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Epidemiological Assessment and Inference in Race-Based Clinical Algorithms: A Narrative Review and Health Policy
Sienna E Schaeffer1, Carolina Gonzalez Bravo1, Christopher D Ahlers1
1Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Health Equity
|July 18, 2025
Summary
Scientific validity issues in studies on racial disparities in kidney donation hinder health equity. Addressing these flaws is crucial for developing effective, equitable health policies for all racial and ethnic groups.
Area of Science:
- Health Equity Research
- Transplantation Science
- Health Disparities
Background:
- Minoritized racial and ethnic groups experience significant health outcome disparities in the U.S.
- These disparities stem from inequitable social and structural determinants of health.
- Limited research exists on the mechanisms and solutions for these health inequities.
Purpose of the Study:
- To conduct a narrative review of living kidney donor eligibility criteria.
- To examine racial and ethnic disparities in kidney transplantation and donation.
- To assess the scientific rigor of evidence on race-based living kidney donation policies.
Main Methods:
- Evidence-based, equity-focused narrative review.
- Analysis of literature on living kidney donor eligibility.
- Examination of racial and ethnic disparities in U.S. kidney transplantation and donation.
Main Results:
- Identified threats to scientific validity in the evidence base.
- Ambiguity in race/ethnicity operationalization, type III errors, and racial essentialist biases were noted.
- Structural barriers like clinical equipoise and shared decision-making impede equity.
Conclusions:
- Flaws in scientific validity and inferential errors in health inequity research impede progress.
- Recommendations are provided to address these barriers.
- Adopting standards from other clinical and research domains can improve equity.
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