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在慢性病诊断和治疗中保持种族
1Life Sciences, Lawrence Berkeley National Laboratory, Berkeley, USA.
Cureus
|September 13, 2023
概括
从估计的膜过率 (eGFRcr) 计算中删除种族可能会不准确地诊断慢性病 (CKD). 一种种族分层的方法可以提供最不偏的eGFR,并改善患者的治疗.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医学诊断 医学诊断 医学诊断
- 健康差异 在健康上的差异
背景情况:
- 淋巴膜过率 (GFR) 是对功能的主要衡量标准,通常使用血清肌素 (eGFRcr) 来估计.
- 关于eGFRcr的公式历史上包含了种族调整,最近由于对准确性和公平性的担忧而被删除.
- 消除基于种族的调整对不同种族群体的CKD诊断和治疗资格有重大影响.
研究的目的:
- 评估从eGFRcr计算中删除种族的论据的有效性.
- 为了评估新的无竞赛eGFRcr公式的性能.
- 为准确的功能估计提出一种替代方法.
主要方法:
- 审查关于eGFRcr计算中的种族现有文献和准则.
- 通过删除基于种族的纠正而引入的统计偏差的分析.
- 无种族对种族分层EGFRcr公式对CKD诊断和治疗的影响的比较.
主要成果:
- 从eGFRcr公式中排除种族会改变统计偏差,导致黑人人口的诊断不足和非黑人人口的过度诊断.
- 预计无种族配方将重新分类数百万个人,扩大对一些人的治疗资格,同时限制其他人的治疗.
- 修订后的eGFRcr公式可能会夸大CKD患病率的种族差异.
结论:
- 从eGFRcr计算中删除种族是基于有缺陷的论证,并导致偏见的功能估计.
- 一种无种族配方不能准确反映CKD负担,并且可能无法有效识别未被诊断的病例.
- 种族分层的eGFRcr方程为所有患者提供最不偏差的估计和最好的医疗治疗,促进公平的CKD护理.
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