Trends and Socioeconomic, Demographic, and Behavioral Determinants of Kidney Disease Prevalence among African Americans in the United States, 1997–2021

Background and Objective: Both race and socioeconomic status (SES) have been associated with the development and progression of chronic kidney disease (CKD), with African Americans/Blacks and low-SES individuals experiencing substantially increased risks of the disease. However, SES and behavioral determinants of kidney disease among Black Americans are not well studied. This study examines the prevalence and socioeconomic, demographic, and behavioral correlates of severe kidney disease among Black adults in the United States. Methods: Using 1997–2000 ( n = 130,497), 2012–2018 ( n = 224,444), and 2020–2021 ( n = 60,894) National Health Interview Surveys, racial/ethnic and SES disparities in kidney disease (weak/failing kidneys) were analyzed by multivariate logistic regression and trend analyses. Results: During 2012–2018, the prevalence of severe CKD was 2.4% for the Black population aged ≥18, compared with 1.8% for non-Hispanic Whites, 3.5% for American Indians/Alaska Natives, 1.1% for Asian/Pacific Islanders, and 1.7% for Hispanics. Even after controlling for socioeconomic and demographic factors, Blacks had 19% higher odds of severe CKD than non-Hispanic Whites and 47% higher odds than Asian/Pacific Islanders. Education, income, occupation, nativity/immigrant status, physical inactivity, body mass index, hypertension, and diabetes were strong predictors of kidney disease in Blacks. In the adjusted models, Black immigrants had 47% lower odds of severe CKD than US-born Blacks; Blacks with <12 years of education and income below the poverty level had 1.7- and 3.0-times higher odds than Blacks with a college degree and income ≥400% of the poverty threshold, respectively. Physical inactivity, diabetes, and hypertension were associated with 1.9-, 2.9-, and 4.4-times higher odds of severe CKD, respectively, controlling for other factors. CKD effects of diabetes and hypertension were greater among adults aged 18–64 than those aged ≥65. Trend analyses show persistent SES disparities in prevalence between 1997 and 2021. Conclusion and Implications for Translation: SES and health-risk factors are independent and powerful predictors of kidney disease among Black Americans. Socioeconomic influences on kidney disease are greater for Blacks than for non-Hispanic Whites. Policies aimed at prevention, management, and treatment of kidney disease need to monitor the socioeconomically disadvantaged segments of the Black population.