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  • Racial disparities in renal function: the role of racial discrimination. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

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Racial disparities in renal function: the role of racial discrimination. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
  1. Lidyane V Camelo1,
  2. Luana Giatti2,
  3. Roberto Marini Ladeira3,
  4. Rosane Harter Griep4,
  5. José Geraldo Mill5,
  6. Dóra Chor6,
  7. Sandhi Maria Barreto7
  1. 1 Faculdade de Medicina & Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  2. 2 Faculdade de Medicina & Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  3. 3 Department of Health, Belo Horizonte, Minas Gerais, Brazil
  4. 4 Laboratory of Health and Environment Education, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
  5. 5 Department of Physiological Sciences, Universidade Federal do Espírito Santo, Vitoria, Espírito Santo, Brazil
  6. 6 Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
  7. 7 Faculdade de Medicina & Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  1. Correspondence to Dr. Lidyane V Camelo, Faculdade de Medicina, Universidade Federal de Minas Gerais. Avenida Professor Alfredo Balena, 190, Belo Horizonte, Minas Gerais, CEP 30130-100, Brazil.; lidyanecamelo{at}gmail.com

Abstract

Background Racial discrimination may play a significant role in higher incidence and poorer prognosis of chronic kidney disease among Black individuals. This study set out to investigate the association between racial discrimination and renal function and to estimate the contribution of racial discrimination to existing racial disparities in renal function.

Methods A cross-sectional analysis using baseline data (2008–2010) of 14 355 participants (35–74 years) in the Brazilian Longitudinal Study of Adult Health cohort study. Renal function was estimated based on estimated glomerular filtration rates (eGFR) obtained by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Racial discrimination was assessed using a modified version of the Lifetime Major Events Scale ; race/colour was self-reported. Covariates included were age, sex, level of education and selected health-related factors.

Results Racial discrimination was reported by 31.6%, 6.3% and 0.8% of Black, Brown and White individuals, respectively. The older the age, the lower the prevalence of racial discrimination among Blacks. Racial discrimination was independently associated with lower mean eGFR (β=−2.38; 95% CI −3.50 to −1.25); however, associations were limited to individuals aged under 55 years. In this age group, eGFR differences between Black and White individuals were reduced by 31% when exposure to racial discrimination was accounted for.

Conclusion Blacks are approximately 40 times more likely to report racial discrimination than Whites. Racial discrimination was associated with lower mean eGFR and explained a significant portion of eGFR differences between Black and White individuals aged under 55 years. Exposure to experiences of racial discrimination should be accounted for in studies investigating racial disparities in renal function.

  • social epidemiology
  • renal
  • health inequalities
  • epidemiology of chronic diseases

https://doi.org/10.1136/jech-2018-210665

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    Footnotes

    • Contributors ​LVC, SMB and LG wrote the analysis plan and had the primary responsibility for​ data analysis and drafting the manuscript. ​​​SMB, DC and JGM​ designed and coordinate​d​​ ​the baseline of ELSA-Brasil stud​y. DC, RHG, RML and JGM ​reviewed and commented on the data analysis​, interpretation​ and drafts. ​ ​Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

    • Funding This study was funded by the Brazilian Ministry of Health (Department of Science and Technology) and the Brazilian Ministry of Science, Technology and Innovation (FINEP, Financiadora de Estudos e Projetos and CNPq, National Research Council), Grant No 01 06 0010.00, 01 06 0212.00, 01 06 0300.00, 01 06 0278.00, 01 06 0115.00 and 01 06 0071.00. SMB, DC, LG, RHG and JGM are research fellows of the National Research Council (CNPq). SMB is supported by a research grant (Pesquisador Mineiro) from the Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), Brazil.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval ELSA-Brasil research protocol was approved by the Research Ethics Committee of Universidade de São Paulo (USP), Research Ethics Committee of Universidade Federal de Minas Gerais (UFMG), Research Ethics Committee of Fundação Oswaldo Cruz (FIOCRUZ), Research Ethics Committee of Universidade Federal do Espírito Santo (UFES), Research Ethics Committee of Universidade Federal da Bahia (UFBA), Research Ethics Committee of Universidade Federal do Rio Grande do Sul (UFRGS) and also by the National Research Ethics Committee (CONEP).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data used in this study are available for research proposal on request to the ELSA’s Datacenter and to the ELSA’s Publications Committee (publiELSA). Additional information can be obtained from the ELSA’s Datacenter (estatisticaelsa@ufrgs.br) and from the ELSA Coordinator from the Research Center of Minas Gerais (sbarreto@medicina.ufmg.br).