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Related Concept Videos

Changes in Skin Color: Clinical Perspectives01:14

Changes in Skin Color: Clinical Perspectives

The first thing a clinician sees is the skin, so the examination of the skin should be part of any thorough physical examination. Most skin disorders are relatively benign, but a few, including melanomas, can be fatal if untreated. A couple of the more noticeable disorders, albinism and vitiligo, affect the appearance of the skin and its accessory organs.
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Clinician behavior when skin tone affects test results.

Marcella Alsan1,2, Liran Einav1,2, Amy Finkelstein2,3

  • 1Department of Economics, Stanford University, Stanford, CA 94305.

Proceedings of the National Academy of Sciences of the United States of America
|May 8, 2026
PubMed
Summary

Pulse oximetry overestimates oxygen saturation in Black patients, warranting more follow-up care. However, Black patients receive less follow-up care than White patients with identical readings, revealing bias propagation in healthcare.

Keywords:
health carepulse oximetryracial bias

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Area of Science:

  • Medical devices
  • Health equity
  • Health disparities

Background:

  • Pulse oximetry is a standard tool for measuring blood oxygen saturation.
  • This device can overestimate oxygen saturation in patients with darker skin tones.
  • This inaccuracy may lead to disparities in medical assessment and care.

Purpose of the Study:

  • To investigate whether pulse oximetry bias affects follow-up care allocation.
  • To compare follow-up care rates for Black versus White patients with similar pulse oximetry readings.
  • To understand how screening device bias influences downstream medical decisions.

Main Methods:

  • Analysis of 3.5 million emergency department visits from the Veterans Health Administration (2014-2018).
  • Comparison of follow-up care rates between Black and White patients with equivalent pulse oximetry measurements.
  • Statistical analysis to identify disparities in care.

Main Results:

  • Black patients systematically received lower rates of follow-up care compared to White patients with the same pulse oximetry readings.
  • Despite a higher medical need for follow-up indicated by their readings, Black patients experienced reduced care.
  • The study identified a pattern of care disparity linked to the pulse oximetry device's performance.

Conclusions:

  • Bias in pulse oximetry technology can lead to inequitable healthcare delivery.
  • Disparities in follow-up care for Black patients highlight the need for bias mitigation in medical devices and algorithms.
  • Addressing technological bias is crucial for achieving health equity and improving patient outcomes.