Among other factors, they are less likely than whites to be referred for pre-transplant evaluations.
Racial health care disparities are represented by measurable and significant differences in the incidence of certain diseases as well as their associated morbidity and mortality rates.
In the United States, a significantly disproportionate burden of disease and morbidity is borne by African Americans when compared to their Caucasian counterparts, may contribute to the fact that African Americans have documented life expectancies seven years shorter than non-Hispanic whites.
In 2002, the Institute of Medicine issued a report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” revealing that minorities tend to receive lower-quality health care than whites, “even when access-related factors, such as patients’ insurance status and income, are controlled.”1,2
The causes are rooted in social and cultural differences among various races and are shaped by historical, political, environmental, hereditary, and economic factors. 2 The purpose of this article is to review racial disparities with respect to end-stage renal disease (ESRD) and kidney transplantation.
ESRD and transplantation
African Americans and other racial/ethnic minority populations are disproportionately afflicted by chronic renal failure (CRF) and ESRD. For example, despite making up only 12.6% of the U.S. population in 1996, African Americans made up nearly 30% of all patients treated for ESRD. African Americans aged 20-44 years were 20 times more likely to develop hypertension-related renal failure than their white counterparts.3
Likewise, other racial minorities, including Hispanics/Latino, Pacific Islanders, and Native Americans appear to be at higher risk for development of renal failure. Although they account for only 0.8% of the U.S. population, Native Americans make up 1.5% of all ESRD patients.3,4
Diabetes is the leading cause of ESRD. Hypertension, another significant cause of ESRD (accounting for 25% of the nearly 379,000 cases of kidney failure in 2000) 4,5,6 is more prevalent among black adults (33%) compared with whites (20%), and there is evidence to support a genetic predisposition towards hypertension among African Americans, people from southern India, and other ethnic populations.6
However, environmental factors, such as high-salt intake, urban living, poverty, and stress, may also play a role. Because of disparities in access to adequate health care, African Americans and other minorities with hypertension are more likely to be untreated and, as a result, are six times more likely than Caucasians to develop kidney failure from hypertension.6,7