In-Center Hemodialysis and Patient Travel Time in Aotearoa New Zealand: A Nationwide Geospatial and Data Linkage Study

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Introduction: Prolonged travel time to receive dialysis is associated with decreased quality of life and increased mortality. However, patient travel time is rarely systematically analyzed during health service planning. This study's aims were as follows: (i) examine spatio-temporal trends in travel time for people commencing dialysis in Aotearoa New Zealand (NZ), (ii) assess the relationship between travel time and dialysis modality, and (iii) create interactive nationwide maps to support renal service planning. Methods: = 6690). Patients' one-way driving times from their residential location to the nearest hemodialysis unit were estimated using geospatial software. Multiple logistic regression modelling explored the association between travel time and dialysis modality, adjusting for demographic, clinical, and service factors. Results: < 0.001). Patients living farther from a unit were independently less likely to receive in-center hemodialysis (0.62 [95% confidence interval, CI: 0.52-0.72] for driving time ≥ 30 minutes; odds ratio, OR: 0.82 [95% CI:0.68-0.99] for 20-29; reference < 10), as were those in regions with greater hemodialysis unit capacity pressure. Our interactive maps demonstrate marked interregional variation in dialysis modality, patient travel time, and unit capacity. Conclusion: Innovative service design is needed to reduce the burden of travel time, particularly for rural dialysis patients. We present novel geospatial techniques to support dialysis service planning that is targeted to the areas of greatest need.

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