Thursday, May 29, 2025
5/29/2025
Structural Racism as a "Third hit" on kidney outcomes of Black individuals with APOL1 risk alleles - PROJECT SUMMARY Black individuals have for decades been disproportionately impacted by kidney failure and rapid progression of kidney disease when compared to their White counterparts. Black individuals with APOL1 high-risk alleles are particularly vulnerable to accelerated chronic kidney disease (CKD) progression and kidney failure. However, these high-risk genotypes only occur in about 12-14% of Black individuals, and they do not guarantee CKD progression or kidney failure. Other risk factors, such as hypertension, HIV, and COVID-19, are thought to confer additional second-hit risks. Structural racism (SR)—defined as discriminatory policies and practices promoted through reinforcing systems (e.g., housing, wealth, health care) –– is also widely understood to be a contributor to racial disparities in kidney health. I hypothesize that SR acts as a “third hit” which contributes to excess risk of adverse kidney health outcomes among Black individuals with APOL1 risk alleles. Through four complementary aims, I will characterize the effects of structural racism on kidney health among Black individuals with high-risk APOL1 alleles and design and test a patient-centered intervention to mitigate effects of SR on health outcomes. In Aim 1, I will engage a multidisciplinary stakeholder board to collaborate in the analysis and interpretation of mixed-methods studies in Aims 2 and 3, and in the design and evaluation of a patient-centered pilot intervention in Aim 4. In Aim 2, I will quantify the longitudinal effects of SR with poor kidney health leveraging 3 large APOL1-enriched cohort studies. In Aim 3, I will characterize the experiences of structural racism of Black patients with APOL1 who have CKD and their clinicians with SR in health settings and their communities using qualitative analyses (photovoice, focus groups, semi-structured interviews). In Aim 4, in collaboration with the stakeholder board, I will pilot a patient-centered, navigator-led intervention designed to mitigate the effects of structural racism on kidney health. Throughout the award period, I will pursue training in advanced epidemiologic and statistical science, including longitudinal analysis and multilevel modeling, and develop skills in patient-centered clinical trial design and execution. Training goals and research aims are aligned and integrated to support a holistic experience. The robust training and world-class mentorship supported by this award, and Mount Sinai's enriched training environment and extensive resources, will prepare me for a career as an independent investigator dedicated to mitigating the devastating impact of structural racism on kidney health and eliminating kidney health disparities.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).