A recent study highlights a troubling disparity in healthcare access, showing that as the level of socioeconomic disadvantage in communities rises, the availability of dialysis facilities significantly diminishes. This finding comes from a research letter released online on February 23 in JAMA Internal Medicine.
The investigation was spearheaded by Yu-Chu Shen, Ph.D., who serves in the Department of Defense Management in Monterey, California, alongside Renee Y. Hsia, M.D., from the University of California, San Francisco. Their work specifically delved into how geographic proximity to dialysis centers might differ based on the socioeconomic conditions of various communities across the nation.
To conduct this comprehensive analysis, the researchers utilized the Area Deprivation Index (ADI), a metric calculated at the ZIP code level using data from 2020. This index provides a robust measure of community disadvantage by incorporating multiple socioeconomic factors. They drew upon national data from the CMS Dialysis Facility Care Compare database, U.S. Census information, and broader social determinants of health (SDOH) datasets covering the period from January to December 2025.
In their examination, the team pinpointed a total of 6,961 dialysis facilities equipped for hemodialysis. These centers were situated within a 30-minute driving distance from 23,737 out of the 33,338 communities studied. Notably, among these, 21,881 communities had valid ADI values, encompassing approximately 307 million individuals out of the nation’s total population of 327 million people.
The results painted a stark picture of inequality. Communities classified as the most disadvantaged exhibited markedly reduced access to essential dialysis services. Specifically, while only 2.3% of the most advantaged communities lacked a dialysis facility within a 30-minute drive, this figure jumped to 11.7% for the most disadvantaged areas. This disparity translates to an odds ratio of 5.56, underscoring a substantially higher likelihood of inadequate access in underprivileged neighborhoods.
Furthermore, the average number of dialysis stations available within 30 minutes per 1,000 residents showed a considerable decline across the socioeconomic spectrum. In the most advantaged communities, this averaged 31.0 stations per 1,000 residents, but it dropped sharply to just 13.2 stations per 1,000 residents in the most disadvantaged ones. Such differences highlight systemic barriers that could critically impact patient outcomes, particularly for those relying on regular hemodialysis treatments to manage end-stage renal disease.
The researchers emphasized the broader implications of their discoveries in their concluding remarks. They stated, “Our findings underscore the importance of regulatory oversight and incorporating community-level SDOH data, like ADI, into payment adjustment and infrastructure planning to prioritize equity and efficiency in health care services.” This call to action suggests that policymakers and healthcare administrators must integrate these socioeconomic metrics into future planning to bridge existing gaps.
By advocating for the use of tools like the ADI in regulatory frameworks, the study proposes a pathway toward more equitable distribution of vital healthcare resources. This approach could involve targeted investments in infrastructure for underserved areas, revised payment models that incentivize facility placement in disadvantaged ZIP codes, and ongoing monitoring to ensure compliance and effectiveness.
The significance of dialysis access cannot be overstated, as hemodialysis is a life-sustaining therapy for patients with kidney failure. Delays or inability to reach treatment centers promptly can lead to severe health complications, increased hospitalization rates, and even higher mortality risks. Therefore, addressing these geographic and socioeconomic disparities is not merely a matter of fairness but a critical public health imperative.
This research contributes valuable evidence to the growing body of literature on health inequities, particularly in nephrology. It builds on prior studies that have noted similar patterns in other aspects of dialysis care, such as transplantation knowledge gaps among staff or hospitalization trends linked to demographic factors. However, this analysis stands out for its national scope and use of driving time as a practical measure of access, reflecting real-world patient experiences.
Looking ahead, the authors and experts in the field hope that their work will spur actionable changes. Regulatory bodies like the Centers for Medicare & Medicaid Services (CMS) could play a pivotal role by mandating the inclusion of ADI scores in facility certification processes or reimbursement formulas. Similarly, urban planners and healthcare networks might prioritize expansion projects in high-deprivation areas to alleviate the burden on existing centers and improve overall service delivery.
In summary, this study serves as a clarion call for systemic reforms to ensure that all communities, regardless of socioeconomic status, have equitable access to life-saving dialysis treatments. By shining a light on these disparities, it paves the way for evidence-based strategies that promote health equity and optimize resource allocation in the healthcare system.
Publication details for the primary research include: Yu-Chu Shen et al, “Access to Dialysis Facilities in Socioeconomically Advantaged and Disadvantaged Communities,” JAMA Internal Medicine (2026). A related commentary by McKenna E. Eisenbeisz et al, titled “Diminished Access to Dialysis in Disadvantaged Communities—Driving Toward More Equitable Care,” also appeared in the same journal (2026).
Key medical concepts explored in this context encompass hemodialyses, the process by which blood is purified outside the body for patients with kidney dysfunction, and social determinants of health, which are the non-medical factors influencing health outcomes, such as economic stability, education access, and neighborhood environment.
This research falls within the clinical category of nephrology, the branch of medicine focused on kidney diseases and treatments. The findings resonate with ongoing discussions in public health about how structural inequalities perpetuate cycles of poor health in vulnerable populations.
