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Kidney Failure and Black Obesity

Kidney failure takes deadly toll on blacks in Chicago

Experts focus on several overlapping factors including obesity and poverty

By Deborah L. Shelton | Tribune reporter

March 30, 2008

Harvet Jones is 48, but he looks much older. Diabetes and high blood pressure have taken their toll.

When he walks, he leans his gaunt frame on a cane because his feet and legs swell and go numb, a complication of hypertension.

Jones' blood-sugar levels spike even though he has been injecting insulin for eight years to control it. A condition called diabetic retinopathy threatens to blind him.

Worst of all, his diabetes and hypertension steadily, relentlessly, mercilessly attacked his kidneys. He went on dialysis in February.

Jones has fallen victim to a quiet epidemic plaguing black Chicago. By the thousands, African-Americans are suffering kidney failure and facing the possibility of blindness, limb amputation, life on dialysis and premature death. Patients with end-stage kidney disease require dialysis or a transplant to survive.

In parts of the city's largely African-American South and West Sides, kidney failure rates are more than twice as high as the national average and three times higher than in the rest of the city, federal statistics show. Those differences are driven by staggeringly high rates of diabetes and hypertension—the top two causes of kidney failure—among Chicago's black residents.

"Hypertension and diabetes are killing us," said Donna Calvin, a Chicago nurse practitioner who specializes in prevention of kidney disease. "These diseases are devastating our community."

Recognizing that kidney failure has reached alarming levels, some individuals and groups are trying to turn those dismal statistics around. They are reaching out to African-Americans across the city with information about prevention, offering diabetes and hypertension screenings in churches, and intervening in various other ways.

Listen To One Womens Story

Dr. Paul W. Crawford oversees a dialysis center near 95th Street and Western Avenue that is "bursting at the seams." To try to solve the problem at the source, the kidney specialist decided to open a prevention clinic in his large South Side practice.

"I'm treating the children of my patients for the same problems their parents had," Crawford said with exasperation. "And most of it is preventable."

• • •

Health experts think the high kidney failure rates in black neighborhoods are fueled by a combination of overlapping factors, including an obesity epidemic; high concentrations of poverty; and a lack of access to medical care, health insurance, affordable, safe places to exercise and supermarkets that sell inexpensive, healthy foods.

Those factors contribute to the high rates of hypertension and diabetes in the community. About 3,500 of every 100,000 black Chicagoans have been diagnosed with high blood pressure, compared with about 1,700 of every 100,000 whites. For diabetes, the rates are 1,700 per 100,000 African-Americans and 600 per 100,000 whites.

By sheer numbers, 180,000 African-Americans in Chicago have been diagnosed with either diabetes or hypertension, and about 62,000 black Chicagoans battle both, according to the Chicago Department of Public Health.

African-Americans are more prone than other groups to hypertension, though experts aren't sure why. It could be genetic; often hypertension runs in families. Diet could be a factor. Some researchers think another cause could be the stress of racism.

Experts say many African-Americans are unaware of how important it is to treat high blood pressure.

"We see so many people who haven't made the connection of how chronic hypertension affects their kidneys," said Courtney Nicholas, associate director of minority health programs for the American Kidney Fund.

The effects of these trends on black areas are clear.

In ZIP code 60620—which includes parts of Ashburn, Auburn Gresham, Beverly, Chatham, Greater Grand Crossing, Roseland and Washington Heights—390 people in every 100,000 suffer from end-stage kidney disease. In ZIP code 60624 on the West Side, it is 387 for every 100,000.

By comparison, the rate for Chicago is 124 cases per 100,000; for the nation, it is 150, according to the U.S. Renal Data System, a government database.

Though Latinos also are at higher risk of kidney failure, the problem is more acute among African-Americans. Nationally, 1 in 8 people who experience kidney failure are Latino, but 1 in 3 are black, Nicholas said. Chicago ZIP codes in the middle range for the disease "more often than not" have large Latino populations, she said.

In the city's black neighborhoods, dialysis centers are full. Whole families struggle medically, financially and emotionally. Significant numbers of people suffer serious, chronic illness during the prime of life, making them too sick to work and unable to move ahead economically.

Studies have reported that African-Americans develop kidney failure at an earlier age than whites, leaving them trapped in a cycle of illness and a poor quality of life during what should be their healthiest years. People die prematurely, leaving family members to grieve.

Diane Williams volunteers with the Chicago Association of Kidney Patients because she has experienced kidney failure up close. Her husband, Major League Baseball umpire Charlie Williams, faced a possible leg amputation and was undergoing dialysis when he died at 61 of complications of kidney failure in 2005. The group formed in 2003 on the Far South Side as a support group for African-Americans battling kidney disease.

