Implicit Racial Bias and Unintentional Harm in Vascular Care

Area of Science:

• Health Disparities
• Vascular Surgery
• Medical Bias

Background:

• Implicit bias can affect physician decisions and worsen health disparities.
• Limited data exist linking implicit bias to actual patient care and outcomes.

Purpose of the Study:

• To investigate the association between implicit racial bias in vascular specialists and surgical treatment selection for peripheral artery disease (PAD)-related claudication.
• To determine if implicit bias influences the likelihood of potentially harmful procedures and subsequent amputation rates in Black patients with PAD.

Main Methods:

• A survey study linked with observational registry data from the Vascular Quality Initiative (VQI) included 218 vascular specialists.
• The Race Implicit Association Test (IAT) measured clinician implicit bias, which was then linked to patient-level procedure data.
• Mixed-effects logistic regression models assessed the odds of infrapopliteal procedures and 1-year amputation based on specialist bias and patient race.

Main Results:

• 72% of vascular specialists exhibited pro-White bias.
• Black patients treated by specialists with pro-White bias had significantly higher odds of receiving infrapopliteal procedures (AOR, 1.67) and increased odds of 1-year amputation (AOR, 2.34) compared to White patients.
• Black patients treated by unbiased specialists had similar procedure and amputation rates as White patients.

Conclusions:

• Implicit bias in vascular specialists is associated with suboptimal treatment selection and worse outcomes for Black patients with PAD.
• These findings highlight the contribution of implicit bias to Black-White health disparities in vascular care.
• System-level interventions are needed to mitigate the impact of implicit bias on clinical decision-making and improve patient outcomes.