By Ronnie Cohen

(Reuters Health) – The vast majority of pediatric clinical
practice guidelines fail to mention race or ethnicity, and most
that include the terms do so in a way that could harm vulnerable
and underrepresented groups, a new study finds.

“It’s really time to look at all of our guidelines, how race
is being used, and how do we change the guidelines,” said lead
author Dr. Courtney A. Gilliam, a pediatric hospital medicine
fellow at Seattle Children’s Hospital at the University of
Washington.

When guidelines note racial or ethnic differences, she told
Reuters Health in a phone interview, “we need to go that next
step and really explore that difference and not blame it on
race.”

“Are we making these guidelines with a true equity lens?”
Dr. Gilliam asked.

The answer is no, she and her colleagues conclude in JAMA
Pediatrics. Most of the time, they found, pediatric clinical
practice guidelines missed the opportunity to proactively
address healthcare inequities.

Researchers examined 414 pediatric clinical practice
guidelines issued from January 2016 through April 2021 and found
only 126, or 30%, used the term race or ethnicity.

The team then used a critical race theory framework to
assess the 126 guidelines that included the term race or
ethnicity, and they classified each set of guidelines according
to its potential to change racial inequities. Was, for example,
race used as a genetic or biological marker?

They found that 58% of the guidelines used the terms race or
ethnicity in ways that could exacerbate health inequities.

Only 12 clinical practice guidelines used race or ethnicity
to discuss recommendations to close gaps in future research.

Two of the recommendations the researchers praised came from
the U.S. Preventive Services Task Force (USPSTF). One on
counseling to prevent skin cancer urges studies for people with
skin types other than “fair.” Another on the prevention and
cessation of tobacco use urges interventions tailored to
subpopulations with elevated smoking rates, such as African
American and LGBTQ youth.

“We’re asking for writers and developers to go the next step
and explore the why,” Dr. Gilliam said. “It’s a lot more work.
But the known healthcare inequities in this country are
staggering, and it’s the work we need to do.”

One piece of the work is to include members from vulnerable
racial and ethnic groups on the committees drafting guidelines,
she said.

Karin Davidson, a psychologist and senior vice president for
research at Northwell Health in New York, commended the study
for sending clear, actionable messages to guideline-making
organizations.

“I think it’s a call to action for guideline-making
organizations to review their current guidelines and update them
to review if they mean race as a proxy variable,” she said in a
phone interview.

“Instead of measuring poverty, transportation difficulties,
lack of primary care availability, we just measure the color of
someone’s skin, and then we make causal attributions for that,”
she said. “We need to look at the most likely causes of the
inequities and fix those.”

Davidson, who also is a professor of medicine and psychiatry
at the Zucker School of Medicine at Hofstra University and is
past chair of the USPSTF, was not involved with the study.

The study points to the need for research that’s inclusive
and representative of the population as well as for models and
frameworks to support guideline-making organizations in
thoughtfully integrating healthcare inequities, she said.

Davidson said she was surprised at how few clinical practice
guidelines explicitly mentioned race and ethnicity and how many
that did were judged to have the potential to widen health
disparities.

“Default assumptions, often implicit assumptions, that race
is a proxy variable for biology or genetics should be questioned
and should not be acceptable without specific high-quality
evidence to back up such a statement,” she said.

“The current evidence available to us is persuasive that
racism and structural barriers to equitable care are far more
likely explanatory variables for our current health inequities
found in vulnerable subgroups,” she said. “The most important
thing for clinicians to take away from this study is that they
should consider carefully the guidelines they follow and whether
they will ensure that everyone benefits.”

SOURCE: https://bit.ly/3MsKbwY JAMA Pediatrics, June 6,
2022.