The USRDS is the largest and most comprehensive national ESRD surveillance system in the US (Collins et al., 2015). The USRDS contains data on all ESRD cases in the US through the Medical Evidence Report CMS-2728 which is mandated for all new patients diagnosed with ESRD (Foley and Collins, 2013). Detailed information about the USRDS can be found on their website (http://www.usrds.org). The EQI was constructed for 2000-2005 for all US counties and is composed of five domains (air, water, built, land, and sociodemographic), each composed of variables to represent the environmental quality of that domain. Domain-specific EQIs were developed using principal components analysis (PCA) to reduce these variables within each domain while the overall EQI was constructed from a second PCA from these individual domains (L. C. Messer et al., 2014). To account for differences in environment across rural and urban counties, the overall and domain-specific EQIs were stratified by rural urban continuum codes (RUCCs) (U.S. Department of Agriculture, 2015). This dataset is not publicly accessible because: EPA cannot release personally identifiable information regarding living individuals, according to the Privacy Act and the Freedom of Information Act (FOIA). This dataset contains information about human research subjects. Because there is potential to identify individual participants and disclose personal information, either alone or in combination with other datasets, individual level data are not appropriate to post for public access. Restricted access may be granted to authorized persons by contacting the party listed. It can be accessed through the following means: Human health data are not available publicly. EQI data are available at: https://edg.epa.gov/data/Public/ORD/NHEERL/EQI. Format: Data stored as csv files. This dataset is associated with the following publication: Kosnik, M., D. Reif, D. Lobdell, T. Astell-Burt, X. Feng, J. Hader, and J. Hoppin. Associations between access to healthcare, environmental quality, and end-stage renal disease survival time: Proportional-hazards models of over 1,000,000 people over 14 years. PLoS ONE. Public Library of Science, San Francisco, CA, USA, 14(3): e0214094, (2019).