Healthcare’s race of place

Who sees a nephrologist before their failing kidneys require chronic dialysis?

This seems like a technical subject for me, but I think I get the point of this new paper from the Journal of the American Society of Nephrology (always a good source for material). They knew that Black kidney patients were less likely to see a specialist before their kidneys fail than White patients — that is, before they reach ESRD, or end-stage renal disease. And failure to receive specialized care can have negative effects on the course of their disease.

I’m always looking for concrete ways of illustrating the point that “race” is not (just) an individual trait, that it’s a structural feature of society. Going back to my dissertation project, and more recently, one way to show that has been to look at the “race” of larger social groupings, like labor markets, workplaces or jobs.

So the kidney treatment analysis caught my attention because they examined the pattern of care according to the racial composition of patients’ zip codes. Sure enough, the Black-White individual disparity in early access to a specialist was pronounced, but it was exacerbated by a Black-White zip-code disparity as well.

The Black-White gap is apparent at all levels of Black concentration by zip code — but everyone in higher-percent-Black zip codes has a higher risk of delayed care. In the detailed analysis, they find the relationship still holds even when individual socioeconomic status, and local-area socioeconomic status, are controlled. So it’s not just a poverty effect.

In the healthcare-access sweepstakes, in which racial inequality is a pronounced feature, places have a race, too.

7 thoughts on “Healthcare’s race of place

  1. If they’re controlling for economic status, what makes you assume the effect is due to residents of darker-skinned zip codes not having access to healthcare? Perhaps it’s a cultural thing to choose not see a doctor.

    I wonder if it goes the other way — that is, when you have middle-class black residents of a white zip, do they see doctors more than black middle-class residents of a black area?

    I would suspect there are a lot of demographic differences between those two latter categories.


    1. Good question; I don’t know. But the thing is both Black and White patients in the Black areas are less likely to see a specialist (or more likely in the White areas). So if it’s “culture,” it’s local culture which crosses race lines.


  2. Hi Dr. Cohen,
    The dialysis issue is certainly an interesting one. I wonder if there might be evidence of race as a structural feature of society in data on who takes SAT prep courses or on ZIP codes where students take the SAT multiple times. This discussion came up in my summer session Intro to Contemporary Social Problems (SOCY 105) at the University of Maryland College Park while discussing Patricia Hill Collins’ Another Kind of Public Education. The larger discussion is posted here (, but I wonder if looking at, say, the formation of expectations about how many times a student should take the SAT might illustrate elements of race (as well as culture, family history, and economic status) as a kind of structure?


    1. Hi Meg,
      The National Longitudinal Study of Adolescent Health ( has collected data on educational expectations/aspirations, by parents and children, and also includes information on students’ neighborhood and school racial composition. Could be something there (and maybe someone’s looked at it already). Good question – and thanks for the link.


  3. In citiies such as Nashville, or Washington DC with medical schools that primarily service Aftrican Americans, does the same hold true?


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