Chronic Health Conditions and Racial Disparities in Black Communities

In the United States, chronic conditions such as hypertension, diabetes, and heart disease disproportionately impact Black communities, unveiling a complex interplay of racial disparities and health outcomes.

Over 50%¹ of US adults have at least one chronic condition, such as high blood pressure (hypertension), diabetes, kidney disease, etc. Chronic conditions represent a significant public health concern in the US. This reality, rooted in a confluence of socioeconomic factors, systemic racism, and healthcare inequities, presents a pressing public health challenge that demands attention and action

Nearly half of US adults, or 119.9 million people, have high blood pressure. Only 1 in 4 are considered controlled.³ Although not as prevalent, diabetes also impacts a significant number of Americans. For instance, around 12% or 38.4 million US adults have diabetes. Surprisingly, just under 9 million are unaware they have diabetes.⁴ 

The burden of chronic conditions is not evenly distributed. Black adults are diagnosed with high blood pressure, diabetes, and kidney disease at higher rates than white Americans.^5-9 They also experience worse health outcomes. 

Understanding the connections between high blood pressure, diabetes, and kidney disease helps in finding ways to prevent and manage these conditions. Decreasing the impact of these disparities requires focusing on several factors. These include access to quality healthcare and targeted public health interventions.

Exploring the Connection Between Specific Chronic Conditions

You or someone you know may have high blood pressure, diabetes, kidney disease, or other chronic conditions. But, have you ever stopped to think if one condition may be causing another? 

If caught early enough, you can take steps to prevent your chronic condition from causing other problems. For example, if you’ve been told you have borderline high blood pressure, you could start making changes to your diet. You could also increase your exercise or start medication to keep it under control. This could keep your blood pressure within range for many years. It could prevent heart attacks, strokes, and kidney disease. The same can be said for diabetes.

So how are high blood pressure, diabetes, and kidney disease connected? High blood pressure and diabetes, unfortunately, work together to increase the risk of kidney disease. Both diseases affect your blood vessels over time, especially if uncontrolled. This can lead to kidney damage and, in severe cases, the need for dialysis.

Impact of High Blood Pressure 

Over time, high blood pressure strains the blood vessels in your kidneys. This forces your kidneys to work harder to maintain your blood pressure. This constant pressure causes your vessels to narrow and weaken. It decreases their ability to filter waste products from the blood.  

The scarring caused by this pressure further reduces your kidney function, leading to kidney damage.¹⁰ You may not notice these changes, so high blood pressure is known as the “silent killer.”

Impact of Diabetes

Chronically elevated blood sugar levels directly damage the tiny kidney filters called nephrons. This decreases their ability to filter effectively, causing waste products to build up and harm your kidneys.¹¹

Diabetes also triggers inflammation in the body, including in the kidneys. This inflammation can further damage the nephrons and blood vessels, accelerating the decline in kidney function.¹⁰

Impact of Kidney Disease

When high blood pressure and diabetes are present, their negative effects become amplified. The high blood pressure worsens the damage caused by diabetes, and vice versa. This eventually leads to chronic kidney disease (CKD), which can progress to kidney failure. 

One of the first signs of kidney damage is the presence of protein in the urine. High blood pressure and diabetes can cause proteinuria, where proteins spill into the urine. If levels remain too high or these chronic conditions go unchecked, you may need dialysis or a kidney transplant to survive.

Root Causes of Disparity Among Black People

Research shows Black people suffer from chronic conditions at higher rates than White people. But it’s important to note that race isn’t the only factor that affects health outcomes. Other factors include^12-14:

• Socioeconomic factors: Access to quality healthcare, education, safe housing, and healthy food 
• Historical and ongoing systemic racism: Discrimination in various aspects of life, including housing, employment, and healthcare
• Environmental factors: Exposure to pollution, toxins, and other environmental hazards 
• Genetic factors: Strong family history of chronic diseases among first-degree relatives

Preventing and Managing Chronic Conditions

Chronic conditions, such as high blood pressure, diabetes, and kidney disease, require long-term management and lifestyle changes. Here are some effective strategies for preventing and managing chronic conditions:

Lifestyle Modifications

• Healthy Diet: Focus on a balanced diet rich in fruits, vegetables, whole grains, and lean protein. Limit processed foods, sugary drinks, and unhealthy fats.
• Regular Physical Activity: Aim for at least 150 minutes of moderate-intensity exercise per week. Or, aim for 75 minutes of vigorous-intensity exercise per week. Include activities you enjoy, like brisk walking, swimming, or biking.
• Weight Management: Maintaining a healthy weight reduces the risk of chronic diseases. Talk to your doctor about setting realistic weight goals.
• Stress Management: Chronic stress can worsen existing health conditions. Find healthy ways to manage stress, such as yoga, meditation, or spending time in nature.
• Sleep Hygiene: Prioritize getting 7-8 hours of sleep each night. Establish a regular sleep schedule and create a relaxing bedtime routine.
• Quit Smoking: Smoking is a major risk factor for many chronic diseases. If you smoke, quitting is the single best thing you can do for your health.

