Social Determinants of Racial Disparities in CKD

Abstract

Significant disparities in CKD rates and outcomes exist between black and white Americans. Health disparities are defined as health differences that adversely affect disadvantaged populations, on the basis of one or more health outcomes. CKD is the complex result of genetic and environmental factors, reflecting the balance of nature and nurture. Social determinants of health have an important role as environmental components, especially for black populations, who are disproportionately disadvantaged. Understanding the social determinants of health and appreciating the underlying differences associated with meaningful clinical outcomes may help nephrologists treat all their patients with CKD in an optimal manner. Altering the social determinants of health, although difficult, may embody important policy and research efforts, with the ultimate goal of improving outcomes for patients with kidney diseases, and minimizing the disparities between groups.

Keywords: chronic kidney disease; end stage kidney disease; psychosocial factors; racial disparities; social determinants; socioeconomic status.

Figure 1.

Theoretical model: interconnected mechanisms underlying associations between SES and health. Socioeconomic factors may contribute to a complex and overlapping set of social determinants that interact and combine to affect health outcomes. Racial biases may amplify associations between SES, social determinants, and health outcomes

Figure 2.

The proportion of persons with CKD who receive medical evaluation with serum creatinine, lipid, and urinary albumin levels. The proportion of persons with CKD who receive medical evaluation with serum creatinine concentration, lipid levels, and urinary albumin assessments has increased for all race groups between 2001 and 2013. Black, white, and Asian populations have all surpassed the Healthy People 2020 target (CKD-4.1) of 28.4%. The proportion of persons with CKD who receive medical evaluation with serum creatinine, lipids, and microalbumin is slightly higher in black than white persons. Reprinted from United States Renal Data System. 2015 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2015, with permission. Af Am; African American.

Figure 3.

Theoretical model: interaction of biologic and clinical factors with the social determinants of health affecting CKD risk and progression. Biologic and clinical factors likely interact with the social determinants of health at several levels to increase risk of CKD incidence and progression. CVD, cardiovascular disease; DM, diabetes mellitus; HTN, hypertension.

Figure 4.

Trends in adjusted ESRD incidence rate by race in the United States, 1980–2012. Trends in age- and sex-adjusted ESRD incidence rate, per million/year, by race, in the United States population, 1980–2012, with the United States population in 2011 as the standard population. The incidence of ESRD among Native Americans fell dramatically between the late 1990s and 2012. Reprinted from United States Renal Data System. 2014 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2014, with permission. Af Am, African American.