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.