Limiting racial disparities and bias for wearable devices in health science research.
Limiting racial disparities and bias for wearable devices in health science research.
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DOI：
10.1093/sleep/zsaa159
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发表时间：
2020-10-13
期刊：
影响因子：
5.6
通讯作者：
Owens RL
中科院分区：
文献类型：
--
作者：
Colvonen PJ;DeYoung PN;Bosompra NA;Owens RL
消费者可穿戴设备是用于跟踪活动，睡眠和其他健康相关结果的设备（例如Apple Watch，Fitbit，Samsung，Basis，Mio，PulseOn，Whoop）。可穿戴设备承诺提供大量与健康相关的信息，包括低心率警报，用于检测心律失常的个人心电图（ECG）监测器，睡眠跟踪（例如睡眠结构）和脉搏压力，旨在促进健康生活并根据实时数据提醒高风险消费者。它们相对较低的成本、纵向数据的收集以及显示/传输信息的能力表明，如果用于临床实践和推进远程研究，它们将带来许多好处。不幸的是，由于光电体积描记（PPG）绿色光信号的技术限制，这些健康构造可能仅可用于具有较浅肤色的人群。我们深为关切地注意到，越来越多的证据表明，这些设备在肤色较深的人群中并不准确，甚至可能根本不起作用[1，2]。可穿戴设备在肤色较深的人群中的准确性降低似乎已经知道了一段时间，但这个问题几乎没有引起医学界的关注。除了有限的媒体报道[3]，轶事报道和最少的研究出版物[1，2，4，5]外，深色肤色对可穿戴准确性的作用是一个严重低估的现象，需要行业和科学界的直接关注和行动。我们的担忧被放大，因为这些设备现在正从消费品过渡到健康相关的研究，其内部算法正在获得美国食品和药物管理局（FDA）的批准。因此，它们会加剧肤色较深的人现有的结构性健康差异，并可能加剧美国黑人现有的结构性健康差异[5]。黑人生命物质运动呼吁每个人揭露和拆除整个社会的系统性偏见。我们要求医疗保健界努力实现这一目标，并确保数字医疗解决方案不会加剧现有的医疗和获取差距，因为这些设备越来越多地用于研究和临床实践。可穿戴设备和肤色的问题之一是技术挑战，因为可穿戴设备使用PPG绿色光信号。血液由于其颜色而容易吸收绿色光，其中存在的血液体积越大（即，当心脏在收缩期间泵送时），则绿色光吸收越高，因此可以相应地测量心率。这种绿色光技术便宜并且通常是鲁棒的，然而，肤色不同地影响光的吸收，这干扰了算法输出。研究表明，当测量深色皮肤类型的心率时，绿色光缺乏精度和准确性，并且可能根本无法读取[2]。还有其他几个影响PPG准确性的因素可能会导致与肤色的相互作用，包括纹身、手臂毛发的存在、汗液、环境温度、活动水平、皮肤表皮厚度[6]和体重[7]。这可能会影响依赖PPG的健康相关结果，包括许多睡眠相关指标，如睡眠持续时间、结构[8]、睡眠呼吸暂停诊断[9]、长期睡眠模式和其他睡眠障碍[10]。尽管如此，绿色光技术仍然是可穿戴设备的行业标准。
Consumer wearables are devices used for tracking activity, sleep, and other health-related outcomes (eg Apple Watch, Fitbit, Samsung, Basis, Mio, PulseOn, Whoop). Wearables promise a myriad of health-related information, including low heart rate alerts, a personal electrocardiogram (ECG) monitor for detecting arrhythmia, sleep tracking (eg sleep architecture), and pulse pressure designed to promote healthy living and alert high-risk consumers based on real-time data. Their relative low cost, the collection of longitudinal data, and the ability to display/transmit information suggest a host of benefits if used in clinical practice and to advance remote research. Unfortunately, due to technological limitations of photoplethysmographic (PPG) green light signaling, these health constructs may only be accessible for a population of people with lighter skin tones. We note with deep concern that there is increasing evidence that these devices are not as accurate, and may not work at all, in people with darker skin tones [1, 2]. The reduced accuracy of wearable devices in people with darker skin tones seems to have been known for some time, yet this issue has garnered little attention from the medical community. Apart from limited media coverage [3], anecdotal reports, and minimal research publications [1, 2, 4, 5], the role of dark skin tones on wearable accuracy is a severely underreported phenomenon that requires direct attention and action from industry and the scientific community. Our concern is amplified as these devices are now transitioning from consumer goods into health-related research and their internal algorithms are becoming Food and Drug Administration (FDA) approved. As such, they stand to exacerbate existing structural health disparities of people with darker skin tones and may compound existing structural health disparities for Black Americans [5]. The Black Lives Matter movement is calling for everyone to unveil and dismantle systemic bias throughout society. We challenge the healthcare community to work towards this goal and to ensure that digital health solutions do not reinforce existing disparities in care and access as these devices are increasingly used in research and clinical practice. One of the issues with wearables and skin tone is a technical challenge, in that wearables use a PPG green light signal. Blood, due to its color, readily absorbs green light, where the greater the volume of blood present (ie when the heart pumps during systole), the higher the green light absorption and thus heart rate can be measured accordingly. This green light technology is cheap and generally robust, however, skin tone affects the absorption of light differently, which interferes with the algorithm output. Studies have shown that green light lacks precision and accuracy, and may not read at all, when measuring heart rate in darker skin types [2]. There are also several other factors that influence PPG accuracy that may cause an interaction with skin tone, including tattoos, presence of arm hair, sweat, ambient temperature, level of activity, thickness of skin epidermis [6], and body mass [7]. This potentially affects health-related outcomes that rely on PPG including a host of sleep-related indices such as sleep duration, architecture [8], diagnosis of sleep apnea [9], long-term sleep patterns, and other sleep disorders [10]. Despite this, green light technology remains the industry standard in wearables.
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影响因子：
3.4
作者：
Moco, Andreia Vieira;Stuijk, Sander;de Haan, Gerard
通讯作者：
de Haan, Gerard
利用无线可穿戴传感器自动进行睡眠阶段分类
影响因子：
15.2
作者：
Boe, Alexander J.;Koch, Lori L. McGee;Jayaraman, Arun
通讯作者：
Jayaraman, Arun
影响因子：
2.2
作者：
Yun, In Sik;Lee, Won Jai;Park, Be-young Yun
通讯作者：
Park, Be-young Yun
影响因子：
5.7
作者：
Feiner, John R.;Severinghaus, John W.;Bickler, Philip E.
通讯作者：
Bickler, Philip E.
DOI：
10.1056/nejmoa1901183
发表时间：
2019-11-14
期刊：
The New England journal of medicine
影响因子：
--
作者：
Perez MV;Mahaffey KW;Hedlin H;Rumsfeld JS;Garcia A;Ferris T;Balasubramanian V;Russo AM;Rajmane A;Cheung L;Hung G;Lee J;Kowey P;Talati N;Nag D;Gummidipundi SE;Beatty A;Hills MT;Desai S;Granger CB;Desai M;Turakhia MP;Apple Heart Study Investigators
通讯作者：
Apple Heart Study Investigators