"When you lose someone you love," Williams said, "there is always a hole in your soul."

Jones, diagnosed with diabetes 14 years ago, worries about what the future holds.

His brother Joseph McNeal, who has diabetes and is a year older, has been tethered to a dialysis machine for a year. Diabetic retinopathy robbed McNeal of his eyesight about 18 months ago. "It's scary to see what he's going through," said a downcast Jones, taking a break at his favorite neighborhood coffeehouse. "Especially when you have the same symptoms."

Weeks later, Jones was hospitalized for kidney failure and went on dialysis. Because of his worsening health problems, he moved from his Hyde Park home to live with another brother in Lombard.

Charles Baker, 57, was first diagnosed with high blood pressure when he was 16. He had a stroke in 1991, went on dialysis in 2001 and eventually got a kidney transplant.

His son, Jemil Floyd, who also has high blood pressure, started dialysis last April at age 17. Baker sobs at the thought of it. "I've been where he is," Baker said, his voice cracking.

• • •

A steady stream of people flowed last fall into the basement of Oakdale Covenant Church on South Vincennes Avenue to undergo a health screening organized by the American Kidney Fund.

Kidney disease had become too serious of a problem for the church to ignore, said Rev. D. Darrell Griffin, who said his own father died of complications of diabetes and kidney failure in 2005.

"This is something we hadn't addressed, and it's really alarming," Griffin said.

The screening was part of an intervention program by the fund, which aims to reduce high rates of kidney failure in minority communities by collaborating with public and private organizations. The group operates minority intervention programs in Chicago, Atlanta and Washington—cities with large African-American populations and high rates of kidney disease.

Samella Sutton, a pharmacist and member of the church's health ministry, led the congregants in an opening prayer: "Oh Lord, we pray for good health."

By noon, 61 members of the church, located in ZIP code 60620, had rolled up their sleeves to give blood samples, get their blood pressure levels taken and give urine specimens for testing.

After the screening, internist Dr. David Ellens led a question-and-answer session in the large basement.

"Let's prevent bad things from happening," he half-shouted into a microphone, listing the medical problems that could be staved off with good health practices. Stroke. Heart attack. Kidney disease. Kidney failure. Premature death.

Heads nodded.

"Thank you, Lord, for giving us this opportunity to talk to people about their health and well-being," Ellens said solemnly in a closing prayer. "We pray it is information they will use."

Black Men Overcoming The Stigma Of Depression

Dr. King said " Racism is meant to instill in Black people  A degenerating sense of nobodyness."

As you travel across America, go into any inner city downtown area and you're likely to see large numbers of Black men standing on corners, living under highways or camped out by food pantries, who are homeless and unemployed. Many observers, both black and white are quick to call them lazy. As a Black man, I know some of the real reasons behind these growing numbers.  But when I'm asked by my children I am forced to tell them some of the bitter truths of racism in America. Many of these homeless Black men that you see are those who have finally given up. They have given up on their families, their communities, their hope for the future, their desire to find a meaningful jobs, their country, despite many being veterans who proudly served their country and most of all they have given up on themselves.  There are so many more Black men who you don't see who are suffering quiet lives of isolation and depression.

Are black men less likely to seek help for mental illness? Are they even willing to acknowledge that they may have a problem?  Journalist and author John Head has seen this problem from the inside and out. For more than 20 years, he worked as a health reporter for the Detroit Free Press and The Atlanta Journal-Constitution. But his own personal experiences led him to write Standing in the Shadows: Understanding and Overcoming Depression in Black Men. Listen to his personal observation of the problem on NPR. After listening, click the back arrow to come back to this site and post your comments. http://www.npr.org/templates/story/story.php?storyId=89238847

Black Suicide Rate Is Cause For Alarm

Suicide is the third leading cause of death for Black Youth after homicides and accidents, according to the American Association of Suicidology. While whites may be twice as likely as African Americans to commit suicide, the rate is growing among black youth. As part of NPR’s series on Mental Health, Dr. Alvin Poussaint of Harvard Medical School and Donna Barnes President of the National Association For People of Color Against Suicide. After listen to this report click the back arrow to post your comments. If you are thinking about suicide and need immediate help call 1-800-273-TALK.

More blacks than whites must lose a leg to diabetes

By Julie Appleby, USA TODAY

Blacks undergo leg amputations as a complication of diabetes at a far higher rate than whites, according to a study out today that also found blacks lag behind whites in breast cancer screening and diabetic tests.

