Does race count in healthcare?

What you look like, or where you come from, shouldn’t matter in the quality of healthcare you receive. But a recent surge of research has flagged multiple examples of racial biases in healthcare that could lead to worse and possibly fatal outcomes in cancer, COVID-19 and emergency treatments.

Underreporting in head and neck cancer trials

There is already evidence for racial disparities in the survival outcomes of patients with head and neck cancers.

The reporting of race and ethnicity is crucial for the generalisability of trial results, and to reduce racial health disparities, but a review of 155 head and neck cancer trials, from 2010 to 2020, found that only 57% of the studies reported race or ethnicity.

Compared to surveillance, epidemiology and end-results programs, head and neck cancer trials enrolled fewer Black (10% against 8%) and Asian or Pacific Islander (6% against 2%) participants.

This work has been published in JAMA Otolaryngology Head & Neck Surgery.

Healthcare, racism, racial bias, cancer, trials, eligibility
Racial biases in cancer treatment eligibility. Credit: Chinnapong / Getty Images

Overestimating wellness and underestimating eligibility in COVID-19 treatments

Pulse oximetry tests are used to measure oxygen levels of the blood, through attaching a painless device usually to your finger. Pulse oximeters are used among COVID-19 patients, to test for the severity of respiratory symptoms, and ultimately influence decisions about treatment, including eligibility for oxygen-threshold specific therapies. Sometimes the oximeter readings can overestimate the level of blood oxygen saturation, something known as occult hypoxemia.

A study of 7126 patients with COVID-19, published in JAMA Internal Medicine, found that occult hypoxemia occurrences were much higher in Asian (30.2%), Black (28.5%) and non-Black Hispanic (29.8%) patients, compared to White patients (17.2%).

This also resulted in lower numbers of patients being recognised as eligible for therapies, where patients who were Black had a 29% lower hazard category rating, and non-Black Hispanic patients had a 23% lower rating, compared to White patients.

This reveals an overestimation of wellness among Asian, Black and Hispanic patients, and a systematic failure to identify Black and Hispanic patients who qualify for COVID-19 therapies.

Healthcare, racism, racial bias, pulse oximetry, covid
Racial biases in pulse oximetry readings. Credit: The Good Brigade / Getty Images

Lower imaging rates at emergency departments of children’s hospitals

A study, published in JAMA Network Open, has examined the difference between the number of children who visit the emergency department, and the likelihood of them receiving diagnostic imaging based on their race.

Of the 12-million-plus emergency-department visits from across 38 hospitals in the US, 28.3% were Hispanic patients, 26.1% were non-Hispanic Black and 35.9% were non-Hispanic White. Of these patients, around 1.5 million received diagnostic imaging testing, including 42.7% White children, 22.4% non-Hispanic Black children, and 25.7% Hispanic children.

Non-Hispanic Black children were consistently less likely to receive diagnostic imaging than non-Hispanic White people at all hospitals, across all imaging modalities (radiograph, ultrasound, MRI, CT).

This research highlights major differences for minoritised patients receiving diagnostic imaging in emergency-department settings, emphasising the urgency for interventions to improve equity in medical care.

Healthcare, racism, racial bias, emergency, scanning, paediatric
Racial biases in emergency scans for children. Credit: xavierarnau / Getty Images

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