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Cerdeña JP, Plaisime MV, Borrell LN. Race as a Risk Marker, Not a Risk Factor: Revising Race-Based Algorithms to Protect Racially Oppressed Patients. J Gen Intern Med 2024:10.1007/s11606-024-08919-z. [PMID: 38980468 DOI: 10.1007/s11606-024-08919-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
Emerging consensus in the medical and public health spheres encourages removing race and ethnicity from algorithms used in clinical decision-making. Although clinical algorithms remain appealing given their promise to lighten the cognitive load of medical practice and save time for providers, they risk exacerbating existing health disparities. Race is a strong risk marker of health outcomes, yet it is not a risk factor. The use of race as a factor in medical algorithms suggests that the effect of race is intrinsic to the patient or that its effects can be distinct or separated from other social and environmental variables. By contrast, incisive public health analysis coupled with a race-conscious perspective recognizes that race serves as a marker of countless other dynamic variables and that structural racism, rather than race, compromises the health of racially oppressed individuals. This perspective offers a historical and theoretical context for the current debates regarding the use of race in clinical algorithms, clinical and epidemiologic perspectives on "risk," and future directions for research and policy interventions that combat color-evasive racism and follow the principles of race-conscious medicine.
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Affiliation(s)
- Jessica P Cerdeña
- Department of Family Medicine, Middlesex Health, Middletown, CT, USA.
- Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
- Department of Anthropology, University of Connecticut, Storrs, CT, USA.
| | - Marie V Plaisime
- FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Penn Program On Race, Science & Society Center for Africana Studies (PRSS), University of Pennsylvania, Philadelphia, PA, USA
| | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
- Department of Surgery, Medical and Social Sciences, Universidad de Alcala, Henares Madrid, Spain
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2
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Bentley-Edwards KL, Adisa O, Ruff KE, McClure ES, Robinson WR. Race, racism, and covid-19 in the US: lessons not learnt. BMJ 2024; 384:e076106. [PMID: 38408791 DOI: 10.1136/bmj-2023-076106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Keisha L Bentley-Edwards
- Samuel DuBois Cook Center on Social Equity at Duke University, Durham, NC, USA
- Duke University School of Medicine, Durham, USA
| | - Olanrewaju Adisa
- Samuel DuBois Cook Center on Social Equity at Duke University, Durham, NC, USA
- Duke University School of Medicine, Durham, USA
| | - Kennedy E Ruff
- Samuel DuBois Cook Center on Social Equity at Duke University, Durham, NC, USA
| | - Elizabeth S McClure
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, USA
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3
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Kane VA, Andrikopoulou M, Bertozzi-Villa C, Mims J, Pinson K, Gyamfi-Bannerman C. Low-dose aspirin and racial disparities in spontaneous preterm delivery in low-risk individuals. AJOG GLOBAL REPORTS 2023; 3:100273. [PMID: 38034022 PMCID: PMC10682009 DOI: 10.1016/j.xagr.2023.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Preterm birth is a leading cause of perinatal morbidity and mortality. There are significant racial disparities in the rates of preterm delivery in the United States, with Black individuals at disproportionately higher risk than their White counterparts. Although low-dose aspirin is currently under investigation for reducing the rates of preterm delivery, limited data are available on how the use of low-dose aspirin might affect racial and ethnic disparities in the rates of preterm delivery. OBJECTIVE Our group and others have shown that low-dose aspirin decreases spontaneous preterm delivery in low-risk parturients. This study aimed to examine whether the relationship between low-dose aspirin and the risk of spontaneous preterm delivery is modified by race and ethnicity. STUDY DESIGN This was a secondary analysis of a randomized clinical trial examining low-dose aspirin for preeclampsia prevention in low-risk nulliparous individuals. The parent trial defined low risk as the absence of preexisting hypertension or other medical comorbidities. Participants received 60-mg aspirin or placebo between 13 and 25 weeks of gestation. Here, multiple pregnancies, fetal anomalies, terminations or abortions at <20 weeks of gestation, and participants with previous miscarriages were excluded. Our exposure, race and ethnicity, was self-reported in the parent trial and categorized as non-Hispanic White, Hispanic, non-Hispanic