Perceived Discrimination and Longitudinal Change in Kidney Function Among Urban Adults

Abstract

Objective Perceived discrimination has been associated with psychosocial distress and adverse health outcomes. We examined associations of perceived discrimination measures with changes in kidney function in a prospective cohort study, the Healthy Aging in Neighborhoods of Diversity Across the LifeSpan. Methods Our study included 1,620 participants with preserved baseline kidney function (estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73m2) (662 Whites and 958 African-Americans (AA), aged 30–64 years). Self-reported perceived racial discrimination (PRD) and perceived gender discrimination (PGD) and a general measure of experience of discrimination (EOD) [“Medium vs. low”, “High vs. low”] were examined in relation to baseline, follow-up and annual rate of change in eGFR using multiple mixed-effects regression (γbase, γrate) and OLS models (γfollow). Results Perceived gender discrimination “High vs. Low PGD” was associated with a lower baseline eGFR in all models (γbase=−3.51(1.34), p=0.009 for total sample). Among White women, High EOD was associated with lower baseline eGFR, an effect that was strengthened in the full model (γbase=−5.86(2.52), p=0.020). Overall, “High vs. Low” PGD was associated with lower follow-up eGFR (γfollow=−3.03(1.45), p=0.036). Among AA women, both PRD and PGD were linked to lower follow-up kidney function, an effect that was attenuated with covariate adjustment, indicating mediation through health-related, psychosocial and lifestyle factors. In contrast, EOD was not linked to follow-up eGFR in any of the sex by race groups. Conclusions Perceived racial and gender discrimination are associated with poor kidney function assessed by glomerular filtration rate and the strength of associations differ by sex and race groups. Perceived discrimination deserves further investigation in psychsocial risk factors for kidney disease.

Nondepressive Psychosocial Factors and CKD Outcomes in Black Americans

“…Despite improved recognition of established risk factors for CKD among black Americans, little progress has been made to narrow disparities in kidney outcomes among black Americans compared with whites (7). A growing body of research suggests that social determinants of health may also contribute to these unexplained disparate kidney outcomes (8,9). Psychosocial factors, including negative affective moods, psychosocial stressors, and coping mechanisms, are thought to affect health outcomes via several physiologic (e.g., elevations in serum cortisol) and behavioral (e.g., poor diet and physical inactivity) mechanisms (10,11), which may affect kidney outcomes (12,13).…”

Kidney Disease in African American Children: Biological and Nonbiological Disparities

“…34 Many factors, studied primarily in adults but likely to have an effect on offspring, include the size and quality of social networks 35 and perceived racial discrimination. 36 Lower income also contributes to minority families being disproportionately exposed to numerous environmental risk factors due to the neighborhoods in which they live, and many environmental toxins (air pollution, water toxins, lead, and others) are known to be nephrotoxic. 37…”

Discrimination and Chronic Kidney Disease among Caribbean Blacks: The Effects of Immigration and Social Status

“…Using data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, an ongoing prospective cohort study of African Americans and Whites residing in Baltimore, Maryland, Beydoun et al (2017) found that perceived racial and gender discrimination were linked to lower kidney function.…”

“…Nevertheless, few studies have examined the relationship between discrimination and kidney function among adults. Although Beydoun et al (2017) have found that discrimination negatively affects kidney function in African Americans, it remains unclear whether discrimination also shapes kidney function in another distinct black population—Caribbean blacks. Although Caribbean blacks are ethnically distinct from African Americans, they suffer from similar prejudices and mistreatments that African Americans endure.…”