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Lewis C, Cohen PR, Bahl D, Levine EM, Khaliq W. Race and Ethnic Categories: A Brief Review of Global Terms and Nomenclature. Cureus 2023; 15:e41253. [PMID: 37529803 PMCID: PMC10389293 DOI: 10.7759/cureus.41253] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Terminology regarding descriptors of race and ethnicity have been constantly evolving. Due to differences in terminology, data collection, demographics, and group identity, there are numerous challenges in determining what descriptors are suitable and acceptable to all individuals. The National Institutes of Health (NIH) has defined six racial and ethnic categories that should be used for reporting purposes. This review gives a historical background of the definition of the different racial and ethnic categories. This review also aims to define acceptable categories of race and ethnicity to provide guidelines for reports and best practices.
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Affiliation(s)
- Catherine Lewis
- General Surgery, East Tennessee State University, Johnson City, USA
| | - Philip R Cohen
- Dermatology, University of California Davis Medical Center, Sacramento, USA
| | - Devyani Bahl
- Oral and Maxillofacial Surgery, NITTE University, Mangalore, IND
| | - Elliot M Levine
- Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, USA
- Obstetrics and Gynecology, Advocate Illinois Masonic Medical Center, Chicago, USA
| | - Waseem Khaliq
- Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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2
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Gombault C, Grenet G, Segurel L, Duret L, Gueyffier F, Cathébras P, Pontier D, Mainbourg S, Sanchez-Mazas A, Lega JC. Population designations in biomedical research: Limitations and perspectives. HLA 2023; 101:3-15. [PMID: 36258305 PMCID: PMC10099491 DOI: 10.1111/tan.14852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 12/13/2022]
Abstract
In biomedical research, population differences are of central interest. Variations in the frequency and severity of diseases and in treatment effects among human subpopulation groups are common in many medical conditions. Unfortunately, the practices in terms of subpopulation labeling do not exhibit the level of rigor one would expect in biomedical research, especially when studying multifactorial diseases such as cancer or atherosclerosis. The reporting of population differences in clinical research is characterized by large disparities in practices, and fraught with methodological issues and inconsistencies. The actual designations such as "Black" or "Asian" refer to broad and heterogeneous groups, with a great discrepancy among countries. Moreover, the use of obsolete concepts such as "Caucasian" is unfortunate and imprecise. The use of adequate labeling to reflect the scientific hypothesis needs to be promoted. Furthermore, the use of "race/ethnicity" as a unique cause of human heterogeneity may distract from investigating other factors related to a medical condition, particularly if this label is employed as a proxy for cultural habits, diet, or environmental exposure. In addition, the wide range of opinions among researchers does not facilitate the attempts made for resolving this heterogeneity in labeling. "Race," "ethnicity," "ancestry," "geographical origin," and other similar concepts are saturated with meanings. Even if the feasibility of a global consensus on labeling seems difficult, geneticists, sociologists, anthropologists, and ethicists should help develop policies and practices for the biomedical field.
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Affiliation(s)
- Caroline Gombault
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - Guillaume Grenet
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Pole de Santé Publique, Hospices Civils de Lyon, Service Hospitalo-Universitaire de PharmacoToxicologie, Lyon, France
| | - Laure Segurel
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - Laurent Duret
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - François Gueyffier
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Pôle de Santé Publique, Hospices Civils De Lyon, Lyon, France
| | - Pascal Cathébras
- Service de Médecine Interne, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Dominique Pontier
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - Sabine Mainbourg
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Service de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, Hospices Civils De Lyon, Lyon, France
| | - Alicia Sanchez-Mazas
- Laboratory of Anthropology, Genetics and Peopling history, Department of Genetics and Evolution, University of Geneva, Geneva, Switzerland
| | - Jean-Christophe Lega
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Service de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, Hospices Civils De Lyon, Lyon, France
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3
