Structural Racism and the Racial Medication Adherence Inequity Within the End-Stage Renal Disease Population: A New Theoretical Framework

Blacks or African Americans are almost four times more likely to develop end-stage kidney disease (ESKD) than Whites (United States Renal Data System (USRDS), 2019). Black or African-American ESKD patients are also less likely to manage their medications successfully compared to White ESKD patients (Browne & Merighi, 2010; Curtin, Svarstad, Keller, 1999). Few studies, however, investigate broad social issues, such as structural racism, as a fundamental cause of the inequity. Furthermore, theinteraction of structural racism and societal power dynamics in the form of social and cultural capital and their effect on medication adherence inequity has not been explored. This article examines this interaction and its link to medication adherence inequity in the Black or African-American ESKD population and posits a new theoretical framework.