Redlining has led to increasing rates of nephrolithiasis in minoritized populations: a hypothesis

Abstract

Purpose of reviewThe persistent rise in kidney stone prevalence in recent decades has prompted much speculation as to the causes. There has been some discussion about the effect of heat on nephrolithiasis. Here, we review recent data and postulate that heat may play a role in stone formation on a large scale and among African-Americans in particular.Recent findingsAfrican-Americans are the race/ancestry group with faster rates of increasing incidence and prevalence of kidney stones. We make the observation that urban heat islands in the United States have resulted in part from the effects of redlining, a practice of systematic segregation and racism in housing that led to the development of neighborhoods with substantial disparities in environmental conditions.SummaryIn this thought experiment, we propose that the disproportionate rise in the prevalence of nephrolithiasis in minoritized populations correlates with increased temperatures specifically in neighborhoods adversely affected by the practice of redlining. We discuss phenomena in support of this hypothesis and ongoing work to test this theory.

Climate change and its implications for kidney health

“…Some data demonstrate that the prevalence of USD is rising faster in Black than in non-Black populations [7]. We have hypothesized that this effect is due to greater heat exposure attributable to racist US housing policies (redlining) of the early 20th century [15]. USD thus serves as a prime example of an environmental health disparity.…”

Climate change and kidney stones

“…2[47,48]. These neighborhoods are less likely to be near green space and are more likely to be in areas that experience greater degrees of air pollution [49 ▪ ], which also has been associated with more progressive CKD [50]. This distribution may also reflect differences in population adaptability (access to air-conditioning, well insulated homes, and availability of water) and physical labor.…”

Structural Racism, Historical Redlining, and Incidence of Kidney Failure in US Cities, 2012–2019

“…Therefore, it is possible that historical redlining could create conditions in present-day neighborhoods (e.g., inequitable wealth, exposure to pollution, food insecurity, housing instability, and worse health care access) that contribute to inequitable rates of kidney failure incidence. 27,[30][31][32][33][34][35][36][37][38][39][40] Although previous studies of contemporary neighborhood conditions account for the impacts of historical redlining and other forces that contributed to segregation, no studies to date have examined the association between residence in a historically redlined area and kidney failure incidence.…”