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Prakash Y, Ward LM, Jaleel Z, Ilavarasan V, Liang JJ, Prakash M, Levi JR. The Use of Race and Socioeconomic Status Variables in Published Otolaryngologic Research. Ann Otol Rhinol Laryngol 2022:34894221111323. [PMID: 35861198 DOI: 10.1177/00034894221111323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To characterize the use of race and socioeconomic status (SES) variables in clinical otolarynogologic research. METHODS Databases were queried for all articles published in 2016 issues of 5 major otolaryngologic journals. One thousand, one hundred and forty of 1593 articles abstracted met inclusion criteria for analysis. RESULTS In total, 244 (21.4%) studies specified race as a variable. The subspecialty of Head and Neck cancer specified race at statistically higher rates compared to other subspecialties (P = .002). Two hundred nine (34.0%) domestic studies specified race compared to 35 (6.7%) international studies. Of the 244 studies that specified race, 79 (32.4%) defined race using racial and ethnic categories interchangeably. Two hundred twenty-four (91.8%) studies reported data by race, 145 (59.4%) analyzed the data, and 112 (45.9%) discussed race-based results.In total, 94 (8.2%) studies specified SES. All subspecialties specified SES at statistically similar rates. Seventy (11.4%) domestic studies specified SES compared to 24 (4.6%) international studies. Of the 94 studies that specified SES, 42 (44.7%) defined SES using insurance status, 35 (37.2%) used education, and 32 (34.0%) used income. Seventy-eight (83.0%) studies reported data by SES, 71 (75.5%) analyzed the data, and 68 (72.3%) discussed SES-based results. CONCLUSION In clinical otolaryngologic research, the study of race and SES is limited. To improve quality of research and patient care for all patients, investigators should clearly justify their use of race and SES variables, carefully select their measures of race and SES (if the use of these variables is justified), and study race/SES-based data beyond just a superficial level.
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Affiliation(s)
- Yash Prakash
- Boston University School of Medicine, Boston, MA, USA
| | - Libby M Ward
- Boston University School of Medicine, Boston, MA, USA
| | - Zaroug Jaleel
- Department of Otolaryngology/Head and Neck Surgery, University of Washington Medical Center, Seattle, WA, USA
| | | | - Jennifer J Liang
- Department of Otolaryngology/Head and Neck Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Jessica R Levi
- Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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4
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Matthews S, Levy PD. A sociogenomic paradigm to replace the racial paradigm. Per Med 2022; 19:377-382. [PMID: 35758011 DOI: 10.2217/pme-2021-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Sajith Matthews
- Department of Internal Medicine, Division of General Medicine, Wayne State University, 4201 St Antoine Street, UHC 5C, Detroit, MI 48201, USA
| | - Phillip D Levy
- Department of Emergency Medicine & Integrative Biosciences Center, Wayne State University, Detroit, MI 48201, USA
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Society for Maternal-Fetal Medicine Special Statement: Race in maternal-fetal medicine research- Dispelling myths and taking an accurate, antiracist approach. Am J Obstet Gynecol 2022; 226:B13-B22. [PMID: 34774520 DOI: 10.1016/j.ajog.2021.11.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Profound inequities in maternal and infant outcomes based on race exist, and the maternal-fetal medicine community has an important role in eliminating these disparities. Accurately employing race and ethnicity as social constructs within research that guides clinical practice is essential to achieving health equity. We must abandon commonly propagated myths that race is a surrogate for genetics or economic status and that data are exempt from potential bias. These myths can lead to harmful misconceptions that exacerbate racial disparities in maternal and infant health outcomes. Furthermore, these myths obscure racism as the true underlying etiology of racial disparities. Understanding that race is a social construct and using an antiracist approach to research are essential in combating racism and eliminating unacceptable disparities in maternal and infant health. This document provides specific suggestions to approach the research process with an antiracist framework.
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Mpody C, Ghimire A, Nafiu OO. Looking Through Race-Conscious or Race-Neutral Lenses in Pediatric Research. Pediatrics 2022; 149:184769. [PMID: 35156123 DOI: 10.1542/peds.2021-054961] [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] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
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Amjad S, Adesunkanmi M, Twynstra J, Seabrook JA, Ospina MB. Social Determinants of Health and Adverse Outcomes in Adolescent Pregnancies. Semin Reprod Med 2021; 40:116-123. [PMID: 34500474 DOI: 10.1055/s-0041-1735847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.
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Affiliation(s)
- S Amjad
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Adesunkanmi
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J Twynstra
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - J A Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.,Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada
| | - M B Ospina
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Aifah A, Onakomaiya D, Rakhra A, Ogedegbe G. Uprooting race-based assumptions in biomedical journal articles. Trends Mol Med 2021; 27:830-832. [PMID: 34172389 PMCID: PMC8219490 DOI: 10.1016/j.molmed.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has exacerbated the structural inequities in healthcare and the challenges of translating research into public discourse. This article highlights key antiracist considerations, presents previously noted core challenges, and provides recommendations for writing and reporting. Importantly, this article contributes to combating racialized science in the biomedical community.
