Abstract
Background: Kidney failure and associated mortality is one of the major components of racial disparities in the United States. Objectives: The current study aimed to investigate the role of distal (socioeconomic status, SES), intermediate (chronic medical diseases), and proximal (health behaviors) factors that may explain Black-White disparities in mortality due to renal diseases. Patients and Methods: This is a nationally representative prospective cohort with 25 years of follow up. Data came from the Americans’ Changing Lives (ACL) study, 1986 to 2011. The study included 3361 Black (n = 1156) or White (n = 2205) adults who were followed for up to 25 years. Race was the main predictor and death due to renal disease was the outcome. SES, chronic medical disease (diabetes, hypertension, obesity), and health behaviors (smoking, drinking, and exercise) at baseline were potential mediators. We used Cox proportional hazards models for data analysis. Results: In age and gender adjusted models, Blacks had higher risk of death due to renal disease over the follow up period. Separate models suggested that SES, health behaviors and chronic medical disease fully explained the effect of race on renal disease mortality. Conclusions: Black-White disparities in rate of death due to renal diseases in the United States are not genuine but secondary to racial differences in income, health behaviors, hypertension, and diabetes. As distal, intermediate, and proximal factors contribute to racial disparities in renal disease mortality, elimination of such disparities requires a wide range of policies and programs that target income, medical conditions, and health behaviors.
Highlights
IntroductionWhile Blacks only make up to 13% of the population, they account for one third of all kidney failures in the United States [1]
Kidney failure and associated mortality is one of the major components of racial disparities in the United States
Compared to Whites, Blacks had lower education and income, smoked more, drank less, and had more hypertension (HTN), diabetes mellitus (DM) and obesity (All differences were significant at P < 0.05)
Summary
While Blacks only make up to 13% of the population, they account for one third of all kidney failures in the United States [1] It is still unknown whether or not racial disparities in renal disease mortality are genuine (i.e. due to biological factors such as genetic predisposition) or they are secondary to Black-White differences in 1) socioeconomic status (SES), 2) chronic medical disease (e.g. hypertension, diabetes, and obesity), or 3) health behaviors (e.g. exercise, smoking, and drinking). Obesity, which is more common among Blacks compared to Whites, increases the risk of chronic renal disease [26] Health behaviors such as exercise, smoking, and drinking may be proximal explanatory factors (i.e. mediators) that explain at least some of the racial disparities in renal disease mortality. More studies are needed which follow a nationally representative sample for a long-term period
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