Spatial Disparities in Access to Dialysis Facilities in Texas: An Analysis of End-Stage Renal Data in 1974-2020.

Background/objectives: This study investigates the spatial disparities in access to dialysis facilities across Texas. The objective is to analyze how urbanization and socio-economic/demographic factors influence these disparities, with a focus on differences between urban and rural areas.

Methods: The enhanced two-step floating catchment area method is employed to calculate accessibility scores to dialysis facilities across the state. Additionally, Moran eigenvector spatial filtering is utilized to analyze the influence of urbanization and socio-economic/demographic factors on accessibility disparities.

Results: The Moran eigenvector spatial filtering analysis revealed a significant level of spatial autocorrelation in accessibility scores, particularly highlighting disparities between urban and rural areas. Urban regions, especially major metropolitan areas, achieved higher accessibility scores due to the dense concentration of dialysis facilities. In contrast, rural areas, notably in western and northern Texas, exhibited lower accessibility, underscoring the challenges faced by residents in these regions. The model further identified urbanization and the percentage of the elderly population as critical covariates affecting accessibility, with urban counties showing higher accessibility and elderly populations in rural areas facing significant challenges.

Conclusions: These findings emphasize the importance of considering spatial dependencies in healthcare accessibility studies. They suggest the need for targeted policy interventions to address the identified disparities, particularly in underserved rural regions, to improve access to dialysis facilities for vulnerable populations.