County-level structural racism may affect mortality rates in people with kidney failure

A new analysis indicates that county-level structural racism is a significant determinant of death among individuals with kidney failure. The research will be presented at ASN Kidney Week 2023 November 1–5.

For the analysis, investigators examined data from United States Renal Data System, the American Community Survey 2006–10, and the Vera Institute, linked by county. They determined county-level structural racism from Black-White disparities in imprisonment, homeownership, college graduation, median income, unemployment, poverty, and segregation.

The researchers found that Black race interacted with structural racism to predict monthly mortality risk among individuals with kidney failure. Black patients experienced survival advantages compared with White patients at lower levels of structural racism, but they experienced survival disadvantages compared with White patients at higher levels of structural racism.

These associations were also apparent when patients were divided into groups based on treatment (hemodialysis, peritoneal dialysis, deceased donor kidney transplant, and living donor kidney transplant).

"This study contributes to a rapidly-growing empirical consensus that structural factors driving racial disparities in non-health life circumstances also drive racial disparities in health and mortality outcomes. The implication is that to eliminate or ameliorate racial disparities in health, systematic social factors driving those disparities must be addressed," said corresponding author Jonathan Daw, Ph.D., of Penn State.

"Our hope is that our quantitative research studies will eventually, with continued study and committed engagement with affected communities, lead to promising targeted interventions to blunt the worst effects of structural racism on marginalized racial/ethnic groups' health. However, these efforts (even if successful) should not obscure the need for more foundational changes."