Journal editors issue statement on addressing racial/ethnic disparities in CV research
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The editorial team of Circulation: Cardiovascular Quality and Outcomes issued a statement urging scientific journals to address racial/ethnic disparities prevalent in health science research, particularly CV trials.
According to the statement, “groundwater analysis” of these racial/ethnic disparities is first needed to illuminate these inequities, followed by the adoption of recommendations put forth in the document.
“The [groundwater] metaphor was developed by Bayard Love, MBA, MPP, and Deena Hayes-Greene of the Racial Equity Institute. It is a form of root cause analysis, meaning that it helps one consider the true source of the problem,” Khadijah Breathett, MD, MS, FAHA, assistant professor of medicine in the division of cardiology at the University of Arizona in Tucson, advanced heart failure and transplant cardiologist at Banner – University Medical Center in Tucson and an author of the statement, told Healio. “Often, racial and ethnic health disparities are blamed on the individual and the individual’s behavior without considering the systemic role of structural racism and social determinants of health. We intended for this paper to help clinical scientists refocus a lens on the etiologies of racial and ethnic disparities. We encourage scientific inquiry that seek to dismantle structural racism, bias and social determinants of health.”
Best practices and coming changes
According to a press release, practices that can be addressed during manuscript preparation include:
- Develop questions and methodological strategies informed by conceptual frameworks.
- Explicitly describe rationale and classification for inclusion of racial and ethnic patient populations in the methods section.
- Form diverse and inclusive study teams and cite their scholarship.
- Contextualize discussion of results within conceptual frameworks and models.
- Avoid generalized genetic explanations for racial and ethnic disparities.
“Understanding the characterization of studies that include race or ethnicity is important since race is a social construct that is self-identified. Understanding how race and ethnicity were selected will help the scientific community generalize the results more appropriately,” Breathett said in an interview. “We [also] expect clinical scientists to examine the role of structural racism and social determinants of health as appropriate and avoid default claims of genetic etiologies when they are not explicitly examined. This may focus the direction for future studies that can achieve cardiovascular health equity.”
Breathett said she expects to see the following changes in clinical research over the next few months:
- conceptual models focused on anti-racism, bias and social determinants of health;
- better characterization of studies that include race or ethnicity, which may reduce the issue of underreporting of some racial groups such as American Indians and prevent broad grouping of heterogenous populations;
- the product of diverse and inclusive study teams, which may contribute to stronger studies on CV equity and better relationships between academia and the community; and
- increased citations of scientists of color.
“It will take time to assess this metric since self-identification of race and ethnicity of an author may not be readily available,” Breathett told Healio. “We are encouraging authors, reviewers, and editorial board members to complete their journal demographic profiles, which will be expanded to additional selections soon. We are also considering a method for self-identification of entire study teams akin to the journal Cell.”
The statement also highlighted changes coming to Circulation: Cardiovascular Quality and Outcomes that reflect the editorial team’s commitment to these recommendations.
“We appreciate the work of Boyd et al [published] in Health Affairs. This work was a catalyst for supporting routine evaluation of systemic barriers to health such as structural racism in scientific journals,” Breathett said in an interview. “Our editorial board developed new instructions for the submission of work examining racial and ethnic disparities, which are immediately in effect. These instructions will be used to evaluate and critique new submissions. It has the potential to reframe the way that racial and ethnic cardiovascular disparities research is performed from start to finish by setting a new standard for our journal.”
According to the statement, the journal’s editorial team aims to work with authors to incorporate these principles into their work, promote diverse talent and ideas and continue to diversify authorship, reviewers and editorial teams.
“In this way, we have an ask for our authors and reviewers to help us collect appropriate categorizations of race, ethnicity and other intersectional demographics,” Breathett and colleagues wrote in the statement. “Although this may seem intrusive, it will be completely voluntary and not affect our decision-making around a submission.”
Disparities ‘illuminated on a broader stage’
“Over the past year, social injustice and racial and ethnic health disparities have been illuminated on a broader stage. This has sparked a multigenerational movement to achieve equity. We expect that most scientists will embrace these changes. Some may have opposing views,” Breathett told Healio. “We hope that continued conversation, reevaluation and titration of the entire scientific process will ultimately lead to the best science that meets our goals of attaining CV health equity for all. We are excited to embark upon this journey and look forward to the future.
“The greatest impact on racial and ethnic disparities research may come from understanding and intervening upon systemic barriers to CV health such as structural racism, bias and social determinants of health,” Breathett said.
Reference:
- Boyd RW, et al. On racism: A new standard for publishing on racial health inequities. Health Affairs. July 2, 2020. Available at: https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/. Accessed Feb. 11, 2021.
Perspective
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Barry London, MD, PhD
This statement represents a critical step in improving health outcomes for diverse populations. We cannot provide optimal care if we do not fully understand the health issues in the context of the many factors related to racial and ethnic disparities. These factors are relatively accepted as important for outcomes research and disparity research and are also important in more basic and translational research. Racial disparities need to be considered when studies are conceived, when funding decisions are made, when the data is interpreted, when it is published, when it is used for patient care and when it ultimately impacts healthy outcomes. With more and even stronger research on these racial and ethnic disparities, we can move the needle on care and outcomes.
The recommendations are in place and we intend to implement them at the Journal of the American Heart Association immediately. I am confident that we will continue to see an evolution of these recommendations as research in this area expands, as we hope it will. The AHA family of journals publishes many manuscripts from around the world, and it will be important that similar recommendations are implemented in manuscripts from other countries where racial disparities exist yet differ from those in the U.S.
The guidance is an important foundation as the AHA continues to delve deeply and find ways to dismantle structural racism within health care and ensure equitable care and access to care for all. It is the latest in the AHA’s bold, concrete and significant commitments, as detailed in the November 2020 Presidential Advisory, to address structural racism and its direct impact on health outcomes.
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Breathett K, et al. Circ Cardiovasc Qual Outcomes. 2021;doi:10.1161/CIRCOUTCOMES.121.007868.
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