Bringing together genetic work with social determinants of health can improve understanding of factors associated with ESKD disparities, said Adriana Hung, MD, MPH, associate professor of medicine at Vanderbilt University, and Bryce Rowan, a statistical genetic analyst.
Bringing together genetic work with social determinants of health can improve understanding of factors associated with end-stage kidney disease (ESKD) disparities, said Adriana Hung, MD, MPH, associate professor of medicine at Vanderbilt University, and Bryce Rowan, a statistical genetic analyst.
Why did you decide to conduct this analysis on African Americans in the Million Veteran Program?
Rowan: Well, I think it's well known that a lot of genome-wide association studies (GWAS) and other genetic studies aren't done in as many admixed populations. It's just something of interest because it's an issue within the whole field that's not just something that we're trying to address. We have the data set to do it. We actually have a large enough sample size to collect power, and actually get these type of hits, because usually, these studies are smaller. But we have 84,000 people, as Dr. Hung mentioned, of African ancestry. It's a perfect opportunity to try to inform the field and it's an area of interest. Plus, this could help deal with some of the health disparities that go on because like we said, we know a lot about different populations' genetics, but African Americans and Hispanics, there's still a lot more to be studied out.
Dr. Hung: As explained already by Bryce, it's very well known by the nephrology community that minorities are at a much higher risk of progressing to end stage renal disease. The Million Veteran program is one of the few biobanks that offer a diverse population of this size. It represented for us, the unique opportunity to go deeper into the questions that we all as nephrologists have. I think the entire nephrology community has been always wondering what different factors influence these health disparities. With that we're very excited to have this opportunity and these biobanks continue to expand. In the very near future, it'll get up to 660,000 by the end of December with DNA samples. These are the very first steps in exploration and we are hoping, as I mentioned at the beginning, to learn what other genetic factors are influencing this risk beyond APOL 1, which is what our own work in nephrology genetics, in kidney genetics allowed us to learn several years ago. We're very excited for the future and the opportunity to learn other genetic determinants of kidney disease progression in minorities.
What steps ought to be taken to help close the racial gap in ESKD incidence rates?
Dr. Hung: This is going to require a lot of work from all of us in many different areas. So it's not just the genetic part but it's also the environmental and the social context. Some of the members on my team are working in social demographic determinants of health, in health disparities. We will be bringing together the genetic work with the social determinants of health. I think it's not a simple answer, how can we resolve these disparities? But I think we, working all together and understanding the social determinants of health and the genetic components, will help us on one hand, to be able to apply precision medicine, but on the other hand, too, how to change policies and processes that affect many different factors, including the access to care, other aspects of self care, and many other factors that determined altogether this difference.
Do you have any final thoughts you'd like to share?
We just wanted to make sure that we inform the nephrology community of this very large biobank, the Million Veteran program that has this unique opportunity because of the diversity of the population that is included in the Million Veteran program compared, for example, to the United Kingdom Biobank that is mainly White. We are hoping that by working with this biobank, together with the electronic health records of Veterans Affairs (VA), which is huge, it's 22 million individuals, and working with social determinants of health in the entire VA databases, that we can really get to learn what different aspects are the major determinants of disparities, and that we get to practice precision medicine. As a matter of fact, we are the Vanderbilt Precision Nephrology Program.