Black, and other. The primary outcome was spontaneous preterm delivery at <34 weeks of gestation; the secondary outcomes included spontaneous preterm delivery at <37 weeks of gestation and all preterm deliveries at <34 and <37 weeks of gestation. Fit logistic regression models were used to examine how the use of low-dose aspirin modified the relationship between race and ethnicity and preterm delivery, adjusting for confounders. Furthermore, sensitivity analyses were performed to compare the rates of preterm delivery by race and ethnicity. RESULTS Of note, 2528 of 3171 parent study participants were included in this analysis. Of the participants, 425 (16.8%) were White, 819 (32.4%) were Hispanic, 1265 (50%) were Black, and 19 (0.8%) were other. The baseline characteristics differed among racial and ethnic groups, including maternal age, body mass index, education level, marital status, tobacco and alcohol use, and pregnancy loss. The rate of spontaneous preterm delivery at <34 weeks of gestation was significantly higher in Black participants (2.8%) than in White (1.2%) and Hispanic (1.2%) participants (P=.04). Logistical regression analysis showed that Black race was no longer an independent risk factor for spontaneous preterm delivery at <34 weeks of gestation when controlling for low-dose aspirin (adjusted odds ratio, 1.71; 95% confidence interval, 0.67-4.40). A similar pattern was found for spontaneous preterm delivery at <37 weeks of gestation and preterm delivery at <34 and <37 weeks of gestation. In our sensitivity analyses, spontaneous preterm delivery at <34 weeks of gestation differed by race and ethnicity in the placebo group (P=.01) but did not differ in the low-dose aspirin group (P=.90). CONCLUSION The use of low-dose aspirin mitigated racial disparities in spontaneous preterm delivery at <34 weeks of gestation. Additional investigation is warranted to assess the reproducibility of our findings.
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Affiliation(s)
- Veronica A. Kane
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Kane)
| | - Maria Andrikopoulou
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (Drs Andrikopoulou and Bertozzi-Villa)
| | - Clara Bertozzi-Villa
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (Drs Andrikopoulou and Bertozzi-Villa)
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, NY (Dr Bertozzi-Villa)
| | - Joseph Mims
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego Health, La Jolla, CA (Drs Mims, Pinson, and Gyamfi-Bannerman)
| | - Kelsey Pinson
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego Health, La Jolla, CA (Drs Mims, Pinson, and Gyamfi-Bannerman)
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego Health, La Jolla, CA (Drs Mims, Pinson, and Gyamfi-Bannerman)
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Cerdeña JP, Tsai JW, Warpinski C, Rosencrans RF, Gravlee CC. Racial, Gender, and Size Bias in a Medical Graphical Abstract Gallery: A Content Analysis. Health Equity 2023; 7:631-643. [PMID: 37786527 PMCID: PMC10541937 DOI: 10.1089/heq.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction Graphical abstracts may enhance dissemination of scientific and medical research but are also prone to reductionism and bias. We conducted a systematic content analysis of the Journal of Internal Medicine (JIM) Graphical Abstract Gallery to assess for evidence of bias. Materials and Methods We analyzed 140 graphical abstracts published by JIM between February 2019 and May 2020. Using a combination of inductive and deductive approaches, we developed a set of codes and code definitions for thematic, mixed-methods analysis. Results We found that JIM graphical abstracts disproportionately emphasized male (59.5%) and light-skinned (91.3%) bodies, stigmatized large body size, and overstated genetic and behavioral causes of disease, even relative to the articles they purportedly represented. Whereas 50.7% of the graphical surface area was coded as representing genetic factors, just 0.4% represented the social environment. Discussion Our analysis suggests evidence of bias and reductionism promoting normative white male bodies, linking large bodies with disease and death, conflating race with genetics, and overrepresenting genes while underrepresenting the environment as a driver of health and illness. These findings suggest that uncritical use of graphical abstracts may distort rather than enhance our understanding of disease; harm patients who are minoritized by race, gender, or body size; and direct attention away from dismantling the structural barriers to health equity. Conclusion We recommend that journals develop standards for mitigating bias in the publication of graphical abstracts that (1) ensure diverse skin tone and gender representation, (2) mitigate weight bias, (3) avoid racial or ethnic essentialism, and (4) attend to sociostructural contributors to disease.
