Assessing Racial Bias in Pulmonary Medicine from the Interpretation of Pulmonary Function Tests

从肺功能测试的解释评估肺医学的种族偏见

基本信息

批准号：
10677310
负责人：
John Henry Brems
金额：
$ 7.86万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10677310
关键词：
Affect Algorithms American Attitude Awareness Bioethics Biological Black Populations Black race Caring Chest Chronic Obstructive Pulmonary Disease Classification Clinical Communities Data Diagnosis Disease Outcome Education Electronic Health Record Equation Ethics Funding Future Glomerular Filtration Rate Goals Guidelines Health Health Sciences Individual Inequity Inhalators Interview Knowledge Lung Lung Transplantation Lung diseases Measures Medical Medical center Medicine Mentorship Methodology Modeling National Research Service Awards Outcome Pathway interactions Patient Care Patients Pharmacological Treatment Physicians Population Predictive Value Pulmonary function tests Pulmonology Race Recommendation Research Research Personnel Respiratory Disease Sampling Scientist Severities Severity of illness Societies Source Structure Surveys Training Translating Transplantation United Network for Organ Sharing Waiting Lists airway obstruction black patient career clinical care clinical practice cohort disease classification health disparity health inequalities novel precision medicine pulmonary function racial bias racial disparity racial population racism shared database skill acquisition skills social tool training opportunity transplant registry trend

项目摘要

Project Summary Racism in medicine causes significant harm to non-White patients in the U.S., and one way this may occur is via the use of racially biased clinical algorithms such as pulmonary function tests (PFTs). PFTs are widely used for the diagnosis, treatment, and related care of respiratory diseases. Currently, interpretation of PFTs relies on race-specific reference equations, which are based on the observation that average lung function varies between different racial groups on a population level. However, with the recognition of race as a social rather than biological construct, race-specific equations may inappropriately ‘normalize’ the lower observed lung function in non-White populations. As such, there exists significant concern that a race-specific interpretation of PFTs promotes racial bias in the care of pulmonary disease. Following a broader trend in medicine as seen with the recent elimination of race from the Glomerular Filtration Rate calculator, many are now calling for a shift to race-neutral equations. Importantly, the clinical implications of the current race-specific or proposed race-neutral interpretations of PFTs remain largely unknown. It has been suggested that race-specific equations may racially bias care via delayed diagnosis and treatment, misclassification of disease severity, and decreased rates of lung transplantation for Black patients. However, there are little data on how these outcomes would change under a race-neutral approach. Further, it is unknown how physicians understand race-specific equations or translate the results into clinical practice. Understanding the clinical implications of a race-specific versus race-neutral interpretation of PFTs among patients with respiratory disease is critical to both informing the current debate and guiding a safe and ethically just transition to race-neutral equations. The main goals of this NRSA application are i) to develop research skills that will allow the applicant to become a successful, independent physician scientist and ii) to better understand how a race-specific interpretation of PFTs may bias treatment of pulmonary disease. Two novel aims are proposed to achieve this objective. First, using COPD as a model respiratory disease, we will estimate the impact that a race-specific approach has on the treatment of patients with COPD by investigating its effect on both inhaler prescriptions and priority for lung transplantation. Second, we will assess physicians’ perspectives on the use of race in PFTs at both a local and national level in order to understand their awareness of how race is used and to identify potential barriers to the elimination of race from reference equations. This application has been structured to provide the applicant with the necessary training to pursue a career as an independently funded researcher working at the intersection of bioethics, race, and pulmonary disease. By incorporating an inter-disciplinary mentorship team, formal education via a Masters in Health Science, and a research plan utilizing both quantitative and qualitative methodologies, the training plan will provide the applicant skills necessary to succeed as an independent investigator.

项目概要医学中的种族主义对美国的非白人患者造成重大伤害，这可能是一种发生的原因是使用存在种族偏见的临床算法，例如肺功能测试（PFT）。目前广泛用于呼吸系统疾病的诊断、治疗和相关护理。 PFT 依赖于特定种族的参考方程，该方程基于平均肺功能的观察然而，随着种族作为社会的一种认识，不同种族群体之间的差异也有所不同。特定种族的方程而不是生物结构，可能会不适当地“正常化”观察到的较低肺因此，人们非常担心对特定种族的解释。 PFT 助长了肺部疾病治疗中的种族偏见，这符合医学领域的更广泛趋势。最近从肾小球滤过率计算器中删除了种族，许多人现在呼吁转向重要的是，当前特定种族或拟议的种族中立方程的临床意义。 PFT 的解释在很大程度上仍然未知，有人认为种族特定的方程可能存在种族差异。由于延迟诊断和治疗、疾病严重程度的错误分类以及肺结核发病率下降而导致的偏向护理然而，关于这些结果将如何改变的数据很少。此外，尚不清楚医生如何理解或翻译特定种族的方程。将结果应用于临床实践。了解特定种族与种族中立的临床意义。对呼吸系统疾病患者 PFT 的解释对于为当前的辩论提供信息和指导安全和道德公正地过渡到种族中立的方程式。此 NRSA 申请的主要目标是 i) 培养研究技能，使申请人能够成为一名成功的、独立的医师科学家，并且 ii) 更好地了解特定种族如何为了实现这一目标，PFT 的解释可能会影响肺部疾病的治疗。目标首先，使用慢性阻塞性肺病作为呼吸系统疾病模型，我们将估计特定种族的影响。通过研究该方法对吸入器处方和治疗方法的影响，对 COPD 患者的治疗产生了影响其次，我们将评估医生对 PFT 中种族因素的看法。地方和国家层面，以了解他们对如何使用种族的认识并确定潜在的从参考方程中消除种族的障碍。该申请的结构旨在为申请人提供必要的培训，以追求作为一名独立资助的研究人员，从事生物伦理学、种族和肺病交叉领域的工作通过组建跨学科指导团队，通过健康硕士学位进行正规教育。科学和利用定量和定性方法的研究计划，培训计划将为申请人提供成功成为独立调查员所需的技能。