Dec 16 2013

Explaining the Link between Income, Race, and Susceptibility to Kidney Disease

Deidra Crews, MD, ScM, an alumna of the Harold Amos Medical Faculty Development Program (2009-2013), was named the 2013-2015 Gilbert S. Omenn Anniversary Fellow at the prestigious Institute of Medicine. Among her current research is a study examining the association between unhealthy diet and kidney disease among low-income individuals.


Human Capital Blog: Congratulations on your fellowship! What are your priorities for the coming year?

Deidra Crews: Over the next two years, I'll be participating in different activities of the Institute of Medicine (IOM). I'll be working with IOM committees and participating in roundtables and workshops. That's the main function of the fellowship. The great thing about it is I'll get to experience firsthand the activities of IOM and hopefully contribute to one or more of the reports that will come out of the IOM over the next couple of years. Because of my interest in disparities in chronic kidney disease, I will be working with the committee on social and behavioral domains for electronic health records, which falls under the IOM board of population health and public health practice. We will be making recommendations on which social and behavioral factors should be tracked in patients' electronic health records.

HCB: How will the fellowship affect your career?

Crews: In a number of ways. Simply having the opportunity to work very closely with leaders and with the senior scholars in my field will advance my career. I’m very interested in the social determinants of health. This board of the IOM and, very specifically, the committee I’ll be working on, includes very senior researchers in this area, some of whom are IOM members themselves. It’s a great opportunity in terms of networking and mentorship. As far as my own sort of research agenda is concerned, I suspect I’m going to get a lot of ideas as I get a sense of where the knowledge gaps are. That will inform my future work as well. Those are the main two ways I see it helping me in my career.

HCB: Can you describe your particular research interests?

Crews: I’m particularly interested in racial and socioeconomic disparities in kidney disease and how the two are interrelated. More than 20 million Americans have chronic kidney disease, and about 600,000 have kidney failure. African Americans are three times more likely than Whites to develop kidney failure, [and African Americans of low socioeconomic status are at especially high risk.]

Specifically, I’ve focused on how low socioeconomic status appears to [differentially] influence African Americans’ chances of getting kidney disease. For example, having a low income is more strongly associated with developing kidney disease among African Americans than among Whites. I’m trying to figure out why that is. What are the factors related to low socioeconomic status that might have a different impact on African Americans than on Whites?

HCB: What are your hypotheses?

Crews: Diet, I think, is a contributing factor, both in terms of access to healthy foods and dietary practices. I’m trying to determine what role diet plays in this disparity. Another factor may be that low socioeconomic status may be more stressful for African Americans than it is for Whites. African Americans are certainly more likely to be discriminated against, particularly if they are also of low socioeconomic status and have little education [or face barriers to health care]. I’m interested in connecting stressors of those kinds to kidney disease.

HCB: What are your next steps?

Crews: I’d really like to focus in on diet, and specifically on different dietary patterns and whether they explain racial disparities in kidney disease, particularly among lower-income individuals. I’m also interested in developing family-based dietary interventions for African Americans who are of low socioeconomic status to try to prevent kidney disease in African Americans.

HCB: Did the Harold Amos Medical Faculty Development program grant prepare you for this work?

Crews: Absolutely. I began the program in 2009 and completed it this year. My work around poverty, socioeconomic status, and race, and its relation to kidney disease, was all a part of my grant. It gave me the protected time and mentorship to complete this work, and it was in recognition of this work that I was granted the IOM fellowship.

Read a related story: Inside the IOM: Advancing a Culture of Health in America.

Tags: Barriers to care: cultural, gender and racial, Barriers to care: financial, Behavior change, Black (incl. African American), Chronic disease management, Disparities, Food access, Harold Amos Medical Faculty Development Program, Human Capital, Poor and economically disadvantaged, Public health, Social determinants of health, Voices from the Field