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Affiliation(s)
- Jessica P. Cerdeña
- Department of Family Medicine, Middlesex Health, Middletown, Connecticut, USA
- Institute for Collaboration on Health, Implementation, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
- Department of Anthropology, University of Connecticut, Storrs, Connecticut, USA
| | - Jennifer W. Tsai
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chloe Warpinski
- Department of Anthropology, University of Florida, Gainesville, Florida, USA
- MD-PhD Training Program, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Robert F. Rosencrans
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Clarence C. Gravlee
- Department of Anthropology, University of Florida, Gainesville, Florida, USA
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Znachko CL, Winburn AP, Frame M, Maines S. Operationalizing the structural vulnerability profile within the medical examiner context. Forensic Sci Int Synerg 2023; 6:100334. [PMID: 37228687 PMCID: PMC10203742 DOI: 10.1016/j.fsisyn.2023.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
The medicolegal death investigation process in the United States, historically focused on personal identification and determination of cause and manner of death, has evolved in recent decades to include space for advocacy centered around public health. Particularly, in the domain of forensic anthropology, practitioners have begun to incorporate a structural vulnerability perspective on human anatomical variation, with the goals of articulating the social determinants of ill health and early death and ultimately influencing public policy. This perspective has explanatory power far beyond the anthropological sphere. In this piece, we argue that biological and contextual indicators of structural vulnerability can be incorporated into medicolegal reporting with potentially powerful impacts on policy. We apply theoretical frameworks from medical anthropology, public health, and social epidemiology to the context of medical examiner casework, highlighting the recently proposed Structural Vulnerability Profile developed and explored in other articles in this special issue. We argue that: 1. Medicolegal case reporting provides a valuable opportunity to record a faithful accounting of structural inequities in the annals of death investigation, and 2. Existing reporting infrastructure could, with limited modifications, provide a powerful opportunity to inform State and Federal policy with medicolegal data, presented within a structural vulnerability framework.
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Affiliation(s)
| | | | - Meredith Frame
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA
| | - Sarah Maines
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA
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Varma T, Jones CP, Oladele C, Miller J. Diversity in clinical research: public health and social justice imperatives. JOURNAL OF MEDICAL ETHICS 2023; 49:200-203. [PMID: 35428737 DOI: 10.1136/medethics-2021-108068] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
It is well established that demographic representation in clinical research is important for understanding the safety and effectiveness of novel therapeutics and vaccines in diverse patient populations. In recent years, the National Institutes of Health and Food and Drug Administration have issued guidelines and recommendations for the inclusion of women, older adults, and racial and ethnic minorities in research. However, these guidelines fail to provide an adequate explanation of why racial and ethnic representation in clinical research is important. This article aims to both provide the missing arguments for why adequate representation of racial and ethnic minorities in clinical research is essential and to articulate a number of recommendations for improving diversity going forward.Appropriate racial and ethnic representation and fair inclusion help (1) increase the generalisability of clinical trial results, (2) equitably distribute any benefits of clinical research and (3) enable trust in the research enterprise.
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Affiliation(s)
- Tanvee Varma
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Camara P Jones
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Harvard University Radcliffe Institute for Advanced Study, Cambridge, Massachusetts, USA
| | - Carol Oladele
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Miller
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Cerdeña JP, Grubbs V, Non AL. Racialising genetic risk: assumptions, realities, and recommendations. Lancet 2022; 400:2147-2154. [PMID: 36502852 DOI: 10.1016/s0140-6736(22)02040-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Jessica P Cerdeña
- Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Anthropology, University of Connecticut, Storrs, CT, USA
| | - Vanessa Grubbs
- Department of Ambulatory and Preventive Medicine, Alameda Health System, Oakland, CA, USA
| | - Amy L Non
- Department of Anthropology, University of California, San Diego, CA, USA.
