Use of Race in Pediatric Clinical Practice Guidelines

Abstract

guidelines (CPGs) guide medical practice. The use of race in CPGs has the potential to positively or negatively affect structural racism and health inequities.OBJECTIVE To review the use of race in published pediatric CPGs.EVIDENCE REVIEW A literature search of PubMed, Medscape, Emergency Care Research Institute Guidelines Trust, and MetaLib.gov was performed for English-language clinical guidelines addressing patients younger than 19 years of age from January 1, 2016, to April 30, 2021. The study team systematically identified and evaluated all articles that used race and ethnicity terms and then used a critical race theory framework to classify each use according to the potential to either positively or negatively affect structural racism and racial inequities in health care.FINDINGS Of 414 identified pediatric clinical practice guidelines, 126 (30%) met criteria for full review because of the use of race or ethnicity terms and 288 (70%) did not use race or ethnicity terms. The use of a race term occurred 175 times in either background, clinical recommendations, or future directions. A use of race with a potential negative effect occurred 87 times (49.7%) across 73 CPGs and a positive effect 50 times (28.6%) across 45 CPGs. CONCLUSIONS AND RELEVANCEIn this systematic review of US-based pediatric CPGs, race was frequently used in ways that could negatively affect health care inequities. Many opportunities exist for national medical organizations to improve the use of race in CPGs to positively affect health care, particularly for racial and ethnic minoritized communities.

Evaluating potential predictors of weight loss response to liraglutide in adolescents with obesity: A post hoc analysis of the randomized, placebo‐controlled SCALE Teens trial

“…In this context, the inclusion of race and ethnicity was a crude surrogate of the structural and societal factors (racism, access to healthcare, poverty, and quality of care) that may predispose someone to developing obesity or being less responsive to AOMs, as race is not a biological marker but rather a social construct. 31 While none of the baseline characteristics assessed in our study predicted whether adolescent participants achieved ≥5% or ≥10% BMI reduction with liraglutide at week 56, in adults, an exposureresponse analysis of three liraglutide trials found that female sex and a lower baseline BMI were associated with greater weight loss compared with male sex and a higher baseline BMI. 32 The weight loss differences between males and females were partly caused by a higher liraglutide exposure in females compared with males of a similar body weight, while exposure differences attributable to baseline BMI were not associated with meaningful differences in weight loss.…”

“…Liraglutide was found to be more effective in reducing BMI by ≥5% and ≥10% compared with placebo regardless of participants' sex, race, ethnicity, age, Tanner (pubertal) stage, glycemic status, severity of depression symptoms, or obesity category at baseline, indicating that it may be a reasonable treatment option for adolescents with obesity irrespective of these characteristics. In this context, the inclusion of race and ethnicity was a crude surrogate of the structural and societal factors (racism, access to healthcare, poverty, and quality of care) that may predispose someone to developing obesity or being less responsive to AOMs, as race is not a biological marker but rather a social construct 31 …”

A Rubric to Center Equity in Obstetrics and Gynecology Research

“…This disclosure also prompts researchers to think critically about their rationale for including race and ethnicity because these data have historically been used in discriminatory and biased ways that can lead to inappropriate clinical decisions. 11,36,37 The Results section (Section 4) is consistent with the Results section of the American Heart Association's rubric and underscores the importance of avoiding statements that imply that a person's race and ethnicity caused their health outcomes because racism, rather than race, is the exposure. 38 The Discussion portion of the rubric (Section 5) is designed to help authors move beyond merely identifying inequities and toward consideration of strategies to eliminate them.…”

Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants

“…clinical decision-making, it is critical that race and ethnicity are interpreted as social constructs and that these findings not be construed to suggest a higher innate susceptibility to infection. [63][64][65]…”