Recommendations based on race, ethnicity should be avoided in GI clinical guidelines
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SAN DIEGO — Gastroenterology societies should refrain from incorporating race and ethnicity into clinical guidelines as doing so may exacerbate health inequities, according to research presented at Digestive Disease Week 2022.
“Race is a social construct, yet health care workers still use race and ethnicity to guide clinical decision-making,” Shazia M. Siddique, MD, MSHP, assistant professor of gastroenterology at the University of Pennsylvania Perelman School of Medicine, told Healio. “Understanding how and when race is being used is important to determine potential proxies for race and replace and correct these practices as needed. Now further steps are needed now to similarly reassess guidelines across all specialties that incorporate race-based decision making.”
Between January 2010 and September 2021, Siddique and colleagues searched for clinical guidance or guidelines from U.S.-based GI professional societies, such as AGA, ACG, AASLD and ASGE, to determine the extent of race and ethnicity inclusion in current recommendations.
Investigators found seven documents with eight race- or ethnicity-based recommendations, which focused on surveillance for hepatocellular carcinoma in individuals with chronic hepatitis B virus, surveillance for gastric intestinal metaplasia, screening for Helicobacter pylori and surveillance for Barrett’s esophagus. According to the guidelines, patients were either screened or surveilled for a clinical condition based on the incidence or risk within a racial or ethnic group.
Siddique and colleagues noted that race and ethnicity definitions varied by guideline, which highlights possible implications on health disparities. They identified best practices for addressing race and ethnicity in the clinical guideline process, which include:
Use country of origin or ancestry rather than broad racial/ethnic groups
Report diversity (or lack of) in patient cohorts
Outline and acknowledge health disparities within the field
Consider the effect of a clinical recommendation on health equity
“In this vein, it is prudent for GI societies to re-examine existing guidelines and current guideline development processes to avoid race/ethnicity-based recommendations when possible, utilize more precise variables in place of race/ethnicity and transparently rationalize the use of race/ethnicity and its potential impact on health equity,” Siddique and colleagues wrote.
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Siddique SM, et al. Abstract 872. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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