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Winburn AP, Miller Wolf KA, Marten MG. Operationalizing a Structural Vulnerability Profile for forensic anthropology: Skeletal and dental biomarkers of embodied inequity. Forensic Sci Int Synerg 2022; 5:100289. [PMID: 36388762 PMCID: PMC9641186 DOI: 10.1016/j.fsisyn.2022.100289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 05/30/2023]
Abstract
Human societies create and maintain structures in which individuals and groups experience varying degrees of inequity and suffering that may be skeletally and dentally embodied. It is necessary to foreground these social and structural impacts for forensic anthropologists to eschew biologically deterministic interpretations of human variation and overly individualistic interpretations of health and disease. We thus propose a 'Structural Vulnerability Profile' (SVP), akin to the Structural Vulnerability Assessment Tool of medical anthropology [1], to be considered along with the traditional 'biological' profile estimated by forensic anthropologists. Assembling an SVP would involve examining and assessing skeletal/dental biomarkers indicative of embodied social inequity-the lived experiences of social marginalization that can get 'under the skin' to leave hard-tissue traces. Shifting our emphasis from presumably hereditary variation to focus on embodied social marginalization, the SVP will allow forensic anthropologists to sensitively reconstruct the lived experiences of the people we examine.
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9
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Ukoha EP, Snavely ME, Hahn MU, Steinauer JE, Bryant AS. Toward the elimination of race-based medicine: replace race with racism as preeclampsia risk factor. Am J Obstet Gynecol 2022; 227:593-596. [PMID: 35640703 DOI: 10.1016/j.ajog.2022.05.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
Abstract
Pregnancy-related morbidity and mortality continue to disproportionately affect birthing people who identify as Black. The use of race-based risk factors in medicine exacerbates racial health inequities by insinuating a false conflation that fails to consider the underlying impact of racism. As we work toward health equity, we must remove race as a risk factor in our guidelines to address disparities due to racism. This includes the most recent US Preventive Services Taskforce, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine guidelines for aspirin prophylaxis in preeclampsia, where the risk factor for "Black race" should be replaced with "anti-Black racism." In this commentary, we reviewed the evidence that supports race as a sociopolitical construct and the health impacts of racism. We presented a call to action to remove racial determination in the guidelines for aspirin prophylaxis in preeclampsia and more broadly in our practice of medicine.
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10
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Perng W, Dhaliwal SK. Anti-Asian Racism and COVID-19: How It Started, How It Is Going, and What We Can Do. Epidemiology 2022; 33:379-382. [PMID: 34954709 PMCID: PMC8983612 DOI: 10.1097/ede.0000000000001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wei Perng
- From the Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Satvinder K. Dhaliwal
- From the Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
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11
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Cerdeña JP, Jaswaney R, Plaisime MV. Race, Ethnicity, and Immigration Status in a Medical Licensing Educational Resource: a Systematic, Mixed-Methods Analysis. J Gen Intern Med 2022; 37:1045-1051. [PMID: 33987787 PMCID: PMC8971213 DOI: 10.1007/s11606-021-06843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical students preparing for the United States Medical Licensing Exam (USMLE) Step 2 Clinical Knowledge (CK) Exam frequently use the UWorld Step 2 CK Question Bank (QBank). Over 90% of medical students use UWorld QBanks to prepare for at least one USMLE. Although several questions in the QBank mention race, ethnicity, or immigration status, their contributions to the QBank remain underexamined. OBJECTIVE We conducted a systematic, mixed-methods content analysis to assess whether and how disease conditions might be racialized throughout this popular medical education resource. DESIGN We screened 3537 questions in the QBank between May 28 and August 11, 2020, for mentions of race, ethnicity, or immigration status. We performed multinomial logistic regression to assess the likelihood of each racial/ethnic category occurring in either the question stem, answer explanation, or both. We used an inductive technique for codebook development and determined code frequencies. MAIN MEASURES We reviewed the frequency and distribution of race or ethnicity in question stems, answer choices, and answer explanations; assessed associations between disease conditions and racial and ethnic categories; and identified whether and how these associations correspond to race-, ethnicity-, or migration-based care. RESULTS References to Black race occurred most frequently, followed by Asian, White, and Latinx groups. Mentions of race/ethnicity varied significantly by location in the question: Asian race had 6.40 times greater odds of occurring in the answer explanation only (95% CI 1.19-34.49; p < 0.031) and White race had 9.88 times greater odds of occurring only in the question stem (95% CI 2.56-38.08; p < 0.001). Qualitative analyses suggest frequent associations between disease conditions and racial, ethnic, and immigration categories, which often carry implicit or explicit biological and genetic explanations. CONCLUSIONS Our analysis reveals patterns of race-based disease associations that have potential for systematic harm, including promoting incorrect race-based associations and upholding cultural conventions of White bodies as normative.
