June 2, 2023 – Lung problems in Black people are widely underdiagnosed or missed altogether because racist medical ideas stretching back centuries have been programmed into medical software used today, a new study shows.
The findings indicate Black people often did not get the same care as white people for health problems ranging from asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis.
Computer software is used by medical professionals to interpret the results of a common lung test called a pulmonary function test. The test measures how well someone breathes such as how much air someone blows into a device called a spirometer.
Published this week in the journal JAMA Network Open, the study compared the currently used software with a race-neutral version. Researchers looked at test results for 8,431 people -- 2,722 who were Black and 5,709 who were white.
Researchers estimated that a race-neutral algorithm could diagnose lung problems in an additional 1 million Black people. Specifically, researchers found that, among Black people, the race-neutral test indicated:
- Lung problems in 10% more people
- An increased severity of problems in 20% more people
- A type of lung problem called restrictive impairment in 40% more people
The medical racism that caused the faulty algorithm stretches back centuries, wrote Lundy Braun, PhD, and Ricky Grisson, MD, MPH, MBA, in a commentary published with the study. Both are with Brown University. Braun is a professor of pathology and laboratory medicine and of Africana studies, and Grisson is an assistant professor of pathology and laboratory medicine.
While other areas of medicine have already come under investigation for medical racism affecting diagnostic algorithms, pulmonary medicine has “surprisingly” lagged behind, they wrote. Medical racism persisted in diagnostic algorithms “in part because the deeply entrenched idea that the lungs of Black people differ innately from those of White people has obscured the harms of race[-based]” adjustments in pulmonary function tests, Braun and Grisson wrote.
“We need to build on this important work to find better ways both to measure more accurately the impact of racism on pulmonary function and to explore more rigorously the biological processes by which racism damages the lungs of people of other racial and ethnic groups globally,” they concluded.