Neighborhood Disadvantage and Its Downstream Effects on Equitable Kidney Care, With Maya Clark Cutaia, PhD, RN

Neighborhood disadvantage creates barriers to kidney care at every stage of the continuum, from chronic kidney disease (CKD) diagnosis to disease progression to kidney failure requiring transplantation.

Neighborhood disadvantage is a place-based measure, defined as 1/5th of a population living below the federal poverty line, and with indices such as the Area Deprivation Index (ADI). Measurable data from the US Census Bureau identified 24 million Americans living in disadvantaged neighborhoods, with a disproportionate amount of racial and ethnic families residing within these communities. For example, only 4.3% of white Americans live in a disadvantaged neighborhood compared to 20.9% of black Americans.

“Unfortunately, for many of the patients that I come in contact with that are facing, you know, access barriers they present far later than I'd like, often after years of silent disease and silent decline, because that earlier phase of chronic kidney disease, which is typically asymptomatic… the screening and follow up may be inconsistent, or, in a lot of cases, non existent,” said Maya Clark Cutaia, PhD, RN, inaugural Evelyn Lauder Associate Dean for Nurse Practitioner Programs and Professor at Hunter-Bellevue School of Nursing at Hunter College.

Clark highlights how subtle clinical biases can compound the problem, influencing who receives close monitoring, early counseling, and timely nephrology referral. These gaps accumulate over time, allowing CKD to advance before intervention begins.

Even for patients who reach advanced disease, geography remains a significant barrier. Clark Cutaia points out that some patients travel 6 to 8 hours to reach a transplant center, an unsustainable burden for those who are working, caregiving, or managing multiple conditions. Transplant programs often assume resources and support structures that simply don't reflect the realities of disadvantaged communities.

“Recognizing, yes, I now have a person who's in a disenfranchised neighborhood. I should be trying even harder to get some of that… preemptive care screening available to them so that they don't end up having the same outcome… doing some of these referrals sooner, the handoff sooner, getting them connected with resources, sooner, as opposed to waiting for us to have, you know, a negative outcome, or for these patients to become symptomatic, because we know that that is going to likely be their end game."

Incorporating social and neighborhood context into every CKD care plan is now a core clinical competency for anyone committed to equitable kidney care.

Editor’s Note: Clark Cutaia reports no relevant disclosures.

References

Christie-Mizell CA. Neighborhood Disadvantage and Poor Health: The Consequences of Race, Gender, and Age among Young Adults. International Journal of Environmental Research and Public Health. 2022;19(13):8107. doi:https://doi.org/10.3390/ijerph19138107

Li Y, Menon G, Kim B, et al. Residential Neighborhood Disadvantage and Access to Kidney Transplantation. JAMA Network Open. 2025;8(12):e2549679-e2549679. doi:https://doi.org/10.1001/jamanetworkopen.2025.49679

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