Why Blacks Tend to Get Worse CKD Care
Among other factors, they are less likely than whites to receive timely care from nephrologists
SAN FRANCISCO—African Americans receive worse care for renal disease compared with whites, and the reason may be related, in part, to a lack of trust in the health care system and inadequate appreciation of African Americans' elevated risk of CKD, according to Neil Powe, MD, MPH, professor of medicine, epidemiology, and health policy management and director of the Welch Center at The Johns Hopkins Medical Institutions in Baltimore.
“There are clear data [from patients in general] that minorities, African Americans, Latinos, and other ethnic groups, are less likely than whites to trust their physician and to trust their hospitals,” Dr. Powe said in a public policy news briefing at Renal Week 2007. “Those beliefs may affect behavior and studies have shown that the more trust you have the more likely you are to be adherent to therapy and to receive essential services.”
Moreover, primary care physicians may not be aware of the elevated risk for CKD among African Americans. In one study, 22% of primary care physicians did not perceive African American race as a CKD risk factor. In addition, minorities are referred less to nephrologists for kidney disease care.
For example, a study published in the Annals of Internal Medicine (2002;137:479-486) showed that 45% of African-American dialysis patients received an evaluation by a nephrologist less than four months before starting dialysis compared with 24.5% of whites.
“We don't know a great deal about the patient-physician interactions that go on between nephrologists and their patients,” he said. “Nephrologists, as well as all physicians, have a professional responsibility to make sure they deliver quality care to patients of all racial and ethnic backgrounds. They should also advocate for health reform that overcomes facilitators of two-tiered health care.”
He noted that African Americans have equal, if not better, survival rates on dialysis, but they have worse outcomes following renal transplantation compared with whites.
The incidence of kidney failure is up to four times greater in racial and ethnic minorities. In blacks, the higher incidence of kidney failure appears to be due to a faster rate of disease progression rather than greater prevalence of early stage CKD. Socioeconomic status, lifestyle, and quality of care factors may explain 44% of the threefold excess risk for CKD in African Americans compared with whites, Dr. Powe said.