To end misuse of 'race' now: Secondary re-analysis of 'race' in veterans with acute and chronic kidney disease

OBJECTIVES Research on ‘racial’ differences and racialized diseases often stresses genetics over social conditions, perhaps because some medical journals limit (or exclude) as social ‘Commentary’ discussion of ‘race’ as a proxy for social determinants of health. Yet, anthropology research shows ‘race’ is socially constructed, and from early childhood, persistent ‘racial’ segregation ‘racializes’ health, education, employment, and access. Because social deprivations contribute to ‘racial’ difference, we hypothesized that selective recruitment into US military service, equal opportunity for military training and jobs, and earned access to Veterans Administration Healthcare could offset childhood deprivations and social determinants of health linked to socially constructed ‘race’. Our research examined whether veteran status could mitigate the starkest ‘racial’ disparity in healthcare—kidney disease. METHODS Our research re-analyzed ‘racialized’ kidney data from US veterans. First, we defined terms to ensure cross-cultural clarity by orienting international colleagues to the semantics of socially constructed ‘race’ (in Europe) and overt and subtle ‘racialization’ of health (in the US). Second, we removed ‘race correction’ from estimated kidney function under more equal conditions. Third, we used data re-analysis and examination of social cofactors to suggest alternative mechanisms for links between socially constructed ‘race’, apolipoprotein L1 genetic variants, and ‘racialized’ kidney disease. RESULTS Under more equal social conditions, our research found no disparity in kidney failure by ‘race’, suggesting mitigation by Armed Services entry requirements, equitable military opportunities, and subsequent access to Veterans Administration Healthcare. We also found that geographically localized “ancestry markers” can proxy for ‘race’, and that ‘colorism’ may be one mechanism of action for apolipoprotein L1 variants. CONCLUSIONS Under equitable social conditions, comparable outcomes should be the expected norm for all, regardless of socially constructed ‘race’, ethnicity, or nationality. Disparity between socially constructed categories should be explored for unequal social conditions. International collaboration to discourage misuse of socially constructed ‘race’ in medical care and research is an actionable Population Health initiative with potentially high impact but low effort and cost. STRENGTHS OF THIS STUDY Reminds readers of cross-cultural contradictions in socially constructed ‘race’. Introduces international observers to racialization of health in the US. Re-analyzes socially constructed ‘race’ under more equal conditions. Applies new ethics recommendations by the National Academies of Sciences, Engineering, and Medicine to older research on socially constructed ‘race’.