Re-analyzed APOL1 kidney data support new ethics of 'race'

OBJECTIVESPersistent US racial segregation racializes health, education, employment, and access. We hypothesized that selective recruitment into US military service, equal opportunity for military training and jobs, and earned access to Veterans Administration Healthcare could mitigate racial differences created by racialized early-life deprivations and harms (i.e., social determinants of health). We examined veteran status and the starkest racial disparity in healthcare--chronic kidney disease. METHODSFirst, 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 glomerular filtration rate and kidney failure under more equal conditions of US veterans. Third, we used data re-analysis and close examination of social cofactors to suggest alternative mechanisms for links between socially constructed race, apolipoprotein L1 gene variants, and racialized kidney disease. RESULTSThere was no racial disparity in kidney failure under more equal social conditions. Geographically localized "ancestry markers" may proxy for race. Colorism may be associated with apolipoprotein L1 variants linked to racial (e.g., pigmentary) genes. CONCLUSIONSUnder equal conditions, comparable outcomes should be the expected norm for all, regardless of socially constructed race, ethnicity, or nationality. Disparity between socially constructed categories implies disparate 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. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=109 SRC="FIGDIR/small/24313684v9_ufig1.gif" ALT="Figure 1"> View larger version (49K): org.highwire.dtl.DTLVardef@c93509org.highwire.dtl.DTLVardef@1b90c55org.highwire.dtl.DTLVardef@1d8ac9dorg.highwire.dtl.DTLVardef@2cb3dc_HPS_FORMAT_FIGEXP M_FIG C_FIG STRENGTHS OF THIS STUDYO_LIReminds readers of cross-cultural conflicts in socially constructed race. C_LIO_LIIntroduces international observers to racialization of health in the US. C_LIO_LIRe-analyzes socially constructed race under more equal conditions. C_LIO_LIApplies new ethics, recommended by the National Academies of Sciences, Engineering, and Medicine, to older research on socially constructed race. C_LI