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Affiliation(s)
- Angela Aifah
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Deborah Onakomaiya
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY, USA
| | - Ashlin Rakhra
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, USA.
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Duello TM, Rivedal S, Wickland C, Weller A. Race and genetics versus 'race' in genetics: A systematic review of the use of African ancestry in genetic studies. Evol Med Public Health 2021; 9:232-245. [PMID: 34815885 PMCID: PMC8604262 DOI: 10.1093/emph/eoab018] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/09/2021] [Indexed: 08/11/2023] Open
Abstract
Social scientists have long understood race to be a social category invented to justify slavery and evolutionary biologists know the socially constructed racial categories do not align with our biological understanding of genetic variation. The completion of the Human Genome Project in 2003 confirmed humans are 99.9% identical at the DNA level and there is no genetic basis for race. A systematic review of the PubMed medical literature published since 2003 was conducted to assess the use of African ancestry to denote study populations in genetic studies categorized as clinical trials, to examine the stated rationale for its use and to assess the use of evolutionary principles to explain human genetic diversity. We searched for papers that included the terms 'African', 'African American' or 'Black' in studies of behavior (20 papers), physiological responses, the pharmacokinetics of drugs and/or disease associations (62 papers), and as a genetic category in studies, including the examination of genotypes associated with life stress, pain, stuttering and drug clearance (126 papers). Of these, we identified 74 studies in which self-reported race alone or in combination with admixture mapping was used to define the study population. However, none of these studies provided a genetic explanation for the use of the self-identified race as a genetic category and only seven proffered evolutionary explanations of their data. The concept of continuous genetic variation was not clearly articulated in any of these papers, presumably due to the paucity of evolutionary science in the college and medical school curricula.
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Affiliation(s)
- Theresa M Duello
- Department of Obstetrics and Gynecology, School of
Medicine and Public Health, University of Wisconsin –
Madison, Madison, WI 53706, USA
| | - Shawna Rivedal
- Department of Obstetrics and Gynecology, School of
Medicine and Public Health, University of Wisconsin –
Madison, Madison, WI 53706, USA
| | - Colton Wickland
- Department of Obstetrics and Gynecology, School of
Medicine and Public Health, University of Wisconsin –
Madison, Madison, WI 53706, USA
| | - Annika Weller
- Department of Obstetrics and Gynecology, School of
Medicine and Public Health, University of Wisconsin –
Madison, Madison, WI 53706, USA
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10
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Ratcliff CG, Zepeda SG, Hall MH, Tullos EA, Fowler S, Chaoul A, Spelman A, Arun B, Cohen L. Patient characteristics associated with sleep disturbance in breast cancer survivors. Support Care Cancer 2020; 29:2601-2611. [PMID: 32964261 DOI: 10.1007/s00520-020-05777-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Disturbed sleep is common among breast cancer survivors. Identifying patients at risk for disturbed sleep and its sequelae will aid in improving screening and intervention strategies to improve sleep and cancer-related quality of life (QOL). METHODS Women with stages I-III breast cancer undergoing neoadjuvant or adjuvant chemotherapy (N = 415) reported subjectively assessed sleep quality (PSQI) and actigraphy-assessed wake after sleep onset (AAS-WASO), total sleep time (AAS-TST), and sleep efficiency (AAS-SE), sociodemographic, and clinical characteristics and completed questionnaires assessing physical and mental health QOL at study entry and 3, 6, 12, and 15 months later. RESULTS Being from a racially/ethnically underserved population was associated with poorer sleep in all indices (p's < .04). Lower income was associated with poorer subjective sleep and greater AAS-WASO (p's < .02). BMI was associated with lower AAS-SE (p < .001). Baseline subjective sleep complaints were positively associated with depression, fatigue, and health-related QOL and cancer-related symptoms across follow-up (p's < 0.05). Baseline AAS-WASO was positively associated with anxiety and negatively associated with physical health-related QOL at the 3-month follow-up (p's < .001). Baseline AAS-WASO and AAS-SE were associated with mental health-related QOL at the 6-month follow-up (p's < .05). CONCLUSIONS In keeping with previous health disparity research, racially/ethnically underserved populations, lower household income, and higher BMI were associated with increased risk for disturbed sleep. Sleep disturbance may have long-term effects on multiple aspects of QOL for women undergoing treatment for breast cancer. Results may inform strategies to identify patients at greatest risk for disturbed sleep and its sequelae.
