Comment on the case for evaluation. Should be at least a paragraph in length, but quality is stressed over quantity. Be as clear and precise as you can.
CASE 2
Using Race to Calculate Risk
(New England Journal of Medicine)—The Society of Thoracic Surgeons produces elaborate calculators to estimate the risk of death and other complications during surgery. The calculators include race and ethnicity because of observed differences in surgical outcomes among racial and ethnic groups; the authors acknowledge that the mechanism underlying these differences is not known. An isolated coronary artery bypass in a low-risk white patient carries an estimated risk of death of 0.492 percent. Changing the race to “black/African American” increases the risk by nearly 20 percent, to 0.586 percent. Changing to any other race or ethnicity does not increase the estimated risk of death as compared with a white patient, but it does change the risk of renal failure, stroke, or prolonged ventilation. When used preoperatively to assess risk, these calculations could steer minority patients, deemed to be at higher risk, away from surgery.*
Is this surgery risk calculator unfair to African Americans and ethnic groups? Does it make sense to use race and ethnicity in the calculator even though the mechanism behind the observed differences in surgical outcomes among racial and ethnic groups is unknown? Is this use of race and ethnicity as a proxy for risk legitimate?
* Darshali A. Vyas, Leo G. Eisenstein, and David S. Jones, “Hidden in Plain Sight—Reconsidering the Use of Race Correction in Clinical Algorithms,” New England Journal of Medicine 383(2020): 874–82.
