University of Texas School of Public Health and University of Texas Health Sciences Center, 8403 Floyd Curl Drive, Mail Code 7992, San Antonio, TX 78229, USA.
Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Curr Cardiol Rep. 2023 Oct;25(10):1131-1138. doi: 10.1007/s11886-023-01938-y. Epub 2023 Aug 15.
Several prediction algorithms include race as a component to account for race-associated variations in disease frequencies. This practice has been questioned recently because of the risk of perpetuating race as a biological construct and diverting attention away from the social determinants of health (SDoH) for which race might be a proxy. We evaluated the appropriateness of including race in cardiovascular disease (CVD) prediction algorithms, notably the pooled cohort equations (PCE).
In a recent investigation, we reported substantial and biologically implausible differences in absolute CVD risk estimates upon using PCE for predicting CVD risk in Black and White persons with identical risk factor profiles, which might result in differential treatment decisions based solely on their race. We recommend the development of raceless CVD risk prediction algorithms that obviate race-associated risk misestimation and racializing treatment practices, and instead incorporate measures of SDoH that mediate race-associated risk differences.
一些预测算法将种族作为一个组成部分，以解释疾病频率与种族相关的差异。最近，这种做法受到了质疑，因为种族作为生物结构的延续存在风险，同时也可能分散了对健康的社会决定因素（SDoH）的关注，而种族可能是其代表。我们评估了将种族纳入心血管疾病（CVD）预测算法中的适当性，特别是汇集队列方程（PCE）。
在最近的一项研究中，我们报告称，在使用 PCE 预测具有相同风险因素谱的黑人和白人的 CVD 风险时，绝对 CVD 风险估计存在显著且生物学上不合理的差异，这可能导致仅基于他们的种族而做出不同的治疗决策。我们建议开发无种族 CVD 风险预测算法，避免与种族相关的风险估计错误和种族化的治疗实践，而是纳入介导与种族相关的风险差异的 SDoH 措施。
