As early as 1977, studies of patients undergoing dialysis in the United States showed that blacks were overrepresented relative to their proportion of the national population.1 However, it was unclear whether this disparity indicated some particular vulnerability of the kidneys of black Americans or was due instead to the well-recognized increased prevalence in blacks of diseases that cause renal insufficiency, such as hypertension2 and type II diabetes mellitus.3 Subsequent epidemiologic investigations that controlled for hypertension, diabetes, their degree of control, and other clinical factors demonstrated that black patients still had two to four times the risk of developing renal insufficiency compared with white patients.4,5 However, each of these studies, including our own,5 was incomplete because (1) they involved patients receiving care in particular settings rather than investigating the population at large and (2) they did not control for socioeconomic status.
In this issue of the
Tierney WM, Harris LE, Luft FC. Time for Action. Arch Intern Med. 1991;151(7):1272-1274. doi:10.1001/archinte.1991.00400070050003