Going beyond the means: Exploring the role of bias from digital determinants of health in technologies.
Going beyond the means: Exploring the role of bias from digital determinants of health in technologies.
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DOI：
10.1371/journal.pdig.0000244
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发表时间：
2023-10
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鉴于最近的回顾性研究揭示了医疗技术获取差异和测量偏差的证据，本叙述性综述评估了技术和医疗配方中的健康数字决定因素（DDoH），这些技术和医疗配方显示了偏差或次优性能的证据，确定了这种偏差背后的潜在机制，并提出了指导未来努力解决这些差异的潜在方法或途径。机制大致分为物理和生物偏差（例如，脉搏血氧测定，非接触式红外测温[NCIT]），人为因素和文化习俗的相互作用（例如，脑电图[EEG]）和解释偏差（例如，肺功能测试[PFT]，光学相干断层扫描[OCT]和Humphrey视野[HVF]测试）。本审查范围特别不包括包含人工智能和机器学习的技术。对于每种技术，我们确定临床和研究建议。在医疗技术和配方中遇到的许多DDoH机制，在应用于最初开发或验证范围之外的患者时，导致准确性或有效性较低。我们的临床建议提醒临床使用者完全信任结果的有效性，并建议与其他对DDoH机制可靠的测量方式相关联（例如，脉搏血氧测定的动脉血气，NCIT的核心温度）。我们的研究建议不仅要增加开发和验证的多样性，而且要提高对所需多样性模式的认识（例如，脉搏血氧仪的皮肤色素沉着，NCIT的皮肤色素沉着和性别/激素变化）。通过增加多样性，更好地反映患者在所有使用情况下的情况，我们可以减轻DDoH机制，增加临床实践和研究中的信任和有效性。
In light of recent retrospective studies revealing evidence of disparities in access to medical technology and of bias in measurements, this narrative review assesses digital determinants of health (DDoH) in both technologies and medical formulae that demonstrate either evidence of bias or suboptimal performance, identifies potential mechanisms behind such bias, and proposes potential methods or avenues that can guide future efforts to address these disparities. Mechanisms are broadly grouped into physical and biological biases (e.g., pulse oximetry, non-contact infrared thermometry [NCIT]), interaction of human factors and cultural practices (e.g., electroencephalography [EEG]), and interpretation bias (e.g, pulmonary function tests [PFT], optical coherence tomography [OCT], and Humphrey visual field [HVF] testing). This review scope specifically excludes technologies incorporating artificial intelligence and machine learning. For each technology, we identify both clinical and research recommendations. Many of the DDoH mechanisms encountered in medical technologies and formulae result in lower accuracy or lower validity when applied to patients outside the initial scope of development or validation. Our clinical recommendations caution clinical users in completely trusting result validity and suggest correlating with other measurement modalities robust to the DDoH mechanism (e.g., arterial blood gas for pulse oximetry, core temperatures for NCIT). Our research recommendations suggest not only increasing diversity in development and validation, but also awareness in the modalities of diversity required (e.g., skin pigmentation for pulse oximetry but skin pigmentation and sex/hormonal variation for NCIT). By increasing diversity that better reflects patients in all scenarios of use, we can mitigate DDoH mechanisms and increase trust and validity in clinical practice and research.