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Affiliation(s)
- Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA. .,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Stephanie G Zepeda
- Departmnet of Psychology, Our Lady of the Lake University, The Woodlands, TX, USA
| | - Martica H Hall
- Department of Psychology, The University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily A Tullos
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
| | - Shaelyn Fowler
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
| | | | - Amy Spelman
- Office of Protocol Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Disparities in Postmastectomy Breast Reconstruction: A Systematic Review of the Literature and Modified Framework for Advancing Research Toward Intervention. Ann Plast Surg 2019; 81:495-502. [PMID: 29851727 DOI: 10.1097/sap.0000000000001503] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the United States' population diversifies, eliminating disparities in health and healthcare has become increasingly important across all disciplines of medicine, including plastic and reconstructive surgery. This is evidenced by the growing body of literature in recent years focusing on disparities in postmastectomy breast reconstruction. No study to date has evaluated whether this research is progressing appropriately to promote tangible evidence-based interventions to reduce these disparities. METHODS A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed to identify studies focusing on disparities in postmastectomy breast reconstruction. A previously established public health framework for advancing health disparities research was used to inform analysis of the quality and progression of the included studies. This triphasic framework categorizes disparities research as follows: detecting (identifies and measures disparities in vulnerable populations), understanding (establishes determinants of disparities), or reducing (proposes and evaluates interventions for eliminating disparities). RESULTS Ninety-five studies were identified between 1979 and 2016, with 61 (64.2%) published after 2010. The majority of studies (51.6%) were retrospective cohort or case-control studies (American Society of Plastic Surgery level III evidence). Fifty-eight (63.7%), 31 (34.1%), and 2 (2.2%) studies provided detecting-, understanding- and reducing-phase disparities research, respectively. Non-plastic and reconstructive surgery journals accounted for 70.5% of all articles and for most higher phase research articles, publishing 83.9% and 100% of second and third phase studies, respectively. Disparity categories investigated included race/ethnicity, age, income, insurance status/type, geography, and education level, with race/ethnicity being the most common (73.7%). The most commonly measured outcome was percent of subpopulation receiving reconstruction (63, 66.3%), followed by reconstruction type (14, 16.7%). Patient-, provider-, system-, and research-level factors were all identified as potential targets for interventions to reduce disparities. CONCLUSIONS Despite a recent increase in literature focusing on postmastectomy breast reconstruction disparities, the majority focuses on identifying vulnerable populations with inadequate progression to second (understanding) and third (reducing) phases. Increasing research funding, availability of language-concordant and culturally concordant educational materials, and advocacy and sociopolitical awareness within the plastic surgery community is necessary to advance research on postmastectomy breast reconstruction and, ultimately, eliminate it.
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Fadus MC, Odunsi OT, Squeglia LM. Race, Ethnicity, and Culture in the Medical Record: Implicit Bias or Patient Advocacy? ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:532-536. [PMID: 30734262 PMCID: PMC6685755 DOI: 10.1007/s40596-019-01035-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
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13
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Affiliation(s)
- Richard S Cooper
- Department of Public Health Sciences, Loyola University Medical School, Maywood, Illinois
| | - Girish N Nadkarni
- The Charles Bronfman Institute of Personalized Medicine, Mt Sinai Hospital and Medical Center, New York, New York
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York
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14
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Smart A, Tutton R, Ashcroft R, Martin P, Balmer A, Elliot R, Ellison GT. Social Inclusivity VS Analytical Acuity? A Qualitative Study of UK Researchers Regarding the Inclusion of Minority Ethnic Groups in Biobanks. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/096853320800900205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper examines how the drive to include minority ethnic groups in biomedical research raises challenging questions for the governance of some biobanks. Using findings from a qualitative study with researchers working at 10 UK biobanks that have been designed to explore common complex diseases, our study highlights the potential discordance between the twin imperatives of ‘social inclusivity’ and ‘analytical acuity’. While the researchers interviewed were keen to include minority ethnic groups in their research, they were also concerned that this could have deleterious effects on the precision of their analyses. In our discussion of these findings we show that there remains considerable debate as to the impact of including participants from minority ethnic groups on analytical acuity. Nevertheless, a principle of justice requires that potential participants from all ethnic groups should be given the opportunity to participate in and benefit from biomedical research, and UK law requires public bodies (including research councils) to demonstrate that there is no unintentional or unjustifiable ‘racial’ discrimination in their activities. Researchers' concerns about analytical acuity could result in calls for study designs that examine every ‘different’ ethnic group, which would have consequences for the governance of some biobank studies and for efforts to challenge the discredited yet resilient idea that differences between ethnic groups are innate, essential and immutable.
