Perceived Discrimination and Longitudinal Change in Kidney Function Among Urban Adults

Abstract

Objective: Perceived discrimination has been associated with psychosocial distress and adverse health outcomes. We examined associations of perceived discrimination measures with changes in kidney function in a prospective cohort study, the Healthy Aging in Neighborhoods of Diversity across the Life Span.

Methods: Our study included 1620 participants with preserved baseline kidney function (estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m) (662 whites and 958 African Americans, aged 30-64 years). Self-reported perceived racial discrimination and perceived gender discrimination (PGD) and a general measure of experience of discrimination (EOD) ("medium versus low," "high versus low") were examined in relation to baseline, follow-up, and annual rate of change in eGFR using multiple mixed-effects regression (γbase, γrate) and ordinary least square models (γfollow).

Results: Perceived gender discrimination "high versus low PGD" was associated with a lower baseline eGFR in all models (γbase = -3.51 (1.34), p = .009 for total sample). Among white women, high EOD was associated with lower baseline eGFR, an effect that was strengthened in the full model (γbase = -5.86 [2.52], p = .020). Overall, "high versus low" PGD was associated with lower follow-up eGFR (γfollow = -3.03 [1.45], p = .036). Among African American women, both perceived racial discrimination and PGD were linked to lower follow-up kidney function, an effect that was attenuated with covariate adjustment, indicating mediation through health-related, psychosocial, and lifestyle factors. In contrast, EOD was not linked to follow-up eGFR in any of the sex by race groups.

Conclusions: Perceived racial and gender discrimination are associated with lower kidney function assessed by glomerular filtration rate and the strength of associations differ by sex and race groups. Perceived discrimination deserves further investigation as a psychosocial risk factors for kidney disease.

Figure 1

Figure 1A. Baseline and follow-up mean eGFR by PRD category Figure 1B. Baseline and follow-up mean eGFR by PGD category Figure 1C. Baseline and follow-up mean eGFR by EOD category

Figure 1

Figure 1A. Baseline and follow-up mean eGFR by PRD category Figure 1B. Baseline and follow-up mean eGFR by PGD category Figure 1C. Baseline and follow-up mean eGFR by EOD category

Figure 1

Figure 1A. Baseline and follow-up mean eGFR by PRD category Figure 1B. Baseline and follow-up mean eGFR by PGD category Figure 1C. Baseline and follow-up mean eGFR by EOD category

Figure 2

Figure 2A. Annual rate of change in eGFR by PRD category Figure 2B. Annual rate of change in eGFR by PGD category Figure 2C. Annual rate of change in eGFR by EOD category

Figure 2

Figure 2A. Annual rate of change in eGFR by PRD category Figure 2B. Annual rate of change in eGFR by PGD category Figure 2C. Annual rate of change in eGFR by EOD category

Figure 2

Figure 2A. Annual rate of change in eGFR by PRD category Figure 2B. Annual rate of change in eGFR by PGD category Figure 2C. Annual rate of change in eGFR by EOD category