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

Background and Purpose: Discrimination has persisted as an important factor that has impacted health disparities in the U.S. Discrimination is pervasive in the lives of Black Americans, and experiences of discrimination are often chronic and perceived as stressful. Thus, it is not surprising that research has identified discrimination as a risk factor for a wide range of physical illnesses among Blacks, including Chronic Kidney Disease (CKD). CKD is a major public health concern in the U.S. that is particularly important to social work, as Medicare mandates Masters level social work involvement in End Stage Renal Disease (ESRD). The health consequences of CKD have exacted a large cost on the healthcare system as individuals living with CKD require extensive medication management and the treatments associated with ESRD are also quite costly.  Medicare spending for all beneficiaries who have CKD exceeded $64 billion in 2015. Blacks are four times more likely to experience chronic kidney disease than Whites in the U.S. To close the knowledge gap on the health effects of discrimination among Black immigrants in the U.S., this study examined the association between discrimination and CKD among Caribbean Blacks and how this association varies by marital status, educational attainment, and length of U.S. residency.

Methods: The analysis was based on nationally representative subsample of Caribbean Blacks from the National Survey of American Life (N = 1551).  Discrimination was measured using the Everyday Discrimination Scale and Chronic Kidney Disease was measured by self-report.  Logistic regression models were conducted to test the aims of this study.

Results: The findings indicate that the association between discrimination and CKD varied by length of U.S. residency, marital status, and education. Among U.S. born participants, higher levels of discrimination were associated with increased probability of CKD. Conversely, among respondents who had resided in the U.S. for less than five years, there was no association between discrimination and CKD. Among individuals who were never married and individuals with lower levels of education, higher levels of discrimination were associated with increased probability of CKD.

Conclusions and Implications: Overall, the findings demonstrate the importance of immigration and sociodemographic context when investigating the relation between discrimination and CKD in immigrant populations. This study has implications for social work practice as there is a need for culturally relevant nephrology social work practice standards to address known disparities among Blacks experiencing chronic kidney disease. Additionally, nephrology social workers must understand the social context that Black patients bring to the medical encounter. This social context is often informed by traumatic experiences, including racial discrimination. Social workers can lead the discussion of moving toward just and equitable care for all chronic kidney disease patients. This study makes several important contributions to the growing literature on discrimination among immigrants, especially Black immigrants. This investigation addresses the complexities of intersectionality. The current analysis provides a detailed examination of the link between discrimination and health by examining not only the direct effect of discrimination on CKD but also how this association varies by sociodemographic and immigration characteristics.