African Americans have one of the highest rates of end-stage renal disease (ESRD) in the United States in comparison to other racial and ethnic groups, according to a study in the American Journal of Kidney Disease. In fact, African Americans are three times more likely to need dialysis than non-Hispanic white Americans.*

Why is this? 

Social determinants of health

Scientists point to multiple factors that adversely impact health outcomes for racial and ethnic minorities in the U.S., particularly African Americans.

Significant among these factors are social determinants, such as health and the collective conditions in which we live, work, and play. These include employment, income, education, literacy, health literacy, insurance, and availability of community health resources, among others.

In addition, people who live in conditions that prevent rather than promote healthy beliefs and behaviors are more likely to suffer poor health outcomes.

• Just 9% of white Americans live below the federal poverty level compared to 20% of African Americans.
• In 2016, 6.3% of white Americans were uninsured compared to 10.5% of black Americans. 
• In a National Kidney Foundation screening, uninsured participants were 72% more likely to develop ESRD than insured participants.
• Those with at least a high school education had a lower risk of death than those without such education.

Risk factor disparities

There are many examples of health disparity between African Americans and non-Hispanic white Americans. African Americans have a higher prevalence of obesity (or being overweight), diabetes, and hypertension. Genetics, lifestyle, and access to care are major factors in the development of these conditions. Beliefs, attitudes, and cultural mores can also interfere with good health outcomes when they prevent people from utilizing resources that are available to them.

Screening and healthcare barriers

A government study, Healthy People—Development of the National Health Promotion and Disease Prevention Objectives for 2030, explored cultural factors that influence African Americans’ likelihood of participating in community-based CKD screenings.

Researchers found that African American U.S. citizens had:

• limited knowledge of CKD and its risk factors;
• low levels of trust in their healthcare system;
• a high financial burden; and
• low levels of compliance with treatments.

Positive advancements

While certain health measurements for African Americans still trail those of white Americans, good progress has been made.

1. The percentage of diabetic African Americans seeking annual urinary albumin tests increased from 29.5% in 2006 to 46% in 2015.
2. The rate of new cases of ESRD for African Americans decreased by roughly 20% between 2006 and 2015, from 1,114 cases per million people to 895. 
3. More healthcare providers are boosting health literacy and access to care for minorities by becoming more effective communicators.

More work must continue to be done, though. The more policymakers and healthcare providers understand the connections between social determinants of health and health outcomes, the better they can empower people throughout the U.S. and all of its diverse communities.

*Laster, M., Norris, K., & Shen, J. (2018, November). American Journal of Kidney Disease. Kidney Disease Among African Americans: A Population Perspective.