Desegregating neighborhoods can lead to reduced CKD, racial disparities in health care
Neighborhood desegregation in the U.S. will solve racial disparities in medicine, including the rapid progression of chronic kidney disease to end-stage renal disease in Black patients, according to a speaker at ASN Kidney Week.
“There are large racial inequities in renal disease,” David Williams, PhD, MPH, professor at Harvard University, said. He noted that the inequities are apparent when you realize that, compared to white individuals, African American individuals have a higher incidence of kidney disease and elevated rates of progression from CKD to ESRD. They also “have a prevalence of ESRD that is four times greater, require dialysis at younger ages, and have greater incidence of ESRD at each decade of life,” he said.
In the U.S., Black people live with a significantly lower life expectancy from birth compared with white people. In 1950, the life expectancy of white individuals was 69.1 years of age, and the life expectancy of Black individuals was 60.8 years of age. Seven decades later, this gap has not closed. In 2020, the life expectancy of white individuals was 77.6 years of age, and the life expectancy of Black individuals was 71.8 years of age.
The gap in life expectancy is due to racial disparities and stressors, Williams said.
“Research indicates that when you are low in economic status and living in a disadvantaged, segregated neighborhood, that leads to higher levels of exposure and greater clustering of economic stressors of psychosocial stressors that are physical and chemical stressors,” he said.
An example is South Los Angeles’ segregated community, Williams said. High levels of preexisting comorbidities and uncontrolled chronic diseases have been tracked there, and there are three times as many cases of diabetes in South Los Angeles than the rest of California, which leads to diabetic amputations being among the most frequent surgical procedures performed. Despite the high risk of disease, there are 10 times fewer MDs in South Los Angeles than the average U.S. community.
This has cut the life expectancy of people living in South Los Angeles 10 years shorter than those living in all other communities in California.
“Populations of color are literally aging biologically more rapidly than white [populations],” Williams said. “Why? Because if you live in a bad environment, your age is not only telling us how long you have lived, it's telling us how long you've been exposed to bad environmental conditions and how physiologically compromised you have become as a result of such exposure. And that leads to the earlier onset of chronic disease.”
Progress Seen in Past Research
In 1972, The Abecedarian Project randomized a population of economically disadvantaged infants at birth (80%, Black) into safe and nurturing childhood programs from birth to 5 years of age. By the patients’ mid-30s, researchers noticed lower levels of risk factor of cardiovascular disease and metabolic disease in the patients.
Similarly, the Moving to Opportunity Program randomized families with children in high poverty neighborhoods to move to less poor areas. After 10 to 15 years, those who moved experienced lower levels of obesity, severe obesity and diabetic risk compared with those in their old communities.
“National data for the U.S. and fancy econometric models [are] able to statistically show if you could eliminate residential segregation in the U.S., you would completely erase black/white differences in income, in education and in unemployment — and reduce black/white differences and single motherhood by two thirds,” Williams said in the presentation. “All of these striking differences are driven by opportunity at the neighborhood level.”
Remaining Barriers
In order to achieve a desegregated America, Williams said that medical professionals need to raise awareness about racial disparities and join together to create a science base that will address the racial and social inequities in health.
“We need to identify how to tell the story of the challenges of disadvantaged populations in ways that resonate with the public so that the public feels their pain and has compassion and says this is unacceptable in our country, and we will work together to build a healthier America for all,” he said.
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Williams D, et al. State-of-the-Art Lecture "Social Inequities in Health: How We Can Effectively Reduce Them.” Presented at: ASN Kidney Week. Nov. 4-7, 2021 (virtual meeting).
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