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. 2022 May 2;5(5):e2211900.
doi: 10.1001/jamanetworkopen.2022.11900.

Perspectives on Racism in Health Care Among Black Veterans With Chronic Kidney Disease

Kevin A Jenkins  1   2 , Shimrit Keddem  1   3 , Selamawite B Bekele  2 , Karisa E Augustine  4 , Judith A Long  1   3
Affiliations

Perspectives on Racism in Health Care Among Black Veterans With Chronic Kidney Disease

Kevin A Jenkins et al. JAMA Netw Open. .

Erratum in

  • Error in Quotation.
    [No authors listed] [No authors listed] JAMA Netw Open. 2022 Jun 1;5(6):e2220419. doi: 10.1001/jamanetworkopen.2022.20419. JAMA Netw Open. 2022. PMID: 35687343 Free PMC article. No abstract available.

Abstract

Importance: The burden of chronic kidney disease (CKD) and end-stage kidney disease falls disproportionately on Black individuals in the US, with Black veterans experiencing substantial consequences, and only a portion of the disparities in health conditions and health care can be explained by nonbiological factors. Among Black individuals, racism is likely one of those factors, suggesting the need to examine the consequences of racism and the resulting social structures that establish and perpetuate these racial disparities.

Objective: To investigate the health care experiences of Black veterans with CKD and identify and explore the racial discrimination encountered by this vulnerable population.

Design, setting, and participants: This qualitative study used semistructured interview guides to investigate the health care experiences of 36 Black veterans with CKD who received care at the Corporal Michael Crescenz Veterans Affairs Medical Center in Philadelphia, Pennsylvania, from October 2018 to September 2019. Interview transcripts were analyzed using applied thematic analysis.

Results: Among 36 Black veterans with CKD who characterized racism in the context of their care at a Veterans Affairs medical center, the mean (SD) age was 66.0 (7.8) years; 35 participants (97.2%) were male, 1 participant (2.8%) was female, and 19 participants (52.8%) were married. The mean (SD) duration of military service was 8.0 (7.0) years. Overall, 15 participants (41.7%) were not dependent on dialysis, and hypertension was the most common comorbidity (9 participants [25.0%]). Veterans described the ways in which racism produced emotional and physical stress, including psychological symptoms (eg, anger and hurt) and physiological symptoms (eg, headaches). Veterans described a strong sense of distrust in the health care system coupled with a need to be hypervigilant during clinical encounters. When encountering racism, veterans described bottling up their feelings, which sometimes led to maladaptive behavior (eg, substance use). Veterans also described individual and collective positive strategies (eg, faith) for coping with the stress of racism.

Conclusions and relevance: In this study, Black veterans with CKD experienced racism in the clinical setting that produced physical and emotional stress and a strong sense of distrust in the health care system. These findings highlight an important opportunity for education and training of health care professionals in the implementation of trauma-informed approaches to care as a means of addressing race-based stress and trauma.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Long reported receiving grants from the Corporal Michael J. Crescenz VA Medical Center during the conduct of the study and grants from US Department of Veterans Affairs (VA) Health Services Research and Development and the VA Quality Enhancement Research Initiative outside the submitted work. No other disclosures were reported.

Comment in

  • Centering Black Men With Kidney Disease.
    Novick TK, Crews DC. Novick TK, et al. JAMA Netw Open. 2022 May 2;5(5):e2211903. doi: 10.1001/jamanetworkopen.2022.11903. JAMA Netw Open. 2022. PMID: 35552730 No abstract available.

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