Today, I wanted to explore how race is used as a metric of performance in medical science. I noticed this from reading patients’ estimated glomerular filtration rates (eGFRs), which are calculated differently for African-American patients. This led me to research on spirometry, or lung function tests, another area where values are calculated differently based on the individual’s race.
Race is acknowledged, at least in academic circles, as a social construct albeit with real social consequences. Although race is often self-defined and identified, its meaning changes across time and place. For example, being “black” in the US is different than being “black” in Cuba or the Dominican Republic or Brazil. “Race” is probably best used in studies that describe social disparity.
However, studies such as KEEP, which sought to find differences in albuminuria between people of different races, continues to perpetuate the idea that racial differences in medicine are real. This study reported that non-white individuals have higher rates of albuminuria, which might lead researchers to assume that it is more acceptable for non-white individuals to have higher creatinine or albuminuria, which has implications for screening, diagnosis of CKD, and treatment.
Lundy Braun, a professor at Brown University and author of Breathing Race Into the Machine, reported in a 2012 paper that 83.6% of studies examining lung function across racial/ethnic groups reported lower lung function in “other racial and ethnic groups,” compared to “whites.” Twenty percent cited “inherent factors” and 30% cited “anthropometric differences.” What was troubling was that some researchers were nuanced about elements such as height as a changeable factor in individuals and populations, while others viewed anthropometric factors as fixed/inherent characteristics.
Even more troubling was that papers from as early as the 1920s continued to be cited in papers from the 2000s as evidence of racial difference in lung function.
Braun concludes that:
“Even though researchers sought to determine differences in lung function by race/ethnicity, they typically failed to define their terms and frequently assumed inherent (or genetic) differences….The fact that the key variable of race and/or ethnicity used to frame comparative studies on lung capacity was rarely defined over a period of nearly 90 years should at the very least raise questions about the reliability of research that reports an association between inherent or genetic racial difference and lung function and the scientific evidence that underpins the practice of “race correction” and this has important implications for health policy.”
There are alternatives to the current system of using racially based correction factors or reference standards. Kiviranta and Haahtela describe how the term “Caucasian” came into being and conclude that white people are not “Caucasians” and that this term should be dropped from research literature. Similarly, Burney and Hooper analyzed the eGFRs of black and white populations and found no differences. They argue that racial reference standards should be dropped from research and practice.
Especially with the explosion of genetic and genomic research, Mersha and Abebe point out that self-reported race may not be as accurate as individual genomic information in helping us better understand disease and treatment outcomes. They propose using “ancestry” as a term to describe genetic variation.
For further reading, see this Atlantic interview with Lundy Braun about her book.