In the United States, chronic kidney disease affects racial and ethnic minority populations including American Indians, African-Americans, and Hispanic Americans at higher rates than whites. Higher disease rates and poor outcomes for chronic conditions in these groups is a problem that has concerned the medical community for decades.
As a doctor, I work to provide the highest quality medical care possible to these patients. As a researcher, I ask, “Why do these disparities exist, and what can we do to narrow the gap?”
In North Carolina, health disparities are even greater in the southeastern counties where the rates of kidney disease are among the highest in the country. Here, racial and ethnic minorities are twice as likely to die from chronic kidney disease or develop end-stage kidney disease, or kidney failure.
With a grant from the American Kidney Fund Clinical Scientist in Nephrology Program, we are studying ways to prevent and improve outcomes for chronic kidney disease in southeastern North Carolina, with an initial focus on Robeson County.
The counties in southeastern North Carolina are among the poorest in the United States, and as such, their residents suffer several economic, social and structural barriers to achieving good health outcomes. In Robeson County alone, where 40 percent of the population is American Indian Lumbee and 30 percent is African-American, the mortality rate for diabetes, kidney disease and cardiovascular disease is more than twice the state average.
Many individuals in these groups experience high social, emotional and economic stress throughout their lives. Prolonged and accumulated stresses can lead to higher rates of disease and poor outcomes for chronic conditions, such as chronic kidney disease, because people under stress may often have limited stress and coping skills, are not good at communicating with caregivers and doctors, and they often have lower health literacy—the ability to obtain, read, understand and use health care information.
We believe that by studying health literacy, self-care behaviors, self-confidence, stress and coping, social support, and self-management skills related to chronic kidney disease, we can improve long-term health outcomes because:
- Health outcomes are improved by modification of self-care behaviors such as diet, lifestyle, and self-management skills like communication with caregivers and taking medication as prescribed;
- Inadequate health literacy has been linked with poor health outcomes for chronic conditions;
- Structural barriers at the community and neighborhood level are important determinants of health;
- Previous work has shown that interventions based on comprehensive assessments of these individual- and community-level factors can mprove health outcomes for chronic diseases including chronic kidney disease.
By identifying how and why these factors are associated with poor outcomes for chronic kidney disease, we will eventually be able to develop interventions that are tailored to the population in our study, but are broad enough to improve health across the region and nuanced enough to address critical differences among the racial/ethnic populations. We consider this to be the beginning of a sustained effort in the region to address these health disparities related to chronic kidney disease. With the generous support of the American Kidney Fund Clinical Scientist in Nephrology Program, we are now positioned to develop a long-term public health agenda to achieve these goals.
Dr. John Stanifer received his medical degree from the University of Tennessee and completed his residency in internal medicine and global health at Duke University. He is completing a renal fellowship at Duke University and is the 2015-2016 American Kidney Fund-Amgen Clinical Scientist in Nephrology fellow.