Black Veterans with Chronic Kidney Disease Experience Racism in the Healthcare Setting, Resulting in Stress and Distrust

BACKGROUND:

Compared to White Veterans with chronic kidney disease (CKD), Black Veterans with CKD are twice as likely to progress to end-stage renal disease (ESRD). Limited access to quality healthcare, lower socioeconomic status, environmental toxins, and health beliefs and behaviors all contribute to the racial disparities observed in CKD. Despite increasing evidence of racial health disparities and mounting indications of healthcare inequalities in the U.S., research exploring the healthcare experiences of Black Veterans with CKD is limited. This qualitative study investigated these experiences to assess any discrimination faced by this vulnerable population. Investigators interviewed 36 Black Veterans with a diagnosis of CKD who used the Corporal Michael J. Crescenz VA Medical Center’s renal clinics in 2018 and 2019. Interviews (30-60 minutes) were conducted by a Black male principal investigator and a Black male research assistant before or after appointments or during dialysis. Interviews centered around three open-ended questions: 1) What are some examples of racism you have experienced by a doctor? 2) What are some examples of racism you have experienced by someone who works at the hospital who is not your doctor? and 3) How do you think racism affects your health?

FINDINGS:

• Black Veterans with CKD experienced racism in the healthcare setting resulting in physical and emotional stress and distrust in the healthcare system. Some Veterans also expressed a need to be hypervigilant during the clinical encounter. Veteran comments included:
• “…it seemed like everything I asked her about, ‘Oh, don’t worry about that. Don’t worry.’ I said, “What do you mean don’t worry about that? I’m concerned about it.” ‘But I tell you when you need to worry.’ “So, I got rid of her.” (patient switched to a different provider)
• “I just watch how… the interaction with other patients that are White. They may spend time with them, talking with them, this or that… less time with me or the other African Americans that are in the clinic.”
• When encountering racism, Veterans described both negative (e.g., hypervigilance) and positive (e.g., faith) coping strategies.
• Talking and sharing stressful events with family was also a major source of support for respondents.

IMPLICATIONS:

• Findings highlight an important opportunity for educating and training providers in implementing trauma-informed approaches to care as a means of addressing race-based stress and trauma.

LIMITATIONS:

• Study participants used only one VA (Philadelphia) for their care, and thus their experiences may be different from Black Veterans seeking care at another VA medical center – or outside VA.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D. Drs. Jenkins, Keddem, and Long are part of HSR&D’s Center for Health Equity, Research and Promotion (CHERP).

Jenkins K, Keddem S, Bekele S, Augustine K, and Long J. Perspectives on Racism in Healthcare Among Black Veterans with Chronic Kidney Disease. JAMA Network Open. May 12, 2022;5(5).e2211900.