Several factors have been associated with racial disparities among Black patients with chronic kidney disease (CKD), including limited access to high-quality healthcare, lower socioeconomic status, exposure to environmental toxins, and specific health beliefs and behaviors.
Black patients with CKD report spending less time with healthcare professionals, experiencing worse treatment from clinicians, and feeling that medical professionals do not convey necessary healthcare information. They are also less likely than White patients to be referred for, evaluated for, and receive kidney transplants.
“We’re increasingly becoming more aware of the consequences of racism, but we still struggle to grasp how it works,” says Kevin Ahmaad Jenkins, PhD. “Sometimes racist discussions or accusations are so hurtful that people shut down rather than see that the most vulnerable heroes must be able to share their experiences.”
Understanding How Racism Impacts the Ability to Manage CKD
Few studies have explored the healthcare experiences of Black veterans with life-impeding chronic diseases like CKD. To address this research gap, Dr. Jenkins and colleagues published a qualitative study in JAMA Network Open that investigated healthcare experiences of 36 Black veterans with CKD. “We wanted to understand how the 360 degree view of racism impacts patients’ ability to manage their CKD,” Dr. Jenkins says.
Among Black veterans with CKD who characterized racism in the context of their care at a Veterans Affairs (VA) medical center, the average age was 66, with an average duration of military service of 8 years. Overall, 41.7% of patients were not dependent on dialysis, and hypertension was the most common comorbidity (25.0%).
A Roadmap for Clinicians on the Impact of Racism in CKD
Based on responses from all participants, four overarching themes were identified regarding perspectives of racism in healthcare among Black veterans with CKD (Figure). Black veterans described the ways in which racism produced emotional and physical stress. These included psychological symptoms, such as anger and hurt, as well as physiological symptoms, like headaches. Respondents also described a strong sense of distrust in the healthcare system and a need to be hypervigilant during clinical encounters.
When encountering racism, Black veterans with CKD described bottling up their feelings, which sometimes led to maladaptive behaviors. These patients also described healthcare experiences that were retraumatizing and further worsened their psychological and physical responses to racism, which can potentially exacerbate CKD symptoms. Furthermore, participants described individual and collective positive strategies for coping with the stress of racism.
“Our study provides a roadmap for clinicians, policymakers, and community leaders to learn how racism inside and outside of healthcare can make people sick,” says Dr. Jenkins. “Our country’s heroes are often stricken with the most challenging collection of chronic diseases. No group is more qualified to explain the toll of racism on their health and healthcare.”
Efforts Needed to Overcome Racism in Healthcare
Implementing care models that acknowledge racism as traumatic experience is one way healthcare institutions can lead the nation in developing antiracist healthcare. For example, trauma-informed care—a standardized approach for delivering sensitive care to patients who have experienced a variety of traumatic experiences—may mitigate adverse effects of racism in the care of Black veterans with CKD. This approach can guide interactions with patients in a way that is culturally appropriate and patient-centered so that adaptive coping strategies can be implemented. To successfully implement trauma-informed care, clinicians must be educated on factors associated with racism and the implications of those factors on clinical encounters.
“We need more studies that explicate the 21st century interpretations of racism in healthcare and disease management,” Dr. Jenkins says. “Such research is not intended to make people uncomfortable. Instead, it will allow us to better grasp our most misunderstood covert social structure. We’re also currently looking at the role that racism plays in algorithms that predict important indicators, such hospitalization and death, among VA patients.”