Recommendations based on race, ethnicity should be avoided in GI clinical guidelines
Siddique SM, et al. Abstract 872. Featured at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
Disclosures: Siddique does not report any relevant financial information.
SAN DIEGO — Gastroenterology societies should refrain from incorporating race and ethnicity into clinical guidelines because it could exacerbate health inequities, according to research presented at Digestive Disease Week 2022.
“Race is a social construct, but healthcare workers still use race and ethnicity to guide clinical decision-making,” Shazia Mr. Siddique, MD, MSHP, assistant professor of gastroenterology at the Perelman School of Medicine at the University of Pennsylvania, Healio told. “Understanding how and when race is used is important in determining potential proxies for race and replacing and correcting those practices if necessary. Now further steps are needed to similarly re-evaluate guidelines across all specialties that incorporate race-based decision making.
Between January 2010 and September 2021, Siddique and colleagues sought clinical advice or guidelines from U.S.-based GI professional societies, such as AGA, ACG, AASLD, and ASGE, to determine the extent to which race and ethnicity are included in current recommendations.
Investigators found seven documents containing eight recommendations based on race or ethnicity, focusing on surveillance for hepatocellular carcinoma in people with chronic hepatitis B virus, surveillance for gastric intestinal metaplasia, screening for Helicobacter pylori and surveillance of Barrett’s esophagus. According to the guidelines, patients were either screened or monitored for clinical status based on incidence or risk within a racial or ethnic group.
Siddique and his colleagues noted that definitions of race and ethnicity varied across guidelines, highlighting possible implications for health disparities. They identified best practices for addressing race and ethnicity in the clinical guideline process, including:
Use country of origin or ancestry rather than broad racial/ethnic groups
Point out diversity (or lack of) in patient cohorts
Describe and recognize health disparities in the field
Consider the effect of a clinical recommendation on health equity
“In this vein, it is prudent for GI societies to re-examine existing guidelines and current guideline development processes to avoid race/ethnicity-based recommendations where possible, use variables more specific in place of race/ethnicity and to transparently rationalize the use of race/ethnicity and its potential impact on health equity,” Siddique and colleagues wrote.