"There are remarkable disparities between blacks and whites and between communities," says Dartmouth Medical School professor and study lead author Elliott Fisher, who says health systems, economics, lifestyle, education and community resources all play a role in the differences.

• Black residents of Louisiana, Mississippi and South Carolina had 6 amputations per 1,000 Medicare enrollees, while black residents of Colorado and Nevada had fewer than 2 per 1,000.

• Overall amputation rates for both blacks and whites vary among states. Utah has the lowest rate at .5 amputations per 1,000 Medicare members, and Louisiana has the highest at 1.7 amputations per 1,000.

Fisher says patients undergo leg amputations partly because of the care they get and partly because of difficulties they may face in getting treatment. Other factors — such as whether patients smoke or exercise, or if they can afford the special shoes some diabetics need — also play a role, he says.

Blacks also were less likely than whites to get mammograms to check for breast cancer, although the size of the gap varied widely among states. In Illinois, for example, 63% of white female Medicare beneficiaries were screened for cancer, while only 51% of blacks were. In Massachusetts, the gap was narrow: 71.9% of whites were screened, 71.5% of blacks.

With the exception of Arizona and Kentucky, black diabetic patients were less likely to get a recommended annual blood test than whites. The biggest gap was in Colorado, where 84% of whites were tested, 66% of blacks.

Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, says it will spend $300 million over three years to fund programs nationwide and targeted in 14 regions to improve medical care and reduce racial and ethnic disparities.

Changes could include getting patients to regular doctor visits and stocking fresh produce at grocery stores, says John Buse, president for Medicine and Science at the American Diabetes Association, who did not work on the study.

Often, he says, patients who have leg amputations live in poorer communities and are either uninsured or have limited coverage. By the time they qualify for Medicare, they may be in bad shape.

"Once someone with modest resources and no health insurance becomes acutely ill or disabled, they can generally get Medicare or Medicaid," Buse says. "But often the price of admission for a patient with diabetes is a serious complication like blindness, kidney failure, amputation or stroke."

The study, paid for by the non-profit Robert Wood Johnson Foundation, used data from Medicare to look at amputations, screening rates and other measures of quality care among the 50 states and the District of Columbia. The foundation is one of the nation's largest philanthropies and backs efforts to change the health care system.

Researchers studied amputation because it can indicate that diabetes patients have received inadequate preventive care. The study found:

• Across the USA, the rate of leg amputation is four times greater among black Medicare recipients than white.

Black Diabetic Care Less Than Equal

Blacks' diabetes care results 'less ideal' than for whites: study

WASHINGTON (AFP) — Even when they are cared for by the same doctor, black Americans who suffer from diabetes are less likely than their white counterparts to bring the illness under control, a study released Monday showed.

Researchers from Harvard Vanguard Medical Associates analysed electronic medical records from 4,556 white patients and 2,258 black patients under the care of 90 doctors for diabetes.

The patients, who were all treated in eastern Massachusetts, were tested for low density lipoprotein (LDL), the "bad" cholesterol that leads to clogged arteries; hemoglobin A1C (HbA1C), which measures blood glucose control over time; and blood pressure.

"White patients were more likely than black patients to reach commonly accepted benchmarks for controlled levels" of all three, the study showed.

Forty-seven percent of the white patients achieved control of HbA1C versus less than four in 10 blacks; 57 percent of white patients brought their LDL under control, compared to 45 percent of blacks, the study showed.

Blacks also lagged six percentage points behind whites in controlling blood pressure (24 percent versus 30 percent).

"Racial differences in outcomes were not related to black patients differentially receiving care from physicians who provide a lower quality of care but rather that black patients experienced less ideal or even adequate outcomes than white patients within the same physician panel," the authors of the study said.

"Our data suggest that the problem of racial disparities is not characterized by only a few physicians providing markedly unequal care but that such differences in care are spread across the entire system," they added.

The study is the latest to address differences in healthcare for diabetes between blacks and whites in the United States.

A study published last week showed that blacks suffering from diabetes are more likely to have a leg amputated than whites.

Black Doctors Finally Get An Apology From The AMA

By LINDSEY TANNER

CHICAGO (AP) — The American Medical Association on Thursday issued a formal apology for more than a century of discriminatory policies that excluded blacks from participating in a group long considered the voice of U.S. doctors.

The apology stems from initiatives at the nation's largest doctors' group to reduce racial disparities in medicine — from the paltry number of black physicians to the disproportionate burden of disease among blacks and other minorities.

"The AMA is committed to improving its relationship with minority physicians and to increasing the ranks of minority physicians so that the work force accurately represents the diversity of America's patients," Dr. Ronald Davis, the group's immediate past president, said in a statement posted on the AMA's Web site.

