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Abstract: PO0090

Stigma Syndemics and ESKD in Disenfranchised Urban Communities Fighting COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Schmidt, Insa Marie, Boston Medical Center, Boston, Massachusetts, United States
  • Stern, Lauren D., Boston Medical Center, Boston, Massachusetts, United States
  • Farr, Margaret, Boston University, Boston, Massachusetts, United States
  • Nguyen, Nicole Han, Boston University, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
  • Shohet, Merav, Boston University, Boston, Massachusetts, United States
Background

Although COVID-19 is impacting all communities, the distribution of its harms is not equal. Poor, urban people of color with compromised health are particularly hard-hit. This study explores how patients with end-stage kidney disease (ESKD), living in underprivileged urban communities, manage their illness and treatment experiences and disease-associated stigmas in the face of COVID-19.

Methods

We used purposive sampling to enroll patients with ESKD at a safety net hospital in Boston, MA. 12 remote ethnographic interviews were conducted from December 2020 to June 2021. Interviews were recorded and transcribed, and data were analyzed using grounded theory and dimensional narrative analysis. We identified dominant themes reflecting the biosocial harms caused by ESKD as well as patients’ sense of isolation and stigmatization before and during the COVID-19 pandemic.

Results

The mean age of patients was 56±14 years, 50% were female, and 90% self-identified as Black. Almost all patients reported adverse effects from dialysis treatment which leaves them depleted and precludes them from working. Facing the biosocial implications of dialysis, patients also experienced severe economic hardship which has been intensified by the COVID-19 pandemic. While many patients framed COVID-19 as “just one more thing” and denied increased stigmatization by others due to their potentially increased susceptibility to infection, male patients more frequently reported experiencing racial stigmatization and narrated it as contributing to and exacerbating their chronic illness and suffering.

Conclusion

Biosocial and environmental factors as well as institutional racism and stigmatization play significant roles in amplifying the burden of ESKD in patients of color who are now syndemically impacted by COVID-19 (Figure 1). A better understanding of how these factors interplay will help to inform policy makers in alleviating tensions and structural conditions that impinge on patients’ well-being and health outcomes.

Funding

  • Private Foundation Support