African American End-Stage Renal Disease and Medication Adherence: What Are the Effects of Everyday Racism?

Background and Purpose:

End-stage renal disease (ESRD) is the ninth leading cause of death in the US.  African Americans are nearly four times more likely to develop ESRD compared to Whites.  ESRD requires a complex medication regimen consisting of the highest pill burden of any chronic disease.  Poor medication adherence leads to increased hospitalizations, morbidity, and mortality in end-stage renal disease (ESRD) patients.  Studies demonstrate that African American ESRD patients have poorer rates of medication adherence when compared to Whites.  However, the reasons for this racial inequity are not understood.  Race has only been denoted as a risk factor.  However, research has not been conducted to investigate the reasons why being African American is a risk factor for medication nonadherence. 

This is the first study to explore how broader, structural factors, specifically everyday racism within the healthcare system, may contribute to this disparity in medication adherence.  A mixed methods study was conducted to investigate the relationship between everyday racism and medication adherence within the African American ESRD community using Critical Race Theory (CRT) as a theoretical foundation.

The aims of this study were two-fold.  Quantitatively, the aim was to examine if medication adherence was associated with everyday racism in the healthcare setting.  We hypothesized that African American ESRD patients who reported high incidences of everyday racism in the healthcare setting would report lower adherence to their medication regimen.  Qualitatively, the aim was to explore African American ESRD patients’ treatment in the healthcare setting and factors that influenced medication adherence including everyday racism.

Methods:

Data were collected from 46 African American ESRD patients.  Participants were recruited from attendees at two patient-centered meetings in Greensboro, NC and Nashville, TN.  All participants completed a cross-sectional survey comprised of a medication adherence survey and an everyday racism in the healthcare setting survey.  Additionally, 27 of the total sample (N=46) participated in in-depth interviews which lasted approximately one hour. 

Pearson’s correlation was used to determine whether there was a statistical association between medication adherence and everyday racism experienced in the healthcare setting.  Furthermore, constructivist grounded theory was used to identify themes that emerged from interview transcripts.

 Results: 

A statistically significant negative relationship was found between medication adherence and everyday racism in the healthcare setting (r = -.477, p< .01).  As everyday racism increased, medication adherence decreased.  Interviews revealed that everyday racism perpetuated within the healthcare setting negatively affected participants’ medication adherence.  Three themes were identified: 1) Concern that medical providers are not knowledgeable about the medications they prescribe to African Americans 2) Concern that the medications are not safe 3) African Americans are given less medication and laboratory results information than Whites.

 Conclusions and Implications:

In this mixed methods study, the results converge.  The findings suggest that everyday racism is associated with medication nonadherence, and everyday racism was explicated to influence medication nonadherence during in-depth interviews.  These findings provide the basis for development of future research that could lead to interventions with healthcare professionals and the production of antiracist policies to address the disparity.