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Sankar P, Cho MK, Monahan K, Nowak K. Reporting Race and Ethnicity in Genetics Research: Do Journal Recommendations or Resources Matter? SCIENCE AND ENGINEERING ETHICS 2015; 21:1353-1366. [PMID: 25407312 DOI: 10.1007/s11948-014-9596-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 09/15/2014] [Indexed: 06/04/2023]
Abstract
Appeals to scrutinize the use of race and ethnicity as variables in genetics research notwithstanding, these variables continue to be inadequately explained and inconsistently used in research publications. In previous research, we found that published genetic research fails to follow suggestions offered for addressing this problem, such as explaining the basis on which these labels are assigned to populations. This study, an analysis of genetic research articles using race or ethnicity terms, explores possible features of journals that are associated with improved reporting of race and ethnicity in genetic research. A journal's expressed commitment to improving how race and ethnicity are used in genetic research, demonstrated by an editorial or in its instructions to authors, was the strongest predictor of following recommendations about reporting race and ethnicity. Journal impact factor had only a limited positive effect on attention to these issues, suggesting that editorial resources associated with higher impact factor journals are not sufficient to improve practices. Our findings reiterate that race and ethnicity variables are used inconsistently in genetic research, but also shed light on how journals might improve practices by highlighting the need for scientists to carefully scrutinize the use of these variables in their work.
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Affiliation(s)
- Pamela Sankar
- Department of Medical Ethics and Health Policy, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA.
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Modular A, Stanford, CA, 94305-5417, USA.
| | - Keri Monahan
- Department of Medical Ethics and Health Policy, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA.
| | - Kamila Nowak
- Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA, 19107, USA.
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Aggarwal NK, DeSilva R, Nicasio AV, Boiler M, Lewis-Fernández R. Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site. ETHNICITY & HEALTH 2013; 20:1-28. [PMID: 25372242 PMCID: PMC4221811 DOI: 10.1080/13557858.2013.857762] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient-clinician communication. DESIGN We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient-clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n = 64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility. RESULTS Despite racial, ethnical, cultural, and professional differences within our group of patients and clinicians, we found that promoting satisfaction through the interview, eliciting data, eliciting the patient's perspective, and perceiving data at multiple levels were common codes that explained how the CFI affected medical communication. We also found that all but two codes fell under the implementation outcome of clinical utility, two fell under acceptability, and none fell under feasibility. CONCLUSION Our study offers new directions for research on how a cultural interview affects patient-clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes such as medication adherence, appointment retention, and health condition.
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Affiliation(s)
- Neil K. Aggarwal
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Ravi DeSilva
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Andel V. Nicasio
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Marit Boiler
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
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Maciejewski ML, Winegar DA, Farley JF, Wolfe BM, DeMaria EJ. Risk stratification of serious adverse events after gastric bypass in the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 2012; 8:671-7. [PMID: 23058451 DOI: 10.1016/j.soard.2012.07.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/19/2012] [Accepted: 07/20/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is now sufficient demand for bariatric surgery to compare bariatric surgeons and bariatric centers according to their postsurgical outcomes, but few validated risk stratification measures are available to enable valid comparisons. The purpose of this study was to develop and validate a risk stratification model of composite adverse events related to Roux-en-Y gastric bypass (RYGB) surgery. METHODS The study population included 36,254 patients from the Bariatric Outcomes Longitudinal Database (BOLD) registry who were 18-70 years old and had RYGB between June 11, 2007, and December 2, 2009. This population was randomly divided into a 50% testing sample and a 50% validation sample. The testing sample was used to identify significant predictors of 90-day composite adverse events and estimate odds ratios, while the validation sample was used to assess model calibration. After validating the fit of the risk stratification model, the testing and validation samples were combined to estimate the final odds ratios. RESULTS The 90-day composite adverse event rate was 1.48%. The risk stratification model of 90-day composite adverse events included age (40-64, ≥ 65), indicators for male gender, body mass index (50-59.9, ≥ 60), obesity hypoventilation syndrome, back pain, diabetes, pulmonary hypertension, ischemic heart disease, functional status, and American Society of Anesthesiology classes 4 or 5. Our final gastric bypass model was predictive (c-statistic = .68) of serious adverse events 90 days after surgery. CONCLUSIONS With additional validation, this risk model can inform both the patient and surgeon about the risks of bariatric surgery and its different procedures, as well as enable valid outcomes comparisons between surgeons and surgical programs.
