Kidney Week

Abstract: TH-PO849

Long-Term Effects of Structural Racism on Kidney Health: Redlining in Atlanta

Session Information

• Race, Ethnicity, and Gender in Kidney Health and Care
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Bragg-Gresham, Jennifer L., University of Michigan Medical School, Ann Arbor, Michigan, United States

Jennifer L. Bragg-Gresham, PhD

• Fraunhofer, Linda, Laboratory Corporation of America Holdings, Burlington, North Carolina, United States

Linda Fraunhofer, MS

• Licon, Ana Laura, University of Michigan Medical School, Ann Arbor, Michigan, United States

Ana Laura Licon, MS

• Veinot, Tiffany C., University of Michigan School of Information, Ann Arbor, Michigan, United States

Tiffany C. Veinot, PhD

• Ennis, Jennifer L., Laboratory Corporation of America Holdings, Burlington, North Carolina, United States

Jennifer L. Ennis, MD

• Saran, Rajiv, University of Michigan Medical School, Ann Arbor, Michigan, United States

Rajiv Saran, MD, MBBS, MS

Background

In 1938, the Home Owners' Loan Corporation (HOLC) produced a map of Alanta, GA, as a safety investment guide for mortgage lenders. Areas labeled “hazardous” reinforced racial residential segregation with lasting patterns of continuing inequality. We hypothesize that individuals residing in “less desirable” neighborhoods continue to face challenges contributing to the risk of kidney disease.

Methods

Using Labcorp's most recent kidney disease laboratory tests (~25K, 2021-2024) from individuals residing in previously mapped HOLC districts in Atlanta, GA, we spatially joined results to each grade (A: Best [Blue], B: Desirable [Green], C: Declining [Yellow], and D: Hazardous [Red]). Kidney disease was defined by either an eGFR <60 ml/min/1.73m² or a UACR ≥30 mg/g. Hot spot analysis was conducted employing the Getis-Ord Gi*. Logistic regression assessed the odds of kidney disease by HOLC grade, adjusted for age, sex, and current Area Deprivation Index (ADI).

Results

Individuals living in HOLC-A & B neighborhoods were older with a higher proportion of females than those in HOLC-C & D. The prevalence of CKD and current ADI were higher within each successively worse HOLC grade (CKD from 5.3%-13.2% and ADI from 1-3.6). The odds of kidney disease was significantly higher for all HOLC grades compared to grade A (B: OR=1.9, C: OR=2.9, and D: OR=3.7, all p<0.0001). Current day ADI was associated with 13% higher odds of CKD per 1 higher ADI score, p<0.0001.

Conclusion

Significant positive associations were seen between historically redlined areas of Atlanta and the odds of kidney disease. It is imperative to determine the mechanisms underlying these observations and to develop place/person-centered intervention programs to mitigate the effects of these disparities. Future work will assess the causal impact of current day social determinants of health in these geographic areas, including measures of housing, food insecurity, access to healthcare, climate/temperature, and air pollution.