The Impact of Structural Racism on Racial/Ethnic Disparities in End-Stage Kidney Disease from Healthy Population to Mortality

结构性种族主义对终末期肾病从健康人群到死亡率的种族/民族差异的影响

• 批准号: 10670913
• 负责人: Jonathan Kyle Daw
• 金额: $ 65.83万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670913
• 关键词: Affect; Alaska Native; American Indians; Black race; Characteristics; Chronic Disease; Chronic Kidney Failure; Clinical; Communication; Communities; Consensus; Data; Data Analyses; Data Set; Demographer; Development; Dialysis procedure; Dimensions; Disease; Disparate; Disparity; Economics; Education; Eligibility Determination; End stage renal failure; Ethnic Origin; Etiology; Future; Health; Health Professional; Health Services; Health Surveys; Healthcare; Hemodialysis; Hispanic; Hispanic Populations; Incidence; Individual; Information Systems; Institution; Institutional Policy; Intervention; Interview; Kidney; Kidney Diseases; Kidney Transplantation; Life Cycle Stages; Link; Measures; Medical; Medicare; Medicare claim; Not Hispanic or Latino; Outcome; Participant; Pathway interactions; Patient-Focused Outcomes; Patients; Pattern; Peritoneal Dialysis; Politics; Population; Positioning Attribute; Process; Race; Research; Research Personnel; Respondent; Role; Sampling; Selection Bias; Sequence Analysis; Social Conditions; Social Policies; Source; Structural Racism; Surveys; Survival Rate; Techniques; Testing; Time; Transplantation; United States; Waiting Lists; Work; community engagement; complex data; disease disparity; ethnic disparity; ethnic minority; experience; graft failure; hazard; high risk; innovation; living kidney donor; mortality; novel; optimal treatments; post-transplant; racial disparity; racial minority; shape analysis; treatment disparity

Project Summary Racial disparities in the incidence and treatment of end-stage kidney disease are well-documented and largely consistent across outcomes, and an emerging consensus indicates that these disparities are likely to be primarily driven by structural racism (SR). Non-Hispanic Black, Hispanic persons of any race, and American Indian or Alaska Natives (AIAN) are a) at higher risk of chronic kidney disease (CKD) throughout their life course; b) more likely to progress from CKD to end-stage kidney disease (ESKD); c) less likely to be referred for kidney transplantation; d) less likely to obtain a living donor kidney transplant (LDKT); e) experience higher mortality hazards on the transplant waiting list and post-transplant; and f) experience higher rates of post- transplant graft failure. The major exception to this rule is the higher survival rate of Black and Hispanic ESKD patients on dialysis. For all other outcomes, the consistency with which highly similar disparities are observed across these disparate processes suggests that deeper mechanisms are at work — i.e., SR. To assess the hidden forces of SR underlying consistent disparities in ESKD, we will analyze a very large health survey linked to longitudinal Medicare claims, geospatial information, and mortality outcomes. Our approach to measuring SR will be multidimensional, capturing local racial/ethnic inequalities in economic, educational, judicial, political, and residential outcomes as well as health care affordability, contact, proximity, and quality. Furthermore, to fully reflect the contribution of divergent medical treatments to racial/ethnic disparities in ESKD patient outcomes, we will measure ESKD patients’ treatments over time, then identify the most important treatment trajectories for racial/ethnic disparities. In our Aim 1 analysis, we hypothesize that non-Hispanic Black, Hispanic, and AIAN individuals will have higher risk of ESKD development, and that SR will significantly explain these disparities. We will test this hypothesis by analyzing restricted Medicare claims and geospatial data linked to the National Health Interview Study (NHIS; 1994-present; N=941,492 Medicare-linkage-eligible respondents). In our Aim 2 analysis, we hypothesize that non-Hispanic Black, and AIAN respondents will be less likely to receive optimal treatment trajectories and more likely to receive suboptimal treatment trajectories than non-Hispanic Whites. We will construct treatment trajectories using sequence analysis techniques, and assess racial/ethnic disparities in treatment trajectories in the United States Renal Data System dataset (USRDS; 1997-2018; N=2,335,340). In our Aim 3 analyses, we investigate whether racial/ethnic ESKD patient survival advantages compared to non-Hispanic Whites are modified by SR and treatment trajectories. We hypothesize that SR and treatment trajectories both modify racial/ethnic disparities in ESKD patient outcomes, but that treatment trajectories will offer the greatest explanatory power due to their more proximate relationship to patient outcomes. We will test this hypothesis by assessing how well each characteristic statistically explains racial/ethnic disparities in ESKD patient mortality. Throughout the research process we will work with two established community advisory boards to generate novel ideas for analyses, results interpretation, and specific proposed interventions, and refine the proposed interventions for future testing with input from the board and ESKD health care professionals.

项目摘要 事件和治疗末期肾脏疾病的种族分布有据可查的 跨结果一致，新兴共识表明这些差异可能是 首先是由结构种族主义（SR）驱动的。非西班牙裔黑人，任何种族的西班牙裔人和美国人 印度人或阿拉斯加原住民（Aian）是a）一生中慢性肾脏疾病（CKD）的风险更高 课程; b）更有可能从CKD发展到末期肾脏疾病（ESKD）； c）不太可能被推荐 肾脏移植； d）不太可能获得活体肾脏肾移植（LDKT）； e）体验更高 移植等待名单和移植后的死亡率危害；和f）经历更高的后率 移植等级失败。该规则的主要例外是黑色和西班牙裔ESKD的较高生存率 透析患者。对于所有其他结果，观察到高度相似差异的一致性 在这些不同的过程中，表明更深的机制正在起作用，即Sr。评估隐藏 SR的基本稳定分布的力量在ESKD中，我们将分析与与之相关的大型健康调查 纵向Medicare主张，地理空间信息和死亡率结果。我们测量SR的方法 将是多维的，在经济，教育，司法，政治上， 以及居民的结果以及医疗保健负担能力，接触，接近性和质量。此外， 充分反映了ESKD患者种族/种族差异的分歧医学治疗的贡献 结果，我们将随着时间的推移测量ESKD患者的治疗方法，然后确定最重要的治疗方法 种族/族裔分布的轨迹。在我们的目标1分析中，我们假设该非西班牙裔黑色， 西班牙裔和艾安个人将面临ESKD发展的较高风险，而SR将大大显着 解释这些分布。我们将通过分析受限的Medicare主张和地理空间来检验这一假设 与国家健康访谈研究相关的数据（NHIS; 1994-PRESENT; n = 941,492 Medicare-Linkage-Ciperique 在我们的目标2分析中，我们假设非西班牙裔黑人和艾安受访者将是 不太可能接受最佳治疗轨迹，更可能接受次优的治疗轨迹 比非西班牙裔白人。我们将使用序列分析技术构建治疗轨迹，并且 评估美国肾脏数据系统的治疗轨迹中的种族/种族差异 （USRDS; 1997-2018; n = 2,335,340）。在我们的目标3分析中，我们研究了种族/民族ESKD患者是否 与非西班牙裔白人相比，SR和治疗轨迹改变了生存优势。我们 假设SR和治疗轨迹既可以修改ESKD患者的种族/种族差异 结果，但由于其更近的 与患者预后的关系。我们将通过评估每个特征的效果来检验这一假设 统计学上解释了ESKD患者死亡率中的种族/种族差异。通过研究过程 将与两个既定的社区咨询委员会合作，以产生新颖的想法进行分析，结果 解释和特定建议的干预措施，并完善提议的干预措施以进行未来测试 董事会和ESKD医疗保健专业人员的投入。