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Affiliation(s)
- Jessica P Cerdeña
- Yale School of Medicine, New Haven, CT, USA.
- Department of Anthropology, Yale University, New Haven, CT, USA.
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12
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Vince RA, Eyrich NW, Mahal BA, Stensland K, Schaeffer EM, Spratt DE. Reporting of Racial Health Disparities Research: Are We Making Progress? J Clin Oncol 2022; 40:8-11. [PMID: 34694897 PMCID: PMC8683227 DOI: 10.1200/jco.21.01780] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Randy A. Vince
- Department of Urology, University of Michigan, Ann Arbor, MI,Randy A. Vince Jr, MD, MS, Department of Urology, The University of Michigan, 1500 E. Medical Center Drive, TC 3875 SPC 5330, Ann Arbor, MI 48109; e-mail:
| | | | - Brandon A. Mahal
- Department of Radiation Oncology, University of Miami, Miami, FL
| | | | | | - Daniel E. Spratt
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
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Keller SA, Hansmann KJ, Powell WR, Bendlin BB, Kind AJH. A Scoping Review of the Association of Social Disadvantage and Cerebrovascular Disease Confirmed by Neuroimaging and Neuropathology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137071. [PMID: 34281008 PMCID: PMC8297247 DOI: 10.3390/ijerph18137071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
Social disadvantage—a state of low-income, limited education, poor living conditions, or limited social support—mediates chronic health conditions, including cerebrovascular disease. Social disadvantage is a key component in several health impact frameworks, providing explanations for how individual-level factors interact with interpersonal and environmental factors to create health disparities. Understanding the association between social disadvantage and vascular neuropathology, brain lesions identified by neuroimaging and autopsy, could provide insight into how one’s social context interacts with biological processes to produce disease. The goal of this scoping review was to evaluate the scientific literature on the relationship between social disadvantage and cerebrovascular disease, confirmed through assessment of vascular neuropathology. We reviewed 4049 titles and abstracts returned from our search and included records for full-text review that evaluated a measure of social disadvantage as an exposure variable and cerebrovascular disease, confirmed through assessment of vascular neuropathology, as an outcome measure. We extracted exposures and outcomes from 20 articles meeting the criteria after full-text review, and described the study findings and populations sampled. An improved understanding of the link between social factors and cerebrovascular disease will be an important step in moving the field closer to addressing the fundamental causes of disease and towards more equitable brain health.
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Affiliation(s)
- Sarah A. Keller
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (W.R.P.); (B.B.B.); (A.J.H.K.)
- Health Services and Care Research Program, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Correspondence:
| | - Kellia J. Hansmann
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA;
| | - W. Ryan Powell
- Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (W.R.P.); (B.B.B.); (A.J.H.K.)
- Health Services and Care Research Program, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Department of Medicine, Geriatrics Division, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
| | - Barbara B. Bendlin
- Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (W.R.P.); (B.B.B.); (A.J.H.K.)
- Department of Medicine, Geriatrics Division, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
| | - Amy J. H. Kind
- Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (W.R.P.); (B.B.B.); (A.J.H.K.)
- Health Services and Care Research Program, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Department of Medicine, Geriatrics Division, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI 53705, USA
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Silverman-Lloyd LG, Bishop NS, Cerdeña JP. Race is not a risk factor: Reframing discourse on racial health inequities in CVD prevention. Am J Prev Cardiol 2021; 6:100185. [PMID: 34327505 PMCID: PMC8315343 DOI: 10.1016/j.ajpc.2021.100185] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/11/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | - Jessica P. Cerdeña
- Yale School of Medicine, Yale University, 10 Sachem Street, New Haven, CT 06511, USA
- Department of Anthropology, Yale University, New Haven, CT, USA
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Cerdeña JP, Tsai J, Grubbs V. APOL1, Black Race, and Kidney Disease: Turning Attention to Structural Racism. Am J Kidney Dis 2021; 77:857-860. [DOI: 10.1053/j.ajkd.2020.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
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Yearby R. Race Based Medicine, Colorblind Disease: How Racism in Medicine Harms Us All. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:19-27. [PMID: 33280534 DOI: 10.1080/15265161.2020.1851811] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The genome between socially constructed racial groups is 99.5%-99.9% identical; the 0.1%-0.5% variation between any two unrelated individuals is greatest between individuals in the same racial group; and there are no identifiable racial genomic clusters. Nevertheless, race continues to be used as a biological reality in health disparities research, medical guidelines, and standards of care reinforcing the notion that racial and ethnic minorities are inferior, while ignoring the health problems of Whites. This article discusses how the continued misuse of race in medicine and the identification of Whites as the control group, which reinforces this racial hierarchy, are examples of racism in medicine that harm all us. To address this problem, race should only be used as a factor in medicine when explicitly connected to racism or to fulfill diversity and inclusion efforts.
