COVID-19 Shines Spotlight on Need for Action on Inequalities in Kidney Care

Karen Blum
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The COVID-19 pandemic has shed light on issues of racial inequality, said Nicole Lurie, MD, MSPH, former Assistant Secretary for Preparedness and Response at the US Department of Health and Human Services. “The excess mortality in Black, Latinx, and Native American populations has been absolutely staggering compared to white populations,” she said. “This has coincided with a very challenging and emotional national dialogue about race and racial injustice, structural inequality, and racism.”

Lurie gave the Christopher R. Blagg, MD, Endowed Lectureship in Kidney Diseases and Public Policy as part of the “Policy in a Post-COVID World” session.

Race-based patient disparities have been described frequently, with Blacks, Hispanics, and indigenous people having poorer outcomes than other groups in most chronic diseases. About 200 studies in the PubMed database report on race-based disparities and COVID-19, said Kiesha Gibson, MD, FASN, chief of pediatric nephrology at the University of North Carolina School of Medicine. Yet many of these studies fail to address the extent to which outcomes may be explained or driven by structural racism leading to poverty, poor access to care, and other factors.

Structural inequalities in society have put many people of color in the path of COVID-19 exposure, including frontline workers, those who need to take public transportation to work or cannot work from home, and those who may not have good access to testing or live in crowded, multigenerational households. This has pointed to “some real underinvestment in the science of how structural racism and inequality make you sick,” Lurie said. Institutional biases, or assumptions that race differences are just differences people cannot change, are now causing people to question whether that’s true, Lurie said.

“The kidney community is at the leading edge of this dialogue in medicine, and it has the opportunity to continue to lead and think [about] how to prevent conditions that cause renal failure, and how to get to equity in transportation, home dialysis, and access to new technologies,” she said.

Role of nephrology workforce, innovation

People of color are underrepresented among physicians in the nephrology caregiving workforce, Lurie said, but many more people of color are working as dialysis technicians. This presents an opportunity for interprofessional learning about the kinds of conditions and communities that predispose people to illness.

The kidney and healthcare communities need to support efforts that increase workforce diversity, Gibson said. She noted that more than half of African Americans in the healthcare field are trained in historically Black colleges and universities, which should be seen as partners to enhance the workforce pipeline. Physicians also need to support policies that allow international medical graduates to train and practice in the United States.

COVID-19 has required physicians to innovate in ways they never have before, Lurie emphasized. This innovation presents opportunities to think about how to leverage existing systems, such as using emPOWER data to urge dialysis patients to get vaccinated for COVID-19 once a vaccine is approved.

Likewise, the quick adoption of telemedicine during the COVID-19 pandemic became a lifeline for many patients, Gibson said. However, a large segment of society, particularly in rural America, has been left behind by the digital divide, which hinders access to healthcare and keeps people from working safely at home, Gibson said.

“As healthcare professionals, we have a responsibility to advocate for policies that will directly address social and structural factors that affect health, like transportation, housing, food insecurity, and the digital divide,” she said. “If we are bold in delivering our actions to push these policies, we may find ourselves much closer to solving race-based health disparities rather than simply describing them.”