U.S. researchers say faulty readings by a pulse oximeter led to many patients who identified as Black or Hispanic not having timely recognition of how sick they really were.
An oxygen monitor considered crucial to determining treatment for COVID-19 patients has failed to work properly for people of colour, causing delays in urgently needed care, a new study found.
Such faulty readings of oxygen levels may be contributing to worse health outcomes for Black and Hispanic patients, specifically those with COVID-19, according to the study published Tuesday in JAMA Internal Medicine.
Pulse oximeters, which clip onto a finger, are widely used to measure oxygen levels in the blood by shining a light through the fingertip, but have been found to give inaccurate readings in people of colour. Melanin, which is found in darker skin tones, may absorb more light and pulse oximeters are not designed to account for that, previous research has shown.
Because COVID-19 severity is classified around oxygen readings, “we saw that this bias translated into over a quarter of patients, most of whom self-identified as Black or Hispanic, not having timely recognition of how sick they were,” said Dr. Tianshi David Wu, co-lead author of the new study and an assistant professor at the Baylor College of Medicine at the Johns Hopkins School of Medicine in Baltimore, where the study was conducted.
Previous research conducted before the pandemic also found the device, which is commonly used in Canada, provided inaccurate results for people of colour and urged that the technology be further examined.
The issue has raised the need for health technology to be assessed for its efficacy for people of colour and is a further indication that health-care remains inequitable, experts told the Star.
“The study illuminates just how systemic racism and systemic discrimination inserts itself into every aspect of health-care delivery,” said Dr. Andrew Boozary, executive director of the Gattuso Centre for Social Medicine at the University Health Network.
“There is also a gross underrepresentation of racialized individuals in the way that these technologies are being developed,” he said.
Researchers in the Johns Hopkins study found that Black and Hispanic COVID-19 patients experienced significant delays in accessing lifesaving treatment due to inaccurate readings from pulse oximeters, which showed that patients of colour were healthier than they actually were.
The results found that of 7,126 patients, Black patients were 29 per cent less likely than white patients to have their need for treatment recognized by the oxygen reader. For people the study classified as non-Black Hispanic patients, they were 23 per cent less likely than white patients to have their treatment needs identified.
And out of 451 patients who never had their need for treatment recognized, close to 55 per cent (247 people) were Black. Black patients also had a median delay in treatment of one hour.
Pulse oximeters guide health-care workers in decisions regarding COVID-19 triage and therapy, the study explains.
When applying these study results to the U.S. population at large with COVID-19, it’s likely the pulse oximeter bias has “caused a higher proportion of racial and ethnic minorities to be inadvertently undertreated or even mis-triaged,” said Wu.
Past studies have raised the alarm about the devices failing to give accurate results for racialized people. One U.S.-based study published in 2020 found that relying on pulse oximetry to triage patients could put Black patients at an increased risk for hypoxemia, which is below normal levels of oxygen in the blood.
“Studies like [ours] also remind us that future medical technologies should have intentional validation in a population as diverse as the people who would use it,” said Wu in a statement to the Star.
According to a 2021 report from the Wellesley Institute that examined data from the first year of the pandemic, Black people in Ontario were 4.6 times more likely to be infected with COVID-19. Latino and Middle Eastern people were nine and seven times more likely to be hospitalized with the disease compared to white people, and Black people were 6.3 times more likely to end up in hospital.
There are fewer racialized individuals who are part of medical studies to test devices and that creates “serious doubt” as to whether technology is effective for everyone, said Boozary.
Black communities need to be involved in the design and testing of health technology to ensure it works properly and meets their needs, said Paul Bailey, executive director of the Black Health Alliance, a Toronto-based charity.
“We have to be willing to engage a diverse cross-section of people … so the accuracy of these interventions actually work,” he said.
Notisha Massaquoi, an assistant professor in the department of health and society at the University of Toronto, Scarborough, said the issues with this device are indicative of a medical system that is not designed “to ensure the health and well-being, and the survival, of Black people.”
She questions why such devices continue to be relied upon.
“That’s where we have to say, ‘then what is the purpose of science and research? Is it not to ensure the survival of all people?’” she said.
Issues with medical technology will also increase mistrust in the health-care system for racialized communities, as it’s clear they aren’t prioritized, she said.
“We have to really sit down post-COVID to think about every aspect of our system that did not work for the people that are hardest hit,” she said.
Article From: Toronto Star
Author: Olivia Bowden