First in an occasional series about chronic diseases and their impact on urban communities.
Harvet Jones is 48, but he looks much older. Diabetes and high blood pressure have taken their toll.
When he walks, he leans his gaunt frame on a cane because his feet and legs swell and go numb, a complication of hypertension.
Jones' blood-sugar levels spike even though he has been injecting insulin for eight years to control it. A condition called diabetic retinopathy threatens to blind him.
Worst of all, his diabetes and hypertension steadily, relentlessly, mercilessly attacked his kidneys. He went on dialysis in February.
Jones has fallen victim to a quiet epidemic plaguing black Chicago. By the thousands, African-Americans are suffering kidney failure and facing the possibility of blindness, limb amputation, life on dialysis and premature death. Patients with end-stage kidney disease require dialysis or a transplant to survive.
In parts of the city's largely African-American South and West Sides, kidney failure rates are more than twice as high as the national average and three times higher than in the rest of the city, federal statistics show. Those differences are driven by staggeringly high rates of diabetes and hypertension—the top two causes of kidney failure—among Chicago's black residents.
"Hypertension and diabetes are killing us," said Donna Calvin, a Chicago nurse practitioner who specializes in prevention of kidney disease. "These diseases are devastating our community."
Recognizing that kidney failure has reached alarming levels, some individuals and groups are trying to turn those dismal statistics around. They are reaching out to African-Americans across the city with information about prevention, offering diabetes and hypertension screenings in churches, and intervening in various other ways.
Dr. Paul W. Crawford oversees a dialysis center near 95th Street and Western Avenue that is "bursting at the seams." To try to solve the problem at the source, the kidney specialist decided to open a prevention clinic in his large South Side practice.
"I'm treating the children of my patients for the same problems their parents had," Crawford said with exasperation. "And most of it is preventable."
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Health experts think the high kidney failure rates in black neighborhoods are fueled by a combination of overlapping factors, including an obesity epidemic; high concentrations of poverty; and a lack of access to medical care, health insurance, affordable, safe places to exercise and supermarkets that sell inexpensive, healthy foods.
Those factors contribute to the high rates of hypertension and diabetes in the community. About 3,500 of every 100,000 black Chicagoans have been diagnosed with high blood pressure, compared with about 1,700 of every 100,000 whites. For diabetes, the rates are 1,700 per 100,000 African-Americans and 600 per 100,000 whites.
By sheer numbers, 180,000 African-Americans in Chicago have been diagnosed with either diabetes or hypertension, and about 62,000 black Chicagoans battle both, according to the Chicago Department of Public Health.
African-Americans are more prone than other groups to hypertension, though experts aren't sure why. It could be genetic; often hypertension runs in families. Diet could be a factor. Some researchers think another cause could be the stress of racism.
Experts say many African-Americans are unaware of how important it is to treat high blood pressure.
"We see so many people who haven't made the connection of how chronic hypertension affects their kidneys," said Courtney Nicholas, associate director of minority health programs for the American Kidney Fund.
The effects of these trends on black areas are clear.
TRIBUNE SPECIAL REPORT URBAN EPIDEMICS