Exploring racism’s health impact in a VA renal clinic

A new study by Penn LDI’s Kevin Jenkins provides new insights into how structural racism impacts Black patients’ lives and treatment experience for chronic kidney disease.

A new study led by Penn LDI associate fellow Kevin Ahmaad Jenkins queried patients at a Veterans Administration (VA) renal clinic and found them angry, resentful, and stressed by their experiences with racism. The findings are published in JAMA Network Open.

African American person at a renal clinic with a blanket on their lap and an IV in their hand.

At a time when most health equity studies are based on data from electronic health records, which often lack personal stories, this project, instead, interviewed the Black patients themselves at Philadelphia’s Corporal Michael Crescenz Veteran Affairs Renal Clinic, asking how they thought racism was impacting their health in general, as well as their treatment for chronic kidney disease in the clinic.

The study tells a story about Black veterans who have endured a lifetime of trauma from structural racism that generates stress that can exacerbate chronic kidney disease (CKD). Then, when they seek treatment for the condition in a VA renal clinic, they regularly encounter additional institutional racism traumas that may make their CKD even worse.

The research was grounded in the well-established fact that traumatic experiences cause stress throughout the human body, and that excessive stress, experienced over a substantial period, can directly cause subsequent long-term physical and mental harm.

Black veterans with CKD are twice as likely to progress to end-stage renal disease than white veterans. Despite the fact that Black veterans make up 12% of the overall veteran population, they account for 37% of all VA end-stage renal disease patients.

“One of the things we’re working through now,” says Jenkins, “is how to provide the evidentiary point that racism is a trauma. We currently talk so much about the existence of racism-driven trauma, but not really about the eradication part. What does it mean if it is trauma? How should clinicians react and respond to that? My argument is metrics. We need to provide the right metrics so we can actually measure that inequity and the trauma it creates.”

Read more at Penn LDI.