COVID-19 sharpens the focus on racism and racial disparities in health
Americans of color are in the midst of a perfect storm. Not the good kind of perfect, but the terrible, most awful kind of perfect: bad things colliding and combining into something far bigger and far worse than the sum of its parts.
I had the privilege of being a panelist in a webinar, “Black America - The Double Pandemic,” that was put on by the Congressional Black Caucus Foundation. Together with U.S. Representative Robin Kelly from Illinois, family physician and epidemiologist Dr. Camara Phyllis Jones, Dr. Oscar Alleyne from the National Association of County and City Health Officials, and Michael Sneed from Johnson & Johnson, we tackled hard questions of systemic, pandemic racism brought into sharp focus by the COVID-19 pandemic.
COVID-19 is having a devastating impact on people of color, and Black people are facing the greatest disparity. Black people make up 13% of the U.S. population but represent 24% of those who have died from the disease. Against the backdrop of the Black Lives Matter protests, and the economic fallout from the pandemic-induced recession, the health disparities facing the Black community appear in sharp relief.
It’s easy to see parallels between kidney disease and health disparities in the country more broadly. People of all races and ethnicities develop chronic kidney disease (CKD) at similar rates, but racial minorities and people of Hispanic ethnicity are more likely to progress to end-stage renal disease—ESRD, or kidney failure. We see this disparity in the racial and ethnic makeup of the low-income ESRD patients who receive financial assistance from AKF, including those receiving help from our Coronavirus Emergency Fund—most of the patients we help are people of color.
Blacks are more than 3 times more likely than whites to develop ESRD, which is most often caused by diabetes and high blood pressure. Researchers believe that a variety of factors combine to create the kidney failure disparity, including genetic factors but also access to health insurance coverage in earlier stages of CKD, and access to pre-dialysis nephrology care. We also know that social determinants of health play a role. People who are low-income experience food insecurity, face barriers to higher education, live in areas with higher pollution and/or live in areas with higher crime rates are more likely to have chronic diseases and illnesses. These non-medical conditions contribute to decreased health outcomes and greatly influence a person’s overall well-being—and they are prevalent in communities of color.
We don’t yet have much insight into the scale of COVID-19’s impact on kidney patients.
As of June 16, 2020, there were over 2.1 million confirmed cases of COVID-19 in the U.S. and 116,000 deaths. The CDC has reported that kidney disease contributed to about 6,700 of those deaths as of June 3, but we do not yet have good, comprehensive data on the rate of COVID among kidney patients, nor its mortality among this population in the U.S.
Initial reports out of China and Europe indicate a high mortality rate among dialysis patients who contract COVID. We need to study this further in the U.S. Dialysis patients have multiple comorbidities and cannot socially distance—most of them have to travel to clinics 3x per week for treatment—so it seems likely that this population is being hit particularly hard.
We are also concerned about the emerging information about COVID patients who develop acute kidney injury (AKI), which is sudden failure of the kidneys that can cause permanent damage to the kidneys.
A study in Kidney International found that of about 5,500 patients hospitalized between March 1 and April 5 in New York, nearly 2,000 (about 4 in 10) developed AKI and more than a third of them died. Being Black was one of the independent risk factors for developing AKI among COVID patients. We do not yet know the long-term health impacts patients who have recovered or are still hospitalized will face as a result of the kidney injury they experienced.
There is so much that is still unknown about COVID, but we are extremely concerned about not only the elevated risk for COVID that comes with having kidney disease—we are also extremely concerned about the potential long-term effects on kidney health that COVID poses—and the disproportionate impact on the Black community.
I am hopeful that one positive to come out of this will be real change in health systems—a greater focus and more resources invested in identifying, preventing and treating those underlying conditions that put the health of the Black community at risk. We know that adopting a chronic care model at the community level can make a difference. For example, intensive interventions for people with diabetes at the community/primary care level by the Indian Health Service have been associated with a decrease in incidence of ESRD in that population.
Our own prevention and education programs work to reach the high-risk population so that individuals may identify their risks and prevent CKD or slow its progression.
AKF runs the nation’s largest free screening program for kidney disease, operating in communities where the rates of the disease are very high. Last year we launched a national awareness campaign, Know Your Kidneys, to highlight the steps people can take to live longer lives by mitigating their risks for kidney disease. We are also working to break down barriers to clinical trial participation, particularly among members of racial and ethnic minority groups, with enhanced educational materials and an awareness campaign. We are reaching deep into communities with an innovative program called Kidney Health Coach that is training people in the communities to educate others about kidney disease.
These types of efforts can make a difference in local communities and nationally. But we are just one organization—and we are constantly looking for partners in this work, so that we may amplify our impact. The pandemic has made this work all the more urgent.
Addressing health disparities has been at the heart of AKF’s mission since our founding almost 50 years ago and as the nation continues to cope with COVID, we will be increasing our focus on addressing those disparities.