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17
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DiGangi EA, Bethard JD. Uncloaking a Lost Cause: Decolonizing ancestry estimation in the United States. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175:422-436. [PMID: 33460459 PMCID: PMC8248240 DOI: 10.1002/ajpa.24212] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/02/2020] [Accepted: 12/13/2020] [Indexed: 12/22/2022]
Abstract
Since the professionalization of US‐based forensic anthropology in the 1970s, ancestry estimation has been included as a standard part of the biological profile, because practitioners have assumed it necessary to achieve identifications in medicolegal contexts. Simultaneously, forensic anthropologists have not fully considered the racist context of the criminal justice system in the United States related to the treatment of Black, Indigenous, and People of Color; nor have we considered that ancestry estimation might actually hinder identification efforts because of entrenched racial biases. Despite ongoing criticisms from mainstream biological anthropology that ancestry estimation perpetuates race science, forensic anthropologists have continued the practice. Recent years have seen the prolific development of retooled typological approaches with 21st century statistical prowess to include methods for estimating ancestry from cranial morphoscopic traits, despite no evidence that these traits reflect microevolutionary processes or are suitable genetic proxies for population structure; and such approaches have failed to critically evaluate the societal consequences for perpetuating the biological race concept. Around the country, these methods are enculturated in every aspect of the discipline ranging from university classrooms, to the board‐certification examination marking the culmination of training, to standard operating procedures adopted by forensic anthropology laboratories. Here, we use critical race theory to interrogate the approaches utilized to estimate ancestry to include a critique of the continued use of morphoscopic traits, and we assert that the practice of ancestry estimation contributes to white supremacy. Based on the lack of scientific support that these traits reflect evolutionary history, and the inability to disentangle skeletal‐based ancestry estimates from supporting the biological validity of race, we urge all forensic anthropologists to abolish the practice of ancestry estimation.
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Affiliation(s)
- Elizabeth A DiGangi
- Department of Anthropology, Binghamton University, Binghamton, New York, USA
| | - Jonathan D Bethard
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
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18
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Duggan CP, Kurpad A, Stanford FC, Sunguya B, Wells JC. Race, ethnicity, and racism in the nutrition literature: an update for 2020. Am J Clin Nutr 2020; 112:1409-1414. [PMID: 33274358 PMCID: PMC7727473 DOI: 10.1093/ajcn/nqaa341] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 01/06/2023] Open
Abstract
Social disparities in the US and elsewhere have been terribly highlighted by the current COVID-19 pandemic but also an outbreak of state-sponsored violence. The field of nutrition, like other areas of science, has commonly used 'race' to describe research participants and populations, without the recognition that race is a social, not a biologic, construct. We review the limitations of classifying participants by race, and recommend a series of steps for authors, researchers and policymakers to consider when producing and reading the nutrition literature. We recommend that biomedical researchers, especially those in the field of nutrition, abandon the use of racial categories to explain biologic phenomena but instead rely on a more comprehensive framework of ethnicity; that authors consider not just race and ethnicity but many social determinants of health, including experienced racism; that race and ethnicity not be conflated; that dietary pattern descriptions inform ethnicity descriptions; and that depersonalizating language be avoided.
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Affiliation(s)
- Christopher P Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Anura Kurpad
- Department of Nutrition, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India
| | - Fatima C Stanford
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Bruno Sunguya
- Directorate of Research and Publications, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, University College London, London, United Kingdom
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19
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Gower BA, Adele Fowler L, Fernandez JR. Response to Tsai and colleagues. J Intern Med 2020; 288:371-372. [PMID: 32744390 DOI: 10.1111/joim.13152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- B A Gower
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - L Adele Fowler
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - J R Fernandez
- University of Alabama at Birmingham, Birmingham, AL, USA
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