The use of race to categorize patients into different biological groups is being challenged. Findings from the human genome project debunked longstanding “five race” theories developed and perpetuated by polygenists. But the use of race as a biological proxy persists in several areas of medicine, including laboratory medicine.
The consideration of race in clinical care is nuanced, said Christina Pierre, PhD, DABCC, director of the Clinical Chemistry Section at Penn Medicine Lancaster General Health in Lancaster, Pennsylvania. “Racial and ethnic health disparities exist and are often influenced by social determinants of health,” she said. “In the absence of patient-specific genetic ancestry data, the question of whether it is more beneficial or deleterious to use racial or ethnic groupings remains a topic of debate.”
During a roundtable discussion “Exploring Racial and Ethnic Health Disparities through a Laboratory Medicine Lens,” at the 2022 AACC Annual Scientific Meeting and Clinical Lab Expo July 24-28 in Chicago, Pierre will review several areas of laboratory medicine where racial or ethnic groupings are used and discuss the implications on providing equitable healthcare.
Multiple publications have highlighted race corrections used in clinical medicine and called for their elimination, Pierre said. Notably, in 2021, a joint task force of the American Society of Nephrology and National Kidney Foundation published guidance that directed clinicians to discontinue the use of race correction in estimating kidney function in Black patients.
Historically, clinicians have measured kidney function using estimated glomerular filtration rate (eGFR), which shows how much creatinine is in a patient’s blood. The equation most often used assigns a higher eGFR to patients who self-identify as Black, in part because Black people historically have been thought to have higher muscle mass than non-Black people. Critics of the equation have said the current equation underestimates kidney disease in people who are Black, leaving them less likely to receive the specialty kidney care they need or be placed on transplant wait lists.
“Races, as we understand them today, are social constructs,” said Pierre. “They are not a biological classification. There is a difference between race and genetic ancestry. You have to think very carefully about how you use race in clinical settings. When you paint everybody with a broad brush, you aren’t really capturing those who have mixed ancestry.”
Prenatal screening is another example of testing that uses separate reference intervals for different races, noted Pierre. “These intervals are based on studies that were performed a long time ago,” she said. “It is a CAP requirement that you have to use different medians for different races, and if you don’t, you have to explain why,” she said. “I believe all lab testing should be race agnostic. Currently, when it comes to maternal serum screening, White people are the standard against which everyone else is measured, and that ideology is harmful.”
Pierre hopes that participants in the roundtable discussion will take away the following:
- Have a better understanding of how the concept of race is used in laboratory medicine.
- Be able to critically assess and study the implication of how race and ethnicity is used in the practice of laboratory medicine.
- Begin to advocate for a change in the way that race is used in laboratory medicine and clinical settings.
For more sessions dealing with health equity, check out the “Transforming Population Health & Equity” pathway in the Annual Scientific Meeting program.
Kimberly Scott is a freelance writer who lives in Lewes, Delaware. +Email: k[email protected]