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Affiliation(s)
- Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina 27705, USA.
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18
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Cathébras P. Pour en finir avec les « Caucasiens ». Catégories raciales et ethniques dans la littérature médicale. Rev Med Interne 2012; 33:65-8. [DOI: 10.1016/j.revmed.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 08/06/2011] [Indexed: 10/17/2022]
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Measurement of ethnic background in cross-national school surveys: agreement between students' and parents' responses. J Adolesc Health 2011; 49:272-7. [PMID: 21856519 DOI: 10.1016/j.jadohealth.2010.12.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 12/09/2010] [Accepted: 12/10/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE Indicators such as country of birth and language spoken at home have been used as proxy measures for ethnic background, but the validity of these indicators in surveys among school children remains unclear. This study aimed at comparing item response and student-parent agreement on four questions about country of birth and language spoken at home in three European countries. METHODS We analyzed data from the Health Behaviour in School-aged Children (HBSC) Child-Parent Validation Study 2005, including 486 matched student-parent pairs from Denmark, Hungary, and Scotland. Selected items from the internationally standardized HBSC questionnaire were completed by 11-year-old students and their parents. We examined item response and student-parent agreement on the four HBSC Ethnic Background Indicators: the student's country of birth, mother's country of birth, father's country of birth, and language usually spoken at home. RESULTS All item response rates were high for both students (>92%) and parents (>96%). The percent student-parent agreement was high on all four items (>97%). The strength of agreement ranged from good to excellent for all items indicated by the kappa value (between .60 and 1.00). Results were robust across countries. CONCLUSIONS Our findings suggest that students as young as 11 years are able to provide valid responses to four simple questions about country of birth and language spoken at home. The four HBSC Ethnic Background Indicators can be useful in epidemiologic studies on identification of subgroups that may receive unequal prevention services or in assessment of how risk factors, symptoms, and diseases may differ by ethnic background among school children.
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Snipes SA, Sellers SL, Tafawa AO, Cooper LA, Fields JC, Bonham VL. Is race medically relevant? A qualitative study of physicians' attitudes about the role of race in treatment decision-making. BMC Health Serv Res 2011; 11:183. [PMID: 21819597 PMCID: PMC3167748 DOI: 10.1186/1472-6963-11-183] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 08/05/2011] [Indexed: 11/10/2022] Open
Abstract
Background The role of patient race in medical decision-making is heavily debated. While some evidence suggests that patient race can be used by physicians to predict disease risk and determine drug therapy, other studies document bias and stereotyping by physicians based on patient race. It is critical, then, to explore physicians' attitudes regarding the medical relevance of patient race. Methods We conducted a qualitative study in the United States using ten focus groups of physicians stratified by self-identified race (black or white) and led by race-concordant moderators. Physicians were presented with a medical vignette about a patient (whose race was unknown) with Type 2 diabetes and untreated hypertension, who was also a current smoker. Participants were first asked to discuss what medical information they would need to treat the patient. Then physicians were asked to explicitly discuss the importance of race to the hypothetical patient's treatment. To identify common themes, codes, key words and physician demographics were compiled into a comprehensive table that allowed for examination of similarities and differences by physician race. Common themes were identified using the software package NVivo (QSR International, v7). Results Forty self-identified black and 50 self-identified white physicians participated in the study. All physicians - regardless of their own race - believed that medical history, family history, and weight were important for making treatment decisions for the patient. However, black and white physicians reported differences in their views about the relevance of race. Several black physicians indicated that patient race is a central factor for choosing treatment options such as aggressive therapies, patient medication and understanding disease risk. Moreover, many black physicians considered patient race important to understand the patient's views, such as alternative medicine preferences and cultural beliefs about illness. However, few white physicians explicitly indicated that the patient's race was important over-and-above medical history. Instead, white physicians reported that the patient should be treated aggressively regardless of race. Conclusions This investigation adds to our understanding about how physicians in the United States consider race when treating patients, and sheds light on issues physicians face when deciding the importance of race in medical decision-making.
