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. 2022 May;37(6):1351-1358.
doi: 10.1007/s11606-022-07444-1. Epub 2022 Mar 9.

Black-White Inequities in Kidney Disease Mortality Across the 30 Most Populous US Cities

Maureen R Benjamins  1   2 , Peter Lorenz  3 , Nazia S Saiyed  4 , Abigail Silva  5 , Holly J Mattix-Kramer  6 , Paulina Pys  3 , Andrew Schulz  3
Affiliations

Black-White Inequities in Kidney Disease Mortality Across the 30 Most Populous US Cities

Maureen R Benjamins et al. J Gen Intern Med. 2022 May.

Abstract

Objectives: To examine city-level kidney disease mortality rates and Black:White racial inequities for the USA and its largest cities, and to determine if these measures changed over the past decade.

Methods: We used National Vital Statistics System mortality data and American Community Survey population estimates to calculate age-standardized kidney disease mortality rates for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations for the USA and the 30 most populous US cities. We examined two time points, 2008-2013 (T1) and 2014-2018 (T2), and assessed changes in rates and inequities over time. Racial inequities were measured with Black:White mortality rate ratios and rate differences.

Results: Kidney disease mortality rates varied from 2.5 (per 100,000) in San Diego to 24.6 in Houston at T2. The Black kidney disease mortality rate was higher than the White rate in the USA and all cities studied at both time points. In T2, the Black mortality rate ranged from 7.9 in New York to 45.4 in Charlotte, while the White mortality rate ranged from 2.0 in San Diego to 18.6 in Indianapolis. At T2, the Black:White rate ratio ranged from 1.79 (95% CI 1.62-1.99) in Philadelphia to 5.25 (95% CI 3.40-8.10) in Washington, DC, compared to the US rate ratio of 2.28 (95% CI 2.25-2.30). Between T1 and T2, only one city (Nashville) saw a significant decrease in the Black:White mortality gap.

Conclusions: The largest US cities experience widely varying kidney disease mortality rates and widespread racial inequities. These local data on racial inequities in kidney disease mortality can be used by city leaders and health stakeholders to increase awareness, guide the allocation of limited resources, monitor trends over time, and support targeted population health strategies.

Keywords: city; health disparities; kidney disease; mortality; nephrology; place; race; racial inequity; structural racism.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
The USA and cities with significant changes in kidney disease mortality rates over two time points. Notes: Mortality rates are per 100,000 population. Red lines indicate a significant increase in rates, while black lines indicate a significant decrease. Non-significant changes are shown with gray lines. City labels are bolded to also differentiate significant changes.
Fig. 2
Fig. 2
Kidney disease mortality rates and racial equity in rates (2014–2018). Note: Quadrants are separated by lines representing the US outcomes (for kidney disease mortality and the Black:White inequity).
See this image and copyright information in PMC

Comment in

References

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