NEW YORK (AP) — Racial bias built into a common medical test for lung function likely leads to fewer black patients receiving care for respiratory problems, according to a study released Thursday.
According to the study, up to 40% more black male patients could have been diagnosed with respiratory problems if the current diagnostic aid computer software had been modified.
Doctors have long discussed the potential problems caused by race-based assumptions that are built into diagnostic software. This study, published in JAMA Network Open, offers one of the first concrete examples of how the problem can affect the diagnosis and care of pulmonary patients, said Dr. Darshali Vyas, a pulmonary care physician at Massachusetts General Hospital.
The results are “exciting” to see published, but it’s also “what we expect” putting aside race-based calculations, said Vyas, who authored an influential New England Journal of Medicine in 2020 which listed examples of how race Assumptions based on assumptions are used in doctors’ decision-making about patient care.
For centuries, some doctors and others believed that there were natural racial differences in health, including that black lungs were inherently worse than whites. This assumption has found its way into modern guidelines and algorithms for assessing risk and deciding on further care. Test results were adjusted to account for — or “correct” for — a patient’s race or ethnicity.
An example beyond lung function is a heart failure risk scoring system that classifies black patients as low risk and less likely to need referral for special heart care. Another is an equation used to determine kidney function that creates estimates of higher kidney function in black patients.
The new study focused on a test to determine how much and how quickly a person can inhale and exhale. This is often done using a spirometer – a device with a mouthpiece connected to a small machine.
After the test, doctors receive a report which has been run through computer software and assesses the patient’s breathing capacity. It helps indicate if a patient has any restrictions and needs additional testing or care for things like asthma, chronic obstructive pulmonary disease, or lung scarring from exposure to air pollutants.
Race-adjusting algorithms raise the threshold for diagnosing a problem in black patients and may make them less likely to start certain medications or be referred for medical procedures or even lung transplants. Vyas said.
While doctors also look at symptoms, lab work, X-rays and family history of breathing problems, lung function tests can be an important part of diagnoses, “especially when patients are borderline,” a said Dr. Albert Rizzo, Chief Medical Officer. at the American Lung Association.
The new study looked at more than 2,700 black men and 5,700 white men tested by physicians from the University of Pennsylvania Health System between 2010 and 2020. The researchers looked at spirometry and lung volume measurements and assessed how many were considered to have respiratory disorders under the race-based algorithm versus a new algorithm.
The researchers concluded that there would be nearly 400 additional cases of lung obstruction or impairment in black men with the new algorithm.
Earlier this year, the American Thoracic Society, which represents physicians in lung care, issued a statement recommending the replacement of race-based adjustments. But the organization also called for more research, including how best to modify the software and whether modification could inadvertently lead to overdiagnosis of lung problems in some patients.
Vyas noted that some other algorithms have already been changed to drop race-based assumptions, including one for pregnant women that predicts the chances of vaginal birth if the mother has had a C-section before.
Changing the lung test algorithm can take longer, Vyas said, especially if different hospitals use different versions of breed-adjusting procedures and software.
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