Clinicians' perspectives on race-specific guidelines for hypertensive treatment.

Autor: Rabay CJ; Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA., Lopez C; Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA., Streuli S; Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; National Environmental Health Association, 720 S. Colorado Blvd. Suite 105A, Denver, CO, 80246-1910, USA., Mayes EC; Department of Sociology, University of California, San Diego. 9500 Gilman Drive, La Jolla, CA, 92093, USA; Department of Science, Technology and Innovation Studies, School of Social and Political Science, University of Edinburgh. 2.05 Old Surgeons' Hall, High School Yards, Edinburgh, EH1 1LZ, GB, UK., Rajagopalan RM; Wertheim School of Public Health and Human Longevity Science, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Center for Empathy and Technology, Sanford Institute for Empathy and Compassion, 9500 Gilman Drive, La Jolla, CA, 92093, USA., Non AL; Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. Electronic address: alnon@ucsd.edu.
Jazyk: angličtina
Zdroj: Social science & medicine (1982) [Soc Sci Med] 2024 Jun; Vol. 351, pp. 116938. Date of Electronic Publication: 2024 May 05.
DOI: 10.1016/j.socscimed.2024.116938
Abstrakt: Despite the general consensus that there is no biological basis to race, racial categorization is still used by clinicians to guide diagnosis and treatment plans for certain diseases. In medicine, race is commonly used as a rough proxy for unmeasured social, environmental, and genetic factors. The American College of Cardiology's Eighth Joint National Committee's (JNC 8) guidelines for the treatment of hypertension provide race-specific medication recommendations for Black versus non-Black patients, without strong evidence for race-specific physiological differences in drug response. Clinicians practicing family or geriatric medicine (n = 21) were shown a video of a mock hypertensive patient with genetic ancestry test results that could be viewed as discordant with their phenotype and self-identified race. After viewing the videos, we conducted in-depth interviews to examine how clinicians value and prioritize different cues about race -- namely genetic ancestry data, phenotypic appearance, and self-identified racial classifications - when making treatment decisions in the context of race-specific guidelines, particularly in situations when patients claim mixed-race or complex racial identities. Results indicate that clinicians inconsistently follow the race-specific guidelines for patients whose genetic ancestry test results do not match neatly with their self-identified race or phenotypic features. However, many clinicians also emphasized the importance of clinical experience, side effects, and other factors in their decision making. Clinicians' definitions of race, categorization of the patient's race, and prioritization of racial cues greatly varied. The existence of the race-specific guidelines clearly influences treatment decisions, even as clinicians' express uncertainty about how to incorporate consideration of a patient's genetic ancestry. In light of widespread debate about removal of race from medical diagnostics, researchers should revisit the clinical justification for maintaining these race-specific guidelines. Based on our findings and prior studies indicating a lack of convincing evidence for biological differences by race in medication response, we suggest removing race from the JNC 8 guidelines to avoid risk of perpetuating or exacerbating health disparities in hypertension.
Competing Interests: Declaration of competing interest The authors declare they have no known competing financial interests that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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