Colorblind Algorithms: Racism in the Era of COVID-19

Williams, J. Corey; Anderson, Nientara; Mathis, Myra; Sanford, Ezelle; Eugene, Jeffrey; Isom, Jessica

doi:10.1016/j.jnma.2020.05.010

Cited by 11 publications

(8 citation statements)

References 5 publications

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“…Inconsistencies in racial data collection at the hospital level may also reflect different conceptualizations of the importance of racial awareness in addressing disparities in care. Color-blind systems have not been shown to be an effective way to address racial disparities in healthcare access or outcome 45. Instead, explicit awareness of how implicit and explicit biases affect care has greater utility in improving the experience of Black and other patients of color 46.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in the 30-Day Outcomes of Gender-affirming Chest Surgeries

2022

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Objective: To determine if and how race impacts the 30-day outcomes of gender-affirming chest surgeries. Background: Little is currently known about how race may affect the outcomes of gender-affirming surgeries. Methods: We analyzed data from the National Surgical Quality Improvement Program (NSQIP) database of 30-day complications of gender-affirming chest surgeries from 2005 to 2019. All participants had a postoperative diagnosis code for gender dysphoria and at least one procedure code for bilateral mastectomy, bilateral breast reduction, or bilateral augmentation mammoplasty. Differences by racial group were analyzed through Pearson χ 2 and multivariate logistic regression. Results: There were no racial differences in the all-complication rates for both transmasculine and transfeminine individuals undergoing genderaffirming chest surgeries. Black patients undergoing masculinizing procedures were significantly more likely to experience mild systemic [adjusted odds ratio (aOR): 2.17, 95% confidence interval (CI): 1.02-4.65] and severe complications (aOR: 5.63, 95% CI: 1.99-15.98) when compared with White patients. Patients of unknown race had increased odds of experiencing severe complications for masculinizing procedures compared with White patients (aOR: 3.77, 95% CI: 1.39-10.24). Transmasculine individuals whose race was unknown were 1.98 times more likely (95% CI: 1.03-3.81) to experience an unplanned reoperation compared with White individuals. Black transfeminine individuals were 10.50 times more likely to experience an unplanned reoperation (95% CI: 1.15-95.51) than their White peers. Conclusions: Although overall complications are uncommon, there is evidence to suggest that there are racial disparities in certain 30-day outcomes of gender-affirming chest surgeries.

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in the 30-Day Outcomes of Gender-affirming Chest Surgeries

2022

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“…The Clinical Setting-Expanding Precision Medicine Beyond "Omics" Data observing inaccurate oximetry readings led to proposals for higher Spo 2 targets in diverse populations to safeguard against desaturation (11). Race is a social construct, so race-based clinical algorithms are not recommended as they perpetuate disparate outcomes for underrepresented races and/or ethnicities, and reinforce dangerous notions of biologic determinism (40)(41)(42). While "race" inadequately groups individuals with different lived experiences into socially derived categories, a patient's skin pigmentation is a unique signature.…”

Section: Stricter Regulatory Requirementsmentioning

confidence: 99%

Discrimination by Design: Is It Time to Recalibrate Interpretation of Pulse Oximetry?*

Barreto

Moynihan²

2023

Pediatric Critical Care Medicine

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balanced representation of populations, and the role of disaggregation for calibration needs to be thoughtfully considered (44). Finally, race categories are inappropriate when what we are measuring is a color-tone scale rather than a social construct. In this research, investigators should endeavor to use objective measures of skin pigmentation over subjective definitions of race and ethnicity (45). CONCLUSIONSDespite being considered an objective measure, robust to implicit biases, pulse oximeters add to a mounting list of chronic racial biases in medicine that may inadvertently promote inequitable outcomes. As structural racism is pervasive, we must seek to critically evaluate all factors that potentially contribute to healthcare disparities. The simple pulse oximeter has numerous limitations. A multitiered approach to improving device accuracy is crucial to advancing healthcare for all but is especially important in improving care of patients who already experience significant health disparities due to their race and/or ethnicity.

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“…For example, Black and Hispanic patients with COVID‐19 have higher risk of hospitalization and death compared to White patients with COVID‐19 18,19 . To address this, some scholars now endorse incorporating SDOH into algorithms for allocating scarce lifesaving resources, such as ventilators, cautioning against a “colorblind” approach 20–22 . From a legal standpoint, some groups caution against allocation based on race/ethnicity due to ethical objections to reverse discrimination, although they support priority decisions based in objective data designed to capture disadvantaged populations, such as the area deprivation index (ADI) 23–25 …”

Section: Proposed Approaches To Prioritization Of Children With Allmentioning

confidence: 99%