Doctors Propose Antiracist Framework for Health Disparities Research

By Carolyn Crist

November 20, 2020

NEW YORK (Reuters Health) - Racial and ethnic disparities continue to persist across a variety of chronic health conditions, which calls for a new approach to research, according to a new report.

Studies tend to focus on the underlying biology of disease, which has led to some breakthroughs, but to make more meaningful progress, researchers need to explicitly incorporate the social context, a group of pediatricians and internal-medicine doctors write in Pediatrics.

"Much of the research focusing on health conditions that disproportionately affect racial and ethnic minority populations - such as asthma, obesity and atopic dermatitis, and others - is grounded in the assumption that inherent biologic or genetic differences are to blame," said lead author Dr. Elizabeth Matsui of the University of Texas at Austin.

Contextual factors, such as socioeconomic status, environmental exposures, racism and access to high-quality healthcare, play a role in health disparities and should be incorporated in the biomedical research framework, she said.

"To make real progress in shrinking these disparities, we need to actively challenge this default conflation of race and biology," she told Reuters Health by email.

Dr. Matsui and colleagues wrote about the challenges underlying the current research framework, which can conflate correlation with causation. Many times, the observed associations between biological measures and disease among racial and ethnic groups are "misconstrued as evidence" that biological differences play an important causal role in health disparities, they write.

For instance, several studies have pointed to biological reasons why Black children may have higher rates of asthma, allergic sensitivities and skin reactions based on phenotypes or inflammatory markers. But they don't discuss the potential role of environmental or socioeconomic factors that could lead to those differences. The focus on biology extends to other racial/ethnic groups as well, which influences clinical guidelines and can result in differential treatment of patients based on their race.

The National Institute of Minority Health and Health Disparities has created a strategic plan to reduce these disparities by training scientists in various populations, engaging affected communities, and prioritizing the funding of institutions that promote diversity, inclusion and equity. Dr. Matsui and colleagues propose several principles to build on top of the institute's framework that can be incorporated at multiple levels, including universities, funding agencies, biotechnology and pharmaceutical companies, professional societies and biomedical journals.

First, they write, race, ethnicity, disparities and contextual factors should be explicitly considered in study design and interpretation. Reviewers with the appropriate expertise should then evaluate research proposals, which can then inform funding decisions.

For instance, the National Institutes of Health has a policy that incorporates sex as a biological variable, which has been associated with an increase in the number of grant applications that consider sex as a variable. This could be a useful model to follow.

Next, measurement tools need to be able to measure the potential for racism, the authors say. Survey tools may not be validated for racial or ethnic groups, or racial "correction" factors could be applied to biological measurements. In addition, research focused on genetics or ancestry should consider historical and contextual factors, and source data for artificial intelligence and machine learning methods should be assessed for potential bias.

Finally, research teams should include expertise in race, ethnicity, disparities and contextual factors, such as social scientists, race scholars, environmental health scientists, epidemiologists, population geneticists and behavioral scientists. Beyond that, the community that is disproportionately affected by the health condition being studied should be engaged with the research, they write.

"An anti-racist framework not only encourages us to design studies with care, it also requires the interrogation of past work that has shaped our ideas about what we 'know' about race, ethnicity and health," said Dr. Rachel Kowalsky of Weill Cornell Medicine in New York City. Dr. Kowalsky, who wasn't involved with this paper, has written about removing race from clinical practice guidelines for urinary-tract infections among children.

"This framework asks researchers to take the critical step of making the implicit into the explicit - it asks researchers to articulate directly why and how they believe their selected variables may lead to their selected outcome," she told Reuters Health by email. "When assumptions about race and biology remain implicit, they cannot be addressed."

SOURCE: Pediatrics, online November 19, 2020.