Bridging the Gap in Cardio-Kidney-Metabolic Care: The Role of Social Determinants of Health

The Impact of Social Determinants of Health 

Health inequities are a widespread challenge in the prevention and management of cardio-kidney-metabolic (CKM) diseases. For millions of Americans, risk factors for conditions like chronic kidney disease (CKD), cardiovascular disease and type 2 diabetes are not just biological – they relate to the environments in which a person lives, works and receives care. Understanding the impact of social determinants of health (SDoH) is essential to addressing health inequities and improving health outcomes, especially for Black and African Americans, who are disproportionately impacted by CKM diseases due to SDoH-related barriers.

SDoH are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live and age, as well as the wider set of forces and systems shaping the conditions of daily life. For patients at risk of or living with CKM diseases, adverse SDoH such as limited access to healthy food, lack of transportation and financial barriers can inhibit early screening, diagnosis and care management. 

Disproportionate Impact on Black and African American Communities

Black and African Americans are disproportionately impacted by both CKM diseases and adverse SDoH. Risk factors for CKD, including diabetes, hypertension and cardiovascular disease are highly prevalent among Black and African Americans, putting this population at an increased risk for developing CKD. Let’s look at the numbers:

• Black adults are 60% more likely to be diagnosed with diabetes and 30% more likely to have hypertension than White adults.
• Diabetes and high blood pressure are responsible for 2 in 3 cases of CKD, which impacts more than 35 million adults in the U.S.
• Black and African Americans are four times more likely to progress to kidney failure than White Americans, yet are much less likely to receive a transplant. 
  • According to one study, Black patients were approximately 70% less likely to receive a living donor kidney transplant than their White counterparts.
• 30% of dialysis patients in the United States are Black and African Americans, even though Black and African Americans only represent about 13% of the U.S. population. 

These disparities, and the progression of CKM diseases, are intensified by adverse SDoH, such as limited access to quality healthcare, healthy food options, clean air and water, as well as higher levels of medical mistrust. 

For example, a person may have health concerns related to CKD, but without reliable transportation, they cannot easily access their doctor’s office for preventative appointments and screening, and subsequently may not receive an early diagnosis. Many people face additional barriers, such as living in food deserts, where access to affordable, nutritious food is restricted or nonexistent due to the absence of grocery stores within convenient traveling distance. These barriers can increase the risk of disease progression and result in worse health outcomes.

The Importance of Targeted, Community-Centered Solutions 

Addressing health disparities requires a multifaceted approach that recognizes systemic barriers and works to dismantle them – keeping a core focus on health equity. At Boehringer Ingelheim, we believe that reducing these disparities begins with understanding and addressing adverse SDoH. This could mean addressing the needs of those without reliable transportation by creating solutions to connect them with the services they need and forming community partnerships that provide education on disease prevention and management.

To be truly effective, this work requires collaboration across all sectors of the healthcare system – including health systems, providers, payers, policymakers, and community organizations – to help ensure that these efforts lead to meaningful and sustainable improvements in health outcomes. These initiatives must go beyond clinical care to address the non-medical barriers that can prevent patients from accessing necessary treatment. 

The work ahead is significant, but the opportunity to make a lasting difference is even greater. By working together and committing to meaningful change, we can strive toward a more equitable healthcare system – one where all patients, regardless of their background, have support and access to care.