Journal article
Epidemiological Assessment and Inference in Race-Based Clinical Algorithms: A Narrative Review and Health Policy Analysis Focused on Living Kidney Donation
Health equity, Vol.9(1), pp.161-169
03/01/2025
DOI: 10.1089/heq.2024.0170
PMCID: PMC12270529
PMID: 40677644
Abstract
Background: Minoritized racial and ethnic groups in the United States face long-standing disparities in a variety of health outcomes, owing to inequitable distribution of social and structural determinants of health along racial and ethnic lines. Although the existence of such disparities has long been a topic of scientific inquiry, there has been a dearth of investigations regarding their underlying mechanisms and potential remedies. This presents a challenge to those creating evidence-based and equity-focused health policy.
Methods: We conducted an evidence-based, equity-focused narrative review about living kidney donor eligibility using salient literature about donor eligibility and racial and ethnic disparities in kidney transplantation and donation in the United States. We sought to examine the rigor and reproducibility of the evidence base regarding race- and ethnicity-based living kidney donation policies.
Results: Our review identified several threats to scientific validity in the evidence base, including ambiguity in the operationalization of race and ethnicity variables, instances of type III error and racial essentialist biases, and causal inferences made using underpowered or scientifically unsubstantial subgroup analyses. We also identified structural barriers to the interpretation of this evidence to advance health equity, including barriers to the practices of clinical equipoise and shared medical decision-making.
Conclusions: Threats to scientific validity and inferential errors in the evidence base about health inequities may forestall progress toward equity. We provide recommendations for addressing such barriers using standards applied in other clinical and research domains.
Details
- Title: Subtitle
- Epidemiological Assessment and Inference in Race-Based Clinical Algorithms: A Narrative Review and Health Policy Analysis Focused on Living Kidney Donation
- Creators
- Sienna E. Schaeffer - University of IowaCarolina Gonzalez Bravo - University of IowaChristopher D. Ahlers - University of IowaAlaina N. Elliott-Wherry - University of IowaHannah Zadeh - University of IowaPrecious-Junia de-Winton Cummings - University of IowaKimberly C. Dukes - University of IowaNasrien E. Ibrahim - Brigham and Women's HospitalDeShauna Jones - University of IowaPatrick T. Zamba - University of IowaAloha D. Wilks - University of IowaMartha L. Carvour - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Health equity, Vol.9(1), pp.161-169
- DOI
- 10.1089/heq.2024.0170
- PMID
- 40677644
- PMCID
- PMC12270529
- NLM abbreviation
- Health Equity
- ISSN
- 2473-1242
- eISSN
- 2473-1242
- Publisher
- MARY ANN LIEBERT, INC
- Number of pages
- 9
- Grant note
- University of Iowa Strategic Initiatives Fund Public-Private Partnership ProgramNational Institutes of Health: UM1TR004403
Funding was provided by the University of Iowa Strategic Initiatives Fund Public-Private Partnership Program and by the National Institutes of Health [UM1TR004403]. This study does not necessarily convey the views of any funding sponsors.
- Language
- English
- Date published
- 03/01/2025
- Academic Unit
- Infectious Diseases; Epidemiology; Center for Social Science Innovation; Institute for Public Health Practice, Research and Policy; Fraternal Order of Eagles Diabetes Research Center; Injury Prevention Research Center; Institute for Clinical and Translational Science; General Internal Medicine; Community and Behavioral Health; Internal Medicine
- Record Identifier
- 9984799674402771
Metrics
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