The dialysis time tax
Most people with kidney failure get hemodialysis at a center three times a week, every week, for years. This map estimates how much of their life goes to the drive alone, based on the distance from every neighborhood in the country to the nearest dialysis center, and shows where households have no car to make that trip.
Distance hits rural areas; car access hits vulnerable ones
Left: estimated hours a year driving to and from in-center dialysis, averaged over residents of each group of neighborhoods. Right: share of households with no vehicle. The most socially vulnerable neighborhoods are mostly urban and closer to a center, but far more of their households have no car to get there.
How this was estimated
Dialysis centers. Every Medicare-certified facility offering in-center hemodialysis in the CMS Dialysis Facility listing, located with the Census Bureau geocoder (ZIP code center when the address did not match).
Drive time. For each of the ~84,000 census tracts, the straight-line distance from the tract's 2020 population center to the nearest center was converted to driving minutes with a model fitted to real routes: Times are floored at 2 minutes and ignore traffic. Annual hours = one-way time × 2 × 3 sessions a week × 52 weeks.
Households without a vehicle and the Social Vulnerability Index come from CDC/ATSDR SVI 2022 (American Community Survey 2018–2022). Without a car, the same trip by transit, paratransit or rides from others usually takes longer than the drive time shown, so those households' real time cost is understated here.
Caveats. Estimates describe a typical resident of each neighborhood, not actual dialysis patients, who are older and more often Black or Hispanic than the population as a whole. Patients do not always use the nearest center (shift times, capacity, insurance and chain networks matter), and some dialyze at home instead. Connecticut and Alaska county boundaries follow the 2020 Census.
Data and build scripts: github.com/usnish/usnish.github.io.