Official websites use .gov

A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS

A lock ( 🔒 ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Need Help

The Impact of Structural Racism on Racial/Ethnic Disparities in End-Stage Kidney Disease from Healthy Population to Mortality

Award Number: R01DK132953
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/01/2022
PERIOD OF PERFORMANCE END DATE: 04/29/2025
AWARD TERMINATION DATE: 04/30/2025

Group Awards By:

View Award Description

The Impact of Structural Racism on Racial/Ethnic Disparities in End-Stage Kidney Disease from Healthy Population to Mortality - Project Summary Racial disparities in the incidence and treatment of end-stage kidney disease are well-documented and largely consistent across outcomes, and an emerging consensus indicates that these disparities are likely to be primarily driven by structural racism (SR). Non-Hispanic Black, Hispanic persons of any race, and American Indian or Alaska Natives (AIAN) are a) at higher risk of chronic kidney disease (CKD) throughout their life course; b) more likely to progress from CKD to end-stage kidney disease (ESKD); c) less likely to be referred for kidney transplantation; d) less likely to obtain a living donor kidney transplant (LDKT); e) experience higher mortality hazards on the transplant waiting list and post-transplant; and f) experience higher rates of post- transplant graft failure. The major exception to this rule is the higher survival rate of Black and Hispanic ESKD patients on dialysis. For all other outcomes, the consistency with which highly similar disparities are observed across these disparate processes suggests that deeper mechanisms are at work — i.e., SR. To assess the hidden forces of SR underlying consistent disparities in ESKD, we will analyze a very large health survey linked to longitudinal Medicare claims, geospatial information, and mortality outcomes. Our approach to measuring SR will be multidimensional, capturing local racial/ethnic inequalities in economic, educational, judicial, political, and residential outcomes as well as health care affordability, contact, proximity, and quality. Furthermore, to fully reflect the contribution of divergent medical treatments to racial/ethnic disparities in ESKD patient outcomes, we will measure ESKD patients’ treatments over time, then identify the most important treatment trajectories for racial/ethnic disparities. In our Aim 1 analysis, we hypothesize that non-Hispanic Black, Hispanic, and AIAN individuals will have higher risk of ESKD development, and that SR will significantly explain these disparities. We will test this hypothesis by analyzing restricted Medicare claims and geospatial data linked to the National Health Interview Study (NHIS; 1994-present; N=941,492 Medicare-linkage-eligible respondents). In our Aim 2 analysis, we hypothesize that non-Hispanic Black, and AIAN respondents will be less likely to receive optimal treatment trajectories and more likely to receive suboptimal treatment trajectories than non-Hispanic Whites. We will construct treatment trajectories using sequence analysis techniques, and assess racial/ethnic disparities in treatment trajectories in the United States Renal Data System dataset (USRDS; 1997-2018; N=2,335,340). In our Aim 3 analyses, we investigate whether racial/ethnic ESKD patient survival advantages compared to non-Hispanic Whites are modified by SR and treatment trajectories. We hypothesize that SR and treatment trajectories both modify racial/ethnic disparities in ESKD patient outcomes, but that treatment trajectories will offer the greatest explanatory power due to their more proximate relationship to patient outcomes. We will test this hypothesis by assessing how well each characteristic statistically explains racial/ethnic disparities in ESKD patient mortality. Throughout the research process we will work with two established community advisory boards to generate novel ideas for analyses, results interpretation, and specific proposed interventions, and refine the proposed interventions for future testing with input from the board and ESKD health care professionals.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = -$805,492 )
2026	2024	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	003	3	4/9/2026	TERMINATION	-$144,270
2026	2024	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	3	4/9/2026	TERMINATION	-$625,511
2026	2023	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	4/9/2026	NON-COMPETING CONTINUATION	-$30,213
2026	2023	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	2	4/9/2026	SUPPLEMENT FOR EXPANSION	-$5,498
														Subtotal = -$805,492

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2024	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	4/29/2025	TERMINATION	$0
2025	2024	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	3	5/1/2025	TERMINATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $769,781 )
2024	2024	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	3	5/17/2024	NON-COMPETING CONTINUATION	$625,511
2024	2024	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	3	5/20/2024	SUPPLEMENT FOR EXPANSION	$144,270
2024	2023	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	10/18/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $769,781

Issue Date FY: 2023 ( Subtotal = $778,143 )
2023	2023	PENNSYLVANIA STATE UNIVERSITY, THE	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	2	5/18/2023	NON-COMPETING CONTINUATION	$658,335
2023	2023	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	2	8/18/2023	SUPPLEMENT FOR EXPANSION	$119,808
2023	2022	PENNSYLVANIA STATE UNIVERSITY, THE	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	10/13/2022	NEW	$0
														Subtotal = $778,143

Issue Date FY: 2022 ( Subtotal = $756,925 )
2022	2022	PENNSYLVANIA STATE UNIVERSITY, THE	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	7/25/2022	NEW	$756,925
														Subtotal = $756,925

Grand Total All Awards = $1,499,357

Top

All Categories

About

Search

Reports

Data Submission

Award Information

The Impact of Structural Racism on Racial/Ethnic Disparities in End-Stage Kidney Disease from Healthy Population to Mortality

Award Number: R01DK132953

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/01/2022

PERIOD OF PERFORMANCE END DATE: 04/29/2025

AWARD TERMINATION DATE: 04/30/2025

Federal Websites

Department of Health & Human Services

HHS Operating Divisions

HHS Staff Divisions

Download A Document Viewer