Healthcare Management

• Regular Checkups: Schedule regular checkups with your healthcare provider. Monitor your health and identify potential problems early on.
• Preventive Screenings: Get recommended preventive screenings. These may include blood pressure checks, diabetes blood work, and kidney screenings.
• Medication Adherence: If prescribed medication, take it exactly as your healthcare provider directs. Don’t skip doses or adjust your medication without talking to them.
• Open Communication: Maintain open communication with your healthcare provider. Discuss your health concerns, treatment options, and any side effects.
• Support Groups: Support groups offer valuable support and encouragement. 

Remember, preventing and managing chronic conditions is an ongoing process. Be patient and persistent. Work closely with your healthcare team to find the best strategies for you.

The Bottom Line

High blood pressure, diabetes, and kidney disease are chronic conditions. If left uncontrolled, they lead to unwanted outcomes. Unfortunately, Black people are more likely to be diagnosed with these conditions at higher rates than other groups. 

Several factors besides race cause these disparities among ethnic groups. But, you can take control of your health by taking the necessary steps to lead a healthy lifestyle. Not all lifestyle changes are one size fits all, and it may take time to figure out what works best for you. 

Speak with your healthcare provider to ensure you stay up-to-date on recommended screenings. An ounce of prevention is worth a pound of cure. 

Conversation Starters

• It’s interesting how high blood pressure and diabetes can work together to increase the risk of kidney disease. Have you ever considered the interconnection of chronic conditions and their potential impact?
• Were you aware of how high blood pressure and diabetes can affect the kidneys, and have you taken steps to protect your kidney health?
• A list of effective strategies for preventing and managing chronic conditions, such as lifestyle modifications and regular checkups, were reviewed. What lifestyle changes do you think would be feasible for you to implement?

Resources

1. Boersma P, Black LI, Ward BW. Prevalence of Multiple Chronic Conditions Among US Adults, 2018. Preventing Chronic Disease. 2020;17(17). doi:https://doi.org/10.5888/pcd17.200130
2. Ge L, Ong R, Yap CW, Heng BH. Effects of chronic diseases on health-related quality of life and self-rated health among three adult age groups. Nurs Health Sci. 2019;21(2):214-222. doi:10.1111/nhs.12585
3. ‌Centers for Disease Control and Prevention. Hypertension Prevalence in the U.S. | Million Hearts®. Centers for Disease Control and Prevention. Published February 5, 2020. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html
4. Statistics About Diabetes | ADA. diabetes.org. https://diabetes.org/about-diabetes/statistics/about-diabetes#:~:text=Overall%20numbers
5. ‌Hill L, Ndugga N, Published SA. Key Data on Health and Health Care by Race and Ethnicity. KFF. Published March 15, 2023. https://www.kff.org/racial-equity-and-health-policy/report/key-data-on-health-and-health-care-by-race-and-ethnicity/#:~:text=Prevalence%20of%20chronic%20disease%20varied
6. ‌Thorpe RJ Jr, Fesahazion RG, Parker L, et al. Accelerated Health Declines among African Americans in the USA. J Urban Health. 2016;93(5):808-819. doi:10.1007/s11524-016-0075-4
7. Aggarwal R, Chiu N, Wadhera RK, et al. Racial/Ethnic Disparities in Hypertension Prevalence, Awareness, Treatment, and Control in the United States, 2013 to 2018. Hypertension. 2021;78(6). doi:https://doi.org/10.1161/hypertensionaha.121.17570
8. Diabetes and African Americans | Office of Minority Health. minorityhealth.hhs.gov. https://minorityhealth.hhs.gov/diabetes-and-african-americans
9. ‌Race, Ethnicity, & Kidney Disease. National Kidney Foundation. Published January 7, 2016. https://www.kidney.org/atoz/content/minorities-KD#:~:text=Black%20or%20African%20Americans%20are
10. ‌Tsalamandris S, Antonopoulos AS, Oikonomou E, et al. The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives. Eur Cardiol. 2019;14(1):50-59. doi:10.15420/ecr.2018.33.
11. CDC. Diabetes and Chronic Kidney Disease. Centers for Disease Control and Prevention. Published 2021. https://www.cdc.gov/diabetes/managing/diabetes-kidney-disease.html
12. ‌Ellis KR. Chronic Disease Among African American Families: A Systematic Scoping Review. Preventing Chronic Disease. 2020;17. doi:https://doi.org/10.5888/pcd17.190431
13. ‌Rahman S, Mirza AS, Wathington D, et al. Chronic disease and socioeconomic factors among uninsured patients: A retrospective study. Chronic Illn. 2021;17(1):53-66. doi:10.1177/1742395319828430
14. LaFave SE, Suen JJ, Seau Q, et al. Racism and Older Black Americans’ Health: a Systematic Review. J Urban Health. 2022;99(1):28-54. doi:10.1007/s11524-021-00591-6