Geographic variation in access among adults with kidney disease: Evidence from medical expenditure panel survey, 2002-2011

Background: To understand geographic variation in access to care over time in patients with kidney disease. Methods: We analyzed 4404 (weighted sample of 4,251,129) adults with kidney disease from the United States using the Medical Expenditure Panel Survey over 10 years. Three dependent variables were created to investigate variation in access: usual source of care, overall medical access to care, which took into account usual source of care, ability to get care, and delay in care, and prescription access, which took into account ability to get prescriptions and delay in getting prescriptions. Multiple logistic regression was used with geographic region as the main independent variable, adjusting for relevant covariates. Results: Compared to the Northeast region, adults living in the Midwest (OR = 0.56; 95 % CI 0.35-0.89), South (OR = 0.48; 95 % CI 0.32-0.72) and West (OR = 0.53; 95 % CI 0.34-0.84) had significantly lower odds of reporting usual source of care. For the combined access measure, compared to Northeast, adults in Midwest (OR = 0.60; 95 % CI 0.40-0.88), South (OR = 0.62; 95 % CI 0.44-0.88) and West (OR = 0.50; 95 % CI 0.34-0.72) had significantly lower odds of medical access to care. Region was not significantly associated with the odds of having prescription access, though a significant increase in prescription access was observed over time. Conclusions: Geographic variation in access to care among adults with kidney disease exists independent of income, education, insurance and comorbid conditions, with those in the South least likely to have a usual source of care and those in the West least likely to have overall access to care when compared to the Northeast United States.