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Use of Race in Pediatric Clinical Practice Guidelines: A Systematic Review

Courtney A Gilliam1, Edwin G Lindo2, Shannon Cannon3

  • 1Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle.

JAMA Pediatrics
|June 6, 2022
PubMed

Insights

Pediatric clinical practice guidelines (CPGs) often use race in ways that may worsen health inequities. Medical organizations can improve CPGs to ensure race is used to promote health equity for all children.

Area of Science:

  • Health Equity Research
  • Clinical Practice Guidelines
  • Pediatric Health

Background:

  • National clinical practice guidelines (CPGs) shape medical practice.
  • The inclusion of race in CPGs can impact structural racism and health inequities, both positively and negatively.

Purpose of the Study:

  • To systematically review the utilization of race within published pediatric CPGs.
  • To assess the potential impact of race usage on structural racism and health disparities in pediatric care.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases (PubMed, Medscape, ECRI, MetaLib.gov) for pediatric CPGs published between January 1, 2016, and April 30, 2021.
  • A critical race theory framework was employed to classify the identified uses of race and ethnicity terms based on their potential to affect health inequities.

Main Results:

  • Out of 414 identified pediatric CPGs, 126 (30%) incorporated race or ethnicity terms.
  • Race was mentioned 175 times within CPGs. Of these, 87 instances (49.7%) had a potential negative effect on health inequities, while 50 instances (28.6%) had a potential positive effect.

Conclusions:

  • The review of US-based pediatric CPGs indicates frequent use of race in ways that may exacerbate health care inequities.
  • National medical organizations have significant opportunities to refine the application of race in CPGs to advance health equity, especially for racial and ethnic minority children.
Abstract

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