在血管护理中隐含的种族偏见和无意的伤害
Corey A Kalbaugh1, Erika T Beidelman1, Kerry A Howard2,3
1Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington.
JAMA surgery
|February 26, 2025
概括
医生隐性偏见,特别是亲白人偏见,与黑人患有外围动脉疾病患者有害手术和截肢的几率增加有关. 解决这种偏见对于减少健康差距至关重要.
科学领域:
- 健康差异 在健康上的差异
- 血管外科 血管外科
- 医学偏见医学偏见
背景情况:
- 隐含的偏见可能会影响医生的决策,并加剧健康差异.
- 有限的数据存在,将隐性偏见与实际的患者护理和结果联系起来.
研究的目的:
- 调查血管专家隐性种族偏见与外围动脉疾病 (PAD) 相关的声的外科治疗选择之间的关联.
- 确定隐性偏见是否会影响黑人患有PAD的潜在有害手术的可能性和随后的截肢率.
主要方法:
- 一项与血管质量倡议 (VQI) 的观察性注册表数据相关的调查研究包括218名血管专家.
- 种族隐性关联测试 (IAT) 测量了临床医生的隐性偏差,然后将其与患者级程序数据联系起来.
- 混合效应的后勤回归模型评估了基于专家偏见和患者种族的基础上进行infrapopliteal手术和1年截肢的几率.
主要成果:
- 72%的血管专家表现出亲白人偏见.
- 与白人患者相比,由亲白人偏见的专家治疗的黑人患者接受infrapopliteal手术的几率明显更高 (AOR,1.67),并增加了1年截肢的几率 (AOR,2.34).
- 被公正的专家治疗的黑人患者的手术和截肢率与白人患者相似.
结论:
- 血管专家的隐性偏见与低于最佳的治疗选择和PAD黑人患者的较差结果有关.
- 这些发现凸显了隐性偏见对血管护理中黑人与白人健康差异的贡献.
- 需要在系统层面进行干预,以减轻隐性偏见对临床决策的影响,并改善患者的治疗结果.
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