. John J. Kochevar received consulting and research fees from Amgen Inc. J. Mark Stephens has received consulting and research fees from Amgen Inc. Samuel Brotherton received funds from Kochevar Research Associates and Prima Health Analytics. Ann C. McClellan, Larry C. Emerson, and David T. Gilbertson have received consulting fees and travel reimbursement fees from Amgen Inc. William M. McClellan has received research grant funding and consulting fees from Amgen Inc. David J. Harrison, Shaowei Wan, and Matthew Gitlin are/were employees of Amgen Inc., and own stock or stock options in Amgen Inc. The authors wish to thank Mandy Suggitt who provided editing and graphics support on behalf of Amgen Inc.

For further information, contact: J. Mark Stephens, BA, Prima Health Analytics, 49 Bald Eagle Road, Weymouth, MA 02190; e-mail: jmarkstephens@gmail.com.



To estimate travel distance and time for US hemodialysis patients and to compare travel of rural versus urban patients.


Dialysis patient residences were estimated from ZIP code-level patient counts as of February 2011 allocated within the ZIP code proportional to census tract-level population, obtained from the 2010 US Census. Dialysis facility addresses were obtained from Medicare public-use files. Patients were assigned to an “original” and “replacement” facility, assuming patients used the facility closest to home and would select the next closest facility as a replacement, if a replacement facility was required. Driving distances and times were calculated between patient residences and facility locations using GIS software.


The mean one-way driving distance to the original facility was 7.9 miles; for rural patients average distances were 2.5 times farther than for urban patients (15.9 vs 6.2 miles). Mean driving distance to a replacement facility was 10.6 miles, with rural patients traveling on average 4 times farther than urban patients to a replacement facility (28.8 vs 6.8 miles).


Rural patients travel much longer distances for dialysis than urban patients. Accessing alternative facilities, if required, would greatly increase rural patient travel, while having little impact on urban patients. Increased travel could have clinical implications as longer travel is associated with increased mortality and decreased quality of life.