Study finds racial bias within medical equipment

A new study has found discrepancies in oxygen readings from pulse oximeters based on the pigmentation of a patient’s skin. As Mark Neufeld reports, the inaccurate readings are used to make clinical decisions that could cause a person harm.

By Mark Neufeld

A new study has found critically ill Black, Asian, and Hispanic patients receive less supplemental oxygen than white patients, due to a flaw in the fingertip device often used to measure oxygen levels in a person’s blood.

The study co-authored by Dr. Barret Rush and Dr. Jennifer Ziegler from the University of Manitoba medical school was published in the Journal of the American Medical Association last month.

It examines anonymous data from 3,000 seriously ill patients admitted into intensive care between 2008 and 2019 in the U.S. and found that non-white patients’ blood oxygen levels were being overestimated by pulse oximeters, resulting in the patients receiving significantly less oxygen than they should have.

“These pulse oximeters had been developed kind of in the 1960s-70s and they were always trained and developed on caucasian males,” explained Dr. Rush.

Dr. Rush adds it’s a serious problem because medical technology provides inaccurate information for people with darker complexions, which is then used to make clinical decisions that could cause harm.

“I mean it’s just evidence of systemic racism and there’s multiple instances of that in medicine as well as society, but this is interesting because it was a technological bias.”

As a result of the study’s findings, Dr. Rush and others are working with bioengineers to solve the issue of racial bias in pulse oximeter technologies.

Dr. Amy Tan in the faculty of medicine at the University of British Columbia says it’s important to accurately gauge oxygen levels in the blood for a variety of illnesses, but is particularly important to measure accurately in a person with a respiratory infection from COVID-19.

“If somebody’s coming in with shortness of breath let’s say they have COVID and the reading makes it look higher because the skin tone is darker, then that one person who is racialized because of darker skin is not going to get oxygen treatment, is not going to get treatment with steroids,” explained Dr. Tan.

If inflation continues without intervention, Dr. Tan says the potential domino effect to worse health outcomes is very real. Pre-existing racial bias in other areas of healthcare has also come under recent scrutiny.

Dr. Tan says kidney function testing has caused harm to people of colour and Dr. Rush says medical imaging devices like x-rays and CT scans can show discrepancies among white and non-white patients. 

“I think there’s growing literature and research interest in our group, looking at other monitoring devices like EKGs, other vital signs and how those differences among races impact all of this data gathering,” explained Dr. Rush.

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