Health inequities and the inappropriate use of race in nephrology.
Health inequities and the inappropriate use of race in nephrology.
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DOI：
10.1038/s41581-021-00501-8
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Norris KC
中科院分区：
文献类型：
--
作者：
Eneanya ND;Boulware LE;Tsai J;Bruce MA;Ford CL;Harris C;Morales LS;Ryan MJ;Reese PP;Thorpe RJ Jr;Morse M;Walker V;Arogundade FA;Lopes AA;Norris KC
慢性肾病是一种重要的临床疾病，其存在与社会不平等相关的种族和民族差异。美国许多医学院和健康中心对使用种族（一种调节结构性种族主义影响的社会政治结构）作为评估肾脏疾病的固定、可测量的生物变量表示担忧。我们讨论了种族和种族主义在医学中的作用，并概述了医学和社会正义界就估计肾小球滤过率方程中使用种族提出的许多担忧，包括其与结构性种族主义和种族不平等的关系。尽管种族可以用来识别经历种族主义和随后的差别待遇的人群，但忽视任何种族群体内的生物和社会异质性并推断先天的个体层面属性在方法论上是有缺陷的。因此，尽管正在研究用于估计肾功能的更准确的方法，但我们支持使用生物标志物来确定估计的肾小球滤过率，而不需要根据种族进行调整。临床医生有责任认识和阐明种族主义的细微差别及其对健康和疾病的影响。否则，我们就有可能延续医学中历史上的种族主义概念，从而加剧健康不平等并影响边缘化患者群体。在这里，作者讨论了结构性种族主义如何成为影响少数族裔群体的许多健康差异的基础。他们还研究了估计肾小球滤过率方程中种族系数的使用可能如何导致黑人肾病患者的健康不平等。种族和族裔是社会政治结构，与世界各地种族和少数民族群体个人的健康结果有着千丝万缕的联系。从历史上看，科学已经发展并依赖种族框架将人们人为地组织成假定的同质且基因上不同的种族群体，以表明这些群体之间存在固有的生物学差异。在估计肾小球滤过率方程中使用种族系数强化了种族本质主义的有缺陷的假设，并可能使患有肾病的黑人长期存在健康不平等。应使用有效且不分种族的肾功能评估方法来促进高质量的科学、指导临床管理决策并减少种族偏见。
Chronic kidney disease is an important clinical condition beset with racial and ethnic disparities that are associated with social inequities. Many medical schools and health centres across the USA have raised concerns about the use of race — a socio-political construct that mediates the effect of structural racism — as a fixed, measurable biological variable in the assessment of kidney disease. We discuss the role of race and racism in medicine and outline many of the concerns that have been raised by the medical and social justice communities regarding the use of race in estimated glomerular filtration rate equations, including its relationship with structural racism and racial inequities. Although race can be used to identify populations who experience racism and subsequent differential treatment, ignoring the biological and social heterogeneity within any racial group and inferring innate individual-level attributes is methodologically flawed. Therefore, although more accurate measures for estimating kidney function are under investigation, we support the use of biomarkers for determining estimated glomerular filtration rate without adjustments for race. Clinicians have a duty to recognize and elucidate the nuances of racism and its effects on health and disease. Otherwise, we risk perpetuating historical racist concepts in medicine that exacerbate health inequities and impact marginalized patient populations. Here, the authors discuss how structural racism underlies many of the health disparities that affect individuals from minority racial groups. They also examine how the use of race coefficients in estimated glomerular filtration rate equations might contribute to health inequities in Black patients with kidney disease. Race and ethnicity are socio-political constructs that are inextricably tied to health outcomes for individuals from racial and ethnic minority groups worldwide. Historically, science has developed and relied on racial frames to artificially organize people into presumed homogeneous and genetically distinct racial groups, to suggest that inherent biological differences exist between the groups. The use of race coefficients in estimated glomerular filtration rate equations reinforces flawed assumptions of race essentialism and potentially perpetuates health inequities for Black individuals with kidney disease. Valid and race-free methods of kidney function estimation should be used to promote high-quality science, guide clinical management decisions and decrease racial bias.
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影响因子：
5.5
作者：
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DOI：
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