Implicit Racial Bias and Unintentional Harm in Vascular Care

Published in the JAMA Surgery. Here is a link to the article.

Regenstrief Institute authors: Andrew Gonzalez, M.D., J.D., MPH

This study explores the relationship between physicians’ implicit racial bias and surgical treatment decisions for peripheral artery disease (PAD)–related claudication. Specifically, it investigates whether racial bias is associated with the increased likelihood of Black patients receiving potentially harmful infrapopliteal procedures and facing worse health outcomes. Conducted within the Vascular Quality Initiative (VQI), the study surveyed 218 vascular specialists who completed the race Implicit Association Test (IAT) and were linked to patient treatment data. Most specialists (72%) exhibited a pro-White bias.

Key findings reveal that Black patients treated by physicians with a pro-White bias were significantly more likely to undergo infrapopliteal procedures and experienced a higher risk of amputation one year later, with adjusted odds ratios of 1.67 and 2.34, respectively. In contrast, Black patients treated by unbiased physicians had similar treatment patterns and outcomes as White patients. These results underscore how implicit bias can negatively shape clinical decisions, leading to disparities in care quality and outcomes.

The study highlights a crucial link between subconscious prejudice and unequal healthcare, emphasizing the urgency for systemic reforms. Suggested interventions include tools that identify care decisions diverging from evidence-based best practices, aimed at mitigating the effects of bias. Overall, the findings reinforce the need for accountability and transparency in clinical decision-making to address racial health disparities in the United States.

Authors:

Corey A Kalbaugh ¹, Erika T Beidelman ¹, Kerry A Howard ^{2 3}, Brian Witrick ², Ashley Clark ⁴, Katharine L McGinigle ⁵, Samantha Minc ⁶, Olamide Alabi ⁷, Caitlin W Hicks ⁸, Andrew A Gonzalez ^{9 10}, Crystal W Cené ¹¹, Samuel Cykert ¹²

Affiliations:

¹Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington.

²Department of Public Health Sciences, Clemson University, Clemson, South Carolina.

³Center for Public Health Modeling and Response, Clemson University, Clemson, South Carolina.

⁴Center for Survey Research and O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington.

⁵Department of Surgery, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill.

⁶Department of Cardiovascular and Thoracic Surgery, West Virginia School of Medicine, Morgantown.

⁷Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.

⁸Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

⁹Department of Surgery, Indiana University School of Medicine; Indianapolis.

¹⁰Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana.

¹¹Department of Medicine, University of California at San Diego Health, La Jolla.

¹²Division of General Medicine and Clinical Epidemiology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill.