Horsfall, Laura J;
Bondaronek, Paulina;
Ive, Julia;
Poduval, Shoba;
(2025)
Clinical Algorithms and the Legacy of Race-Based Correction: Historical Errors, Contemporary Revisions and Equity-Oriented Methodologies for Epidemiologists.
Clinical Epidemiology
, 17
pp. 647-662.
10.2147/CLEP.S527000.
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Abstract
Clinical algorithms are widely used tools for predicting, diagnosing, and managing diseases. However, race correction in these algorithms has faced increasing scrutiny for potentially perpetuating health disparities and reinforcing harmful stereotypes. This narrative review synthesizes historical, clinical, and methodological literature to examine the origins and consequences of race correction in clinical algorithms. We focus primarily on developments in the United States and the United Kingdom, where many race-based algorithms originated. Drawing on interdisciplinary sources, we discuss the persistence of race-based adjustments, the implications of their removal, and emerging strategies for bias mitigation and fairness in algorithm development. The practice began in the mid-19th century with the spirometer, which measured lung capacity and was used to reinforce racial hierarchies by characterizing lower lung capacity for Black people. Despite critiques that these differences reflect environmental exposure rather than inherited traits, the belief in race-based biological differences in lung capacity and other physiological functions, including cardiac, renal, and obstetric processes, persists in contemporary clinical algorithms. Concerns about race correction compounding health inequities have led many medical organizations to re-evaluate their algorithms, with some removing race entirely. Transitioning to race-neutral equations in areas like pulmonary function testing and obstetrics has shown promise in enhancing fairness without compromising accuracy. However, the impact of these changes varies across clinical contexts, highlighting the need for careful bias identification and mitigation. Future efforts should focus on incorporating diverse data sources, capturing true social and biological health determinants, implementing bias detection and fairness strategies, ensuring transparent reporting, and engaging with diverse communities. Educating students and trainees on race as a sociopolitical construct is also important for raising awareness and achieving health equity. Moving forward, regular monitoring, evaluation, and refinement of approaches in real-world settings are needed for clinical algorithms serve all patients equitably and effectively.
| Type: | Article |
|---|---|
| Title: | Clinical Algorithms and the Legacy of Race-Based Correction: Historical Errors, Contemporary Revisions and Equity-Oriented Methodologies for Epidemiologists |
| Location: | New Zealand |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.2147/CLEP.S527000 |
| Publisher version: | https://doi.org/10.2147/clep.s527000 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Public, Environmental & Occupational Health, clinical algorithms, race correction, health disparities, algorithmic fairness, algorithmic bias, lung function, spirometer, bias mitigation, bias detection, VAGINAL BIRTH, PREDICTION, RISK, VALIDATION, MEDICINE, DELIVERY, HEALTH, BIAS, TOOL |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > CHIME UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > Clinical Epidemiology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10212232 |
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