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Affiliation(s)
- Shedra Amy Snipes
- Biobehavioral Health, The Pennsylvania State University, 315 Health and Human Development East, University Park, PA 16802, USA.
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Abstract
PURPOSE We examined the terminology used to describe populations in genetic research to understand how and when terminology is being used, changed, and framed. METHODS We compiled 36 complete article sets, which included newspaper articles and corresponding press releases and journal articles. Population terminology was traced from peer-review article, to press release, to newspaper article to determine changes in language and frequency. A qualitative analysis was then conducted on a smaller sample of the article sets to shed further light on the use and source of population terminology in this context. RESULTS Results indicated a wide variation in the frequency and terminology of population descriptor language used by genetic researchers and the media. The qualitative textual analysis highlighted differences in the use and the framing of population terminology between scientific literature and media representations. CONCLUSIONS This study demonstrates how difficult it can be to control terminology use, even within the reporting of a specific study. Further work needs to be done in this area with a focus on accuracy in defining research terms and research populations in both the scientific literature and the media representations of genetic research.
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Knerr S, Wayman D, Bonham VL. Inclusion of racial and ethnic minorities in genetic research: advance the spirit by changing the rules? THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2011; 39:502-12. [PMID: 21871045 PMCID: PMC4082969 DOI: 10.1111/j.1748-720x.2011.00617.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Genetic research aimed at understanding human health and disease is grounded in the study of genetic variation. The inclusion of research subjects with diverse ancestral backgrounds is essential for genetic and genomic research that fully explores human diversity. Large-scale cohort studies and biobanks in Europe and the United States often do not include the breadth of ethnic and racial diversity observed in their countries' citizens. This article explores the findings of a qualitative study of U.S. scientists' understanding and views of the NIH Policy and Guidelines on the Inclusion of Minorities as Subjects in Clinical Research. The findings suggest that the policy restricts how scientists use racial and ethnic categories to define and report their study populations and does little to motivate their efforts to increase the inclusion of non-European ancestral populations in genetic and genomic research.
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Affiliation(s)
- Sarah Knerr
- Department of Health Services, University of Washington School of Public Health, WA, USA
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23
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Case studies in the co-production of populations and genetics: The making of ‘at risk populations’ in BRCA genetics. BIOSOCIETIES 2010. [DOI: 10.1057/biosoc.2010.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Admixture mapping: from paradigms of race and ethnicity to population history. THE HUGO JOURNAL 2010; 4:23-34. [PMID: 21472046 PMCID: PMC3051047 DOI: 10.1007/s11568-010-9145-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 08/26/2010] [Accepted: 08/31/2010] [Indexed: 11/02/2022]
Abstract
Admixture mapping is a whole genome association strategy that takes advantage of population history-or genetic ancestry-to map genes for complex diseases. However, because it uses racial/ethnic groupings to examine differential disease risk, admixture mapping raises ethical and social concerns. While there has been much theoretical commentary regarding the ethical and social implications of population-based genetic research, empirical data from stakeholders most closely involved with these studies is limited. One of the first admixture mapping studies carried out was a scan for Multiple Sclerosis (MS) risk factors in an African-American population. Applying qualitative research methods, we used this example to explore developing views, experiences and perceptions of the ethical and social implications of admixture mapping and other population-based research-their value, risks and benefits, and the future prospects of the field. Additionally, we sought to understand how social and ethical risks might be mitigated, and the benefits of this research optimized. We draw on in-depth, one-on-one interviews with leading population geneticists, genome scientists, bioethicists, and African-Americans with MS. Here we present our findings from this unique group of key informants and stakeholders.
