A Framework for Considering the Value of Race and Ethnicity in Estimating Disease Risk.

IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Annals of Internal Medicine Pub Date : 2025-01-01 Epub Date: 2024-12-03 DOI:10.7326/M23-3166
Madison Coots, Soroush Saghafian, David M Kent, Sharad Goel
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引用次数: 0

Abstract

Background: Accounting for race and ethnicity in estimating disease risk may improve the accuracy of predictions but may also encourage a racialized view of medicine.

Objective: To present a decision analytic framework for considering the potential benefits of race-aware over race-unaware risk predictions, using cardiovascular disease, breast cancer, and lung cancer as case studies.

Design: Cross-sectional study.

Setting: NHANES (National Health and Nutrition Examination Survey), 2011 to 2018, and NLST (National Lung Screening Trial), 2002 to 2004.

Patients: U.S. adults.

Measurements: Starting with risk predictions from clinically recommended race-aware models, the researchers generated race-unaware predictions via statistical marginalization. They then estimated the utility gains of the race-aware over the race-unaware models, based on a simple utility function that assumes constant costs of screening and constant benefits of disease detection.

Results: The race-unaware predictions were substantially miscalibrated across racial and ethnic groups compared with the race-aware predictions as the benchmark. However, the clinical net benefit at the population level of race-aware predictions over race-unaware predictions was smaller than expected. This result stems from 2 empirical patterns: First, across all 3 diseases, 95% or more of individuals would receive the same decision regardless of whether race and ethnicity are included in risk models; second, for those who receive different decisions, the net benefit of screening or treatment is relatively small because these patients have disease risks close to the decision threshold (that is, the theoretical "point of indifference"). When used to inform rationing, race-aware models may have a more substantial net benefit.

Limitations: For illustrative purposes, the race-aware models were assumed to yield accurate estimates of risk given the input variables. The researchers used a simplified approach to generate race-unaware risk predictions from the race-aware models and a simple utility function to compare models.

Conclusion: The analysis highlights the importance of foregrounding changes in decisions and utility when evaluating the potential benefit of using race and ethnicity to estimate disease risk.

Primary funding source: The Greenwall Foundation.

在估计疾病风险时考虑种族和民族价值的框架。
背景:在估计疾病风险时考虑种族和民族可能会提高预测的准确性,但也可能鼓励种族化的医学观。目的:以心血管疾病、乳腺癌和肺癌为案例研究,提出一个决策分析框架,以考虑种族意识比种族不意识的风险预测的潜在益处。设计:横断面研究。背景:2011 - 2018年NHANES(全国健康与营养检查调查)和2002 - 2004年NLST(全国肺筛查试验)。患者:美国成年人。测量:从临床推荐的种族意识模型的风险预测开始,研究人员通过统计边缘化产生了种族无意识的预测。然后,他们根据一个简单的效用函数,假设筛查的成本不变,疾病检测的收益不变,估计了种族意识模型相对于种族无意识模型的效用收益。结果:与种族意识预测作为基准相比,种族意识预测在种族和民族群体中存在很大的误差。然而,在人群水平上,有种族意识的预测比没有种族意识的预测的临床净收益小于预期。这一结果源于两种经验模式:首先,在所有3种疾病中,无论种族和民族是否包括在风险模型中,95%或更多的个体都会得到相同的决定;其次,对于那些接受不同决策的患者,筛查或治疗的净收益相对较小,因为这些患者的疾病风险接近决策阈值(即理论上的“无差异点”)。当用于配给时,种族意识模型可能具有更大的净收益。限制:为了说明目的,假设种族意识模型能够在给定输入变量的情况下产生准确的风险估计。研究人员使用了一种简化的方法,从种族意识模型和一个简单的效用函数来比较模型中产生种族无意识的风险预测。结论:该分析强调了在评估使用种族和民族来估计疾病风险的潜在益处时,在决策和效用方面的前景变化的重要性。主要资金来源:绿墙基金会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Internal Medicine
Annals of Internal Medicine 医学-医学:内科
CiteScore
23.90
自引率
1.80%
发文量
1136
审稿时长
3-8 weeks
期刊介绍: Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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