Davis said that "by confronting the past we can embrace the future."

The apology comes more than 40 years after AMA delegates denounced policies at state and local medical societies dating to the 1800s that barred blacks. For decades, AMA delegates resisted efforts to get them to speak out forcefully against discrimination or to condemn the smaller medical groups that historically have had a big role in shaping AMA policy.

While the national organization didn't have a blatant policy against black doctors, physicians were required to be members of the local groups to participate in the AMA, Davis said in a phone interview.

"To the extent that our practices may have impeded the ability of African-American physicians to interact collegially with white physicians, it's conceivable" that patient care was harmed, Davis said. "That would certainly be another reason why we would have profound regret for our past practices."

Davis said he hopes the apology "will hasten healing between the AMA and our African-American physician colleagues so that we can create a better future for our patients, our communities and the medical profession."

The apology might seem belated, but it isn't the AMA's first for its discriminatory history. Dr. John Nelson, then AMA's president, offered a similar apology at a 2005 meeting on improving health care and eliminating disparities, sponsored by the government's Agency for Healthcare Research and Quality.

That came a year after the AMA joined the National Medical Association, a black doctors' group, and other minority doctors' groups in forming the Commission to End Health Care Disparities.

The new apology is a more formal acknowledgment of the AMA's embarrassing past, and is also part of the AMA's efforts to improve an image that in recent years has lost its luster. In many circles, the AMA is seen as a stodgy trade group focused on doctors' rather than patients' best interests.

Many black physicians applauded the AMA's move.

"It is true that what the AMA did historically was awful," said Dr. Otis Brawley, the American Cancer Society's chief medical officer. "There were AMA local chapters that actually had rules against black members well into the late 1960s, and policies that made blacks not feel comfortable well into the 1980s."

Brawley, who is black, said he's never been an AMA member, but that the apology "certainly makes me much more interested in working with them."

Dr. Nelson Adams, president of the National Medical Association, said the apology is courageous and "extremely important."

AMA's discriminatory actions hurt black doctors and kept many from working and caring for patients, Adams said. That's because in many places doctors couldn't work in hospitals unless they were members of local medical societies, he said.

He said there's evidence that black patients fare better when treated by black doctors, so these policies could have contributed to poor health care for blacks.

While blacks represent roughly 13 percent of the U.S. population, less than 3 percent of the nation's 1 million doctors and medical students are black, Adams noted.

And according to 2006 data on AMA's Web site, less than 2 percent of AMA members and voting delegates are black.

"We've got a lot of work to do," Adams said.

Dr. Monica Peek, a Chicago internist and member of the AMA and National Medical Association, said the apology "creates an open and healthy dialogue for addressing these issues" that black doctors have long been aware of.

But she said AMA's actions don't lessen the need for a separate group representing black doctors.

Addressing health disparities hasn't always been a part of AMA's mission "but it's something that has never been off of NMA's radar," Peek said

Blacks Hit Harder In Subprime Mess

A Federal Reserve study found that 55 percent of blacks and 17 percent of whites were steered to sub prime mortgages, even when they qualified for lower interest rates. Randall Pinkston reports.

Aids (HIV) Among Black Men And Women In The US

Black AIDS Institute Report Finds AIDS in segments of Black America as Severe as in Many African Countries, But Receives Much Less Attention.

(Los Angeles, CA) -- The United States leads the global response to HIV/AIDS, but fails to mobilize the same commitment to address the large and growing epidemic within its own borders, finds a new report released today by the Black AIDS Institute. "Left Behind! Black America: A Neglected Priority in the Global AIDS Epidemic" praises the United States for it vital efforts to address HIV worldwide, but criticizes the government's profoundly inadequate response to the epidemic within its own borders, where Black Americans are most severely affected by the disease.

"More Black Americans are infected with HIV than the total populations of people living with HIV in seven of the 15 countries served by PEPFAR," noted Phill Wilson, CEO of the Black AIDS Institute and one of the authors of the report, referring to the U.S. government’s program of extraordinary aid for countries severely impacted by the epidemic. "Were Black America a separate country, it would elicit major concern and extensive assistance from the U.S. government. Instead, the national response to AIDS among Black Americans has been lethargic and often neglectful."

"Left Behind!" illustrates a clear and startling gap between the U.S. government’s appropriate concern about AIDS overseas, and its ongoing denial of the epidemic at home – despite the fact that, in areas of the United States such as Detroit, Newark, New York, Washington D.C. and the Deep South, HIV levels among segments of the Black community approach those of many severely affected countries in Africa. For example, HIV prevalence among middle-aged Black men in Manhattan is almost as high as overall prevalence in South Africa, home to the world’s largest population of people living with HIV.

