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Race Based Medicine

Neda Frayha, MD and Jay-Sheree Allen, MD
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21:16

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Have you ever wondered why there’s a Black and Non Black eGFR for our patients or why is race even a factor in pulmonary function tests? Dr. Jay-Sheree Allen and Dr. Neda Frayha discuss the use of race in clinical decision making tools. Think calculators, algorithms, where you insert your patient’s demographic data - including race - and the outcome disparities depending on what data you put in.

Posted 3/8/21

References: 

 

  1. Eneanya, N. D., Yang, W., & Reese, P. P. (2019). Reconsidering the Consequences of Using Race to Estimate Kidney Function. JAMA, 322(2), 113–114. https://doi.org/10.1001/jama.2019.5774

 

  1. Vyas, D. A., Jones, D. S., Meadows, A. R., Diouf, K., Nour, N. M., & Schantz-Dunn, J. (2019). Challenging the Use of Race in the Vaginal Birth after Cesarean Section Calculator. Women's health issues : official publication of the Jacobs Institute of Women's Health, 29(3), 201–204. https://doi.org/10.1016/j.whi.2019.04.007

 

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  1. Jones CP. Levels of Racism: A Theoretic Framework and a Gardener’s Tale. American Journal of Public Health, 2000; (90)8: 1212-1215. Accessed 11 June 2020. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.90.8.1212

 

  1. Lander, E. S., Linton, L. M., Birren, B., Nusbaum, C., Zody, M. C., Baldwin, J., Devon, K., Dewar, K., Doyle, M., FitzHugh, W., Funke, R., Gage, D., Harris, K., Heaford, A., Howland, J., Kann, L., Lehoczky, J., LeVine, R., McEwan, P., McKernan, K., … International Human Genome Sequencing Consortium (2001). Initial sequencing and analysis of the human genome. Nature, 409(6822), 860–921. https://doi.org/10.1038/35057062

 

  1. Winker M. A. (2004). Measuring race and ethnicity: why and how?. JAMA, 292(13), 1612–1614. https://doi.org/10.1001/jama.292.13.1612

 

  1. Amutah, C., Greenidge, K., Mante, A., Munyikwa, M., Surya, S. L., Higginbotham, E., Jones, D. S., Lavizzo-Mourey, R., Roberts, D., Tsai, J., & Aysola, J. (2021). Misrepresenting Race — The Role of Medical Schools in Propagating Physician Bias. New England Journal of Medicine. https://doi.org/10.1056/NEJMms2025768 

 

  1. Brewster, L. M., & Seedat, Y. K. (2013). Why do hypertensive patients of African ancestry respond better to calcium blockers and diuretics than to ACE inhibitors and β-adrenergic blockers? A systematic review. BMC medicine, 11, 141. Retrieved 2013/05//, from http://europepmc.org/abstract/MED/23721258 https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23721258/?tool=EBI https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23721258/pdf/?tool=EBI https://doi.org/10.1186/1741-7015-11-141 https://europepmc.org/articles/PMC3681568 https://europepmc.org/articles/PMC3681568?pdf=render 

 

  1. Hsu, J., Johansen, K. L., Hsu, C.-y., Kaysen, G. A., & Chertow, G. M. (2008). Higher Serum Creatinine Concentrations in Black Patients with Chronic Kidney Disease: Beyond Nutritional Status and Body Composition. Clinical Journal of the American Society of Nephrology, 3(4), 992. https://doi.org/10.2215/CJN.00090108

 

  1. Langan, R., & Jones, K. (2015). Common questions about the initial management of hypertension. American family physician, 91(3), 172-177. 

 

  1. The, A. O. a. C. f. t. A. C. R. G. (2002). Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs DiureticThe Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA, 288(23), 2981-2997. https://doi.org/10.1001/jama.288.23.2981

 

  1. Vyas, D. A., Eisenstein, L. G., & Jones, D. S. (2020). Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms. New England Journal of Medicine, 383(9), 874-882. https://doi.org/10.1056/NEJMms2004740

 

  1. Williams, S. K., Ravenell, J., Seyedali, S., Nayef, H., & Ogedegbe, G. (2016). Hypertension Treatment in Blacks: Discussion of the U.S. Clinical Practice Guidelines. Progress in Cardiovascular Diseases, 59(3), 282-288. https://doi.org/https://doi.org/10.1016/j.pcad.2016.09.004

 

  1. Wright, J. T., Jr., Harris-Haywood, S., Pressel, S., Barzilay, J., Baimbridge, C., Bareis, C. J., Basile, J. N., Black, H. R., Dart, R., Gupta, A. K., Hamilton, B. P., Einhorn, P. T., Haywood, L. J., Jafri, S. Z. A., Louis, G. T., Whelton, P. K., Scott, C. L., Simmons, D. L., Stanford, C., & Davis, B. R. (2008). Clinical Outcomes by Race in Hypertensive Patients With and Without the Metabolic Syndrome: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Archives of Internal Medicine, 168(2), 207-217. https://doi.org/10.1001/archinternmed.2007.66 

 

  1. Gendered Innovations in Science, Medicine, and Engineering Project Director Professor Londa Schiebinger John L. Hinds Professor of History of Science Stanford University https://genderedinnovations.stanford.edu/terms/race.html Accessed 20 January 2021.

 

  1. Revisions to the Standards for Classification of Federal Data on Race and Ethnicity. https://obamawhitehouse.archives.gov/omb/fedreg_1997standards Accessed 20 January 2021.

 

  1. Okah E, Westby A. Why we care about how race is used in medical research, practice and clinical decision-making, and why you should, too. Minnesota Family Physicians. Fall 2019. https://mafpadvocacy.org/2019/11/03/whats-race-got-to-do-with-it/

 

  1. UW Medicine to exclude race from calculation of eGFR (measure of kidney function) https://medicine.uw.edu/news/uw-medicine-exclude-race-calculation-egfr-measure-kidney-function#:~:text=As%20of%20June%201%2C%202020,excludes%20race%20as%20a%20variable Accessed 20 January 2021.

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