APOL1 and Other metabolic disease: This heterogeneity may reflect the fact that genetic predisposition (e.g., APOL1 variants among blacks), socioeconomic factors, or healthcare accessibility such as systemic barriers to healthcare access, low insurance coverage, and inadequate primary care may delay the diagnosis and management of metabolic disorders, resulting in confounders (e.g., uncontrolled comorbidities) that mask the true association.