The report points out that, while the U.S. government requires countries receiving PEPFAR support have a national AIDS strategy in place, the United States itself has no strategy for its own epidemic, and was one of 40 countries that failed to fulfill its commitment to report to the Joint United Nations program on HIV/AIDS (UNAIDS) on its response to AIDS at home. At the same time that the United States has dramatically, and appropriately scaled up funding for AIDS overseas, it has simultaneously cut real spending for domestic HIV prevention and care initiatives – even as HIV caseloads in Black America have risen sharply.

"U.S. policy treats AIDS as a foreign policy priority, but virtually ignores the epidemic among Black citizens here at home," said Rev. Al Sharpton, founder and CEO of the National Action Network (NAN). "U.S. policy makers seem to be much more interested in the epidemic in Botswana than the epidemic in Louisiana. This is an unnecessary and deadly choice. Both need urgent attention."  (report continues on BlackAids.org)

The CEO of the institute, Phill Wilson, outlines the report's findings. "We see an epidemic that is growing in black America. A half a million black Americans are infected with HIV. And 50 percent of all new HIV diagnoses in the US are black. AIDS in America today, it can be argued, is a black disease. No matter how you look at it – through the lens of gender, sexual orientation, age, social-economic class, level of education, a region of the country where you live – black people bear the brunt of the AIDS epidemic. We are 30 percent of the new cases among gay men, 40 percent of the new cases among men in general, 60 percent of the new cases among women and 70 percent of the new cases among youth," he says.

Black Women Must Protect Themselves First, Our Future Depends On It!

Black Wall Street:The Untold Story Of 'Little Africa' Tulsa's Black Race Riot Holocaust

The story of the establishment, destruction, resurrection and final burning of America's most prosperous Black communities.

Taken from the documentary "Going Back to T Town".

Ever wonder what life would be like economically and socially for Black People, if there had never been integration?

Black Wall Street in Tulsa, Oklahoma - Pt. 1

Black Wall Street in Tulsa, Oklahoma - Pt. 2

Black Wall Street in Tulsa, Oklahoma - Pt. 3

Pt 4/11 Black Wall Street

Pt 5/11 Black Wall Street - This Is American History

Pt 6/11 Black Wall Street---The White Power Structure Hides The Truth

Pt 7/11 Black Wall Street-White Laws Were Passed To Take The Land Of Black People

Pt 8/11 Black Wall Street- This is out of sink but the words are powerful

Pt 9/11 Black Wall Street

Pt 10/11 Black Wall Street

Pt 11/11 Black Wall Street---The Untold Story Of America's Worse Race Riot

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Medical Racism: Doctors subconsciously favor whites

Findings may explain racial disparities in health care, researcher says.

CHICAGO - Doctors subconsciously favor whites over blacks, U.S. researchers said on Tuesday in a finding that may explain widespread racial disparities in health care in the United States. A long line of studies have found that U.S. blacks get inferior care for cancer and a variety of other ailments compared to whites but experts concerned about the disparities have struggled to understand why. "This supports speculation that subtle race bias may affect health care, but does not imply that it will," said Janice Sabin of the University of Washington in Seattle, who presented the study at the American Public Health Association's annual meeting in San Diego. Sabin said it was too early to know if there was a direct link between the findings and the quality of care delivered to blacks in the United States. She said the findings reinforce other studies showing racial bias is common in the general population. "But we have to remember people are not racist if they hold an implicit bias," she said in a statement.

 

White Healthcare vs. Black Health: Doctor Kenneth Cowens

Sabin used data from a study of more than 400,000 people who took an online test between 2004 and 2006 about their attitudes on race. More than 2,500 of the test-takers said they were doctors. Subconscious signs Rather than overt racism, the test looks for subconscious signs of bias by asking a series of questions. For example, people were asked to quickly say whether photos of blacks and whites were positive or negative. "We don't call what these tests show prejudice. We talk about it as hidden bias or unconscious bias, something that most people are unaware they even possess," said Anthony Greenwald of the University of Washington, who created the test and helped with the study. Overall, 86 percent of people who took the test said they lived in the United States. Out of 2,535 physicians, 76 percent said they were U.S. residents. Of the entire sample, 69 percent said they were white, while 66 percent of those who said they were doctors identified themselves as white. Doctors in all racial and ethnic groups showed an implicit preference for whites versus blacks except for black doctors, who did not favor either group.