Race-Based Medicine: How Does it Impact Patient Care and What Can Be Done to Mitigate its Effects on Health Outcomes?

Reprinted from the summer 2021 Issue of The Ohio Family Physician

By: Denee Moore, MD, Member, AAFP Commission on Health of the Public and Science (from Virginia); Melanie Bird, PhD, MSAM, Assistant Staff Executive to the AAFP Commission on Health of the Public and Science; Danielle D. Jones, PhD, MPH, AAFP Center for Diversity and Health Equity Director; and Shannon Connolly, MD, Chair of the Subcommittee on Health Equity, AAFP Commission on Health of the Public and Science (from California)

Race is socially constructed to sort people into groups based on physical appearance, shared behaviors, and/or shared geography.¹ Race is shaped by the social and political dynamics of the local environment; therefore, the definition of a racial group can differ from place to place and over time.² Studies exploring genetic variations across the world have found that more genetic difference occurs within individuals of a given population than between populations.³ For these reasons, the use of race in medical diagnosis and treatment is increasingly being called into question.

Currently, race is used as a biological marker for disease states or as a variable in diagnosis and treatment. For example, equations that are used to calculate estimated glomerular filtration rate (eGFR), such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, require users to select the race of a patient in order to generate a result. Such equations produce different results based on the racial category selected. With the CKD-EPI creatinine equation, selecting the Black racial category produces an eGFR result that is higher compared to selecting the non-Black racial category. Because eGFR is used in the decision-making process for referral for kidney transplantation and because the lower the eGFR the earlier the referral is generated, patients who are assumed to be members of the Black race may be referred for kidney transplant and added to the kidney transplant waiting list later in the course of disease. Such actions can reduce these patients’ access to a treatment for end-stage renal disease that has been shown to have substantial positive outcomes over the long term compared to renal replacement therapy.⁴ Recently, the Heaton Norms used to evaluate National Football League players’ performance on post-concussion neurocognitive tests have been criticized for their use of race, as the expected level of cognitive performance for Black players is lower than for non-Black players. This has resulted in Black players’ dementia claims being rejected more often than non-Black players.⁵ Other calculators or tools using race include those for estimating cardiovascular risk and for adjustments in spirometry.

All of these issues led the American Academy of Family Physicians (AAFP) to develop a policy opposing the inappropriate use of race in clinical evaluation and management.⁶ The policy was developed in response to multiple resolutions from AAFP members. In addition to the policy, the AAFP continues to call for research to address the misuse of race to ensure that it is not used as a proxy for biology, but rather as a risk factor based on health disparities resulting from societal and economic factors.⁷ In a letter to the House Ways and Means Committee, the AAFP stressed the importance of research focused on understanding how systemic racism and oppression create health disparities and how to best include those factors in clinical decision making.⁷ The AAFP acknowledges the need for the collection of data using sociodemographic identifiers like race in order to accurately identify and address disparities in disease prevalence and access to health care. The AAFP advocates for the inclusion of diverse patients and communities in clinical trials, surveys, and other research activities.

The AAFP has policy statements against discrimination⁸ and institutionalized racism,⁹ and supports members by providing training¹⁰ on how to minimize their racial/ethnic bias as part of the clinical decision-making process, while providing tools that can be utilized to collect data on indicators other than race/ethnicity, such as patients’ social determinants of health. Additional work is underway to address continued requests from members and state chapters to address the use of race in educational offerings by AAFP journals and continuing medical education courses.

References available on the OAFP website.