#14 James Diao: When should race be used in medical algorithms?

Bio(un)ethical

In this episode, we speak with researcher and physician Dr. James Diao about when and why race should be included or excluded from clinical algorithms. We focus on his work evaluating the implications of including race as a variable in two clinical algorithms: one used to assess lung function, and another used to assess cardiovascular disease risk.

(00:00) Our introduction
(05:10) Interview begins
(09:47) Criteria for the inclusion/exclusion of race of clinical algorithms
(16:23) Inclusion of race in lung function equations
(27:04) Estimated racial disparities in lung disease classification
(31:37) Estimated racial disparities in access to social services and healthcare
(37:44) The PREVENT equations for cardiovascular risk
(47:44) Anticipated impact on statin recommendations
(57:22) Estimated changes in statin eligibility by race
(1:10:03) Whether we should exclude race from clinical algorithms by default
(1:20:36) Common themes and failure modes

Used or referenced:

• Diao et al., “Implications of Race Adjustment in Lung-Function Equations”
• Diao et al., “Projected Changes in Statin and Antihypertensive Therapy Eligibility with the AHA PREVENT Cardiovascular Risk Equations”
• Nwamaka Eneanya, Wei Yang, and Peter Reese, “Reconsidering the Consequences of Using Race to Estimate Kidney Function”
• MDCalc ASCVD risk calculator
• MDCalc CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk calculator
• MDCalc Preventing Risk of Cardiovascular Disease EVENTs (PREVENT) calculator
• National Cancer Institute Breast Cancer Risk Assessment Tool
• Darshali Vyas, Leo Eisenstein, and David Jones, “Hidden in Plain Sight–Reconsidering the Use of Race Correction in Clinical Algorithms”
• Emma Pierson, “Accuracy and Equity in Clinical Risk Prediction”
• CDC “Health, United States Spotlight: Racial and Ethnic Disparities in Heart Disease”
• Roni Caryn Rabin, “Race Cannot Be Used to Predict Heart Disease, Scientists Say”

Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Ambedo Media (previous production support by Audiolift.co). Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

Kapitel

1. Our introduction (00:00:00)

2. Interview begins (00:05:10)

3. Criteria for the inclusion/exclusion of race in clinical algorithms (00:09:47)

4. Inclusion of race in lung function equations (00:16:23)

5. Estimated racial disparities in lung disease classification (00:27:04)

6. Estimated racial disparities in access to social services and healthcare (00:31:37)

7. The PREVENT equations for cardiovascular risk (00:37:44)

8. Anticipated impact on statin recommendations (00:47:44)

9. Estimated changes in statin eligibility by race (00:57:22)

10. Whether we should exclude race from clinical algorithms by default (01:10:03)

11. Common themes and failure modes (01:20:36)