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Systematic reviews reveal unrepresentative evidence for the development of drug formularies for poor and nonwhite populations. J Clin Epidemiol 2009; 62:1268-78. [DOI: 10.1016/j.jclinepi.2009.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 12/01/2008] [Accepted: 01/05/2009] [Indexed: 11/23/2022]
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Race as a variable in pharmacogenomics science: from empirical ethics to publication standards. Pharmacogenet Genomics 2008; 18:837-41. [DOI: 10.1097/fpc.0b013e32830a48f3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nagaraj S, Tey NP, Ng CW, Balakrishnan B. Ethnic dimensions of gender differentials in mortality in Malaysia. JOURNAL OF POPULATION RESEARCH 2008. [DOI: 10.1007/bf03031948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Listgarten J, Brumme Z, Kadie C, Xiaojiang G, Walker B, Carrington M, Goulder P, Heckerman D. Statistical resolution of ambiguous HLA typing data. PLoS Comput Biol 2008; 4:e1000016. [PMID: 18392148 PMCID: PMC2289775 DOI: 10.1371/journal.pcbi.1000016] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 01/30/2008] [Indexed: 11/18/2022] Open
Abstract
High-resolution HLA typing plays a central role in many areas of immunology, such as in identifying immunogenetic risk factors for disease, in studying how the genomes of pathogens evolve in response to immune selection pressures, and also in vaccine design, where identification of HLA-restricted epitopes may be used to guide the selection of vaccine immunogens. Perhaps one of the most immediate applications is in direct medical decisions concerning the matching of stem cell transplant donors to unrelated recipients. However, high-resolution HLA typing is frequently unavailable due to its high cost or the inability to re-type historical data. In this paper, we introduce and evaluate a method for statistical, in silico refinement of ambiguous and/or low-resolution HLA data. Our method, which requires an independent, high-resolution training data set drawn from the same population as the data to be refined, uses linkage disequilibrium in HLA haplotypes as well as four-digit allele frequency data to probabilistically refine HLA typings. Central to our approach is the use of haplotype inference. We introduce new methodology to this area, improving upon the Expectation-Maximization (EM)-based approaches currently used within the HLA community. Our improvements are achieved by using a parsimonious parameterization for haplotype distributions and by smoothing the maximum likelihood (ML) solution. These improvements make it possible to scale the refinement to a larger number of alleles and loci in a more computationally efficient and stable manner. We also show how to augment our method in order to incorporate ethnicity information (as HLA allele distributions vary widely according to race/ethnicity as well as geographic area), and demonstrate the potential utility of this experimentally. A tool based on our approach is freely available for research purposes at http://microsoft.com/science.
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Affiliation(s)
| | - Zabrina Brumme
- Partners AIDS Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carl Kadie
- Microsoft Research, Redmond, Washington, United States of America
| | - Gao Xiaojiang
- SAIC-Frederick, National Cancer Institute, Frederick, Maryland, United States of America
| | - Bruce Walker
- Partners AIDS Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Howard Hughes Medical Institute, Frederick, Maryland, United States of America
| | - Mary Carrington
- SAIC-Frederick, National Cancer Institute, Frederick, Maryland, United States of America
| | - Philip Goulder
- Partners AIDS Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - David Heckerman
- Microsoft Research, Redmond, Washington, United States of America
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Ellison GTH, Kaufman JS, Head RF, Martin PA, Kahn JD. Flaws in the U.S. Food and Drug Administration's rationale for supporting the development and approval of BiDil as a treatment for heart failure only in black patients. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2008; 36:449-57. [PMID: 18840235 PMCID: PMC2683256 DOI: 10.1111/j.1748-720x.2008.290.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The U.S. Food and Drug Administration's (FDA) rationale for supporting the development and approval of BiDil (a combination of hydralazine hydrochloride and isosorbide dinitrate; H-I) for heart failure specifically in black patients was based on under-powered, post hoc subgroup analyses of two relatively old trials (V-HeFT I and II), which were further complicated by substantial covariate imbalances between racial groups. Indeed, the only statistically significant difference observed between black and white patients was found without any adjustment for potential confounders in samples that were unlikely to have been adequately randomized. Meanwhile, because the accepted baseline therapy for heart failure has substantially improved since these trials took place, their results cannot be combined with data from the more recent trial (A-HeFT) amongst black patients alone. There is therefore little scientific evidence to support the approval of BiDil only for use in black patients, and the FDA's rationale fails to consider the ethical consequences of recognizing racial categories as valid markers of innate biological difference, and permitting the development of group-specific therapies that are subject to commercial incentives rather than scientific evidence or therapeutic imperatives. This paper reviews the limitations in the scientific evidence used to support the approval of BiDil only for use in black patients; calls for further analysis of the V-HeFT I and II data which might clarify whether responses to H-I vary by race; and evaluates the consequences of commercial incentives to develop racialized medicines. We recommend that the FDA revise the procedures they use to examine applications for race-based therapies to ensure that these are based on robust scientific claims and do not undermine the aims of the 1992 Revitalization Act.
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