The March 9, 2021 session of Duke Medicine LEADS featured two presentations on health equities and disparities in medicine.
Presenters included John K. Roberts, MD, MS, MEd, on, "Hidden in Plain Sight: Race, GFR, and the Will to Change" and Richard Lee, MD, on, "Hidden in Plain Sight: Resetting the Racial Disparities Break in FRAX."
Here are pearls and takeaways from the session:
- Race is a poor surrogate for biology, and race-based medicine perpetuates health disparities. The use of race in clinical decision tools is dubious: this does not reflect biological differences, but instead is a proxy for the effects of systemic racism, occupational opportunities, nutritional options and habits, and a legitimate lack of trust in US healthcare.
- Estimated Glomerular Filtration Rate (eGFR) is an imprecise measurement tool, and is truly an estimate of kidney function within a range.
- Consider using Cystatin-C and the urinary albumin/Cr ratio with the KFRE (Kidney Failure Risk equation) to estimate a patient’s risk of kidney failure.
- eGFR assumptions harm black patients. Minority patients are diagnosed with CKD later, stay on dialysis longer, and are less likely to be listed for kidney transplant.
- The Fracture Risk Assessment Tool (FRAX) is a country-specific calculator created to estimate the absolute 10-year fracture risk from clinical risk factors and bone mineral density. The US calculator was created from observational data of mainly white non-Hispanic patients, with race and ethnicity correction factors, which underestimates fracture risk in non-whites and perpetuates race-based health inequities.
- Consider using the FRAX tool as an imprecise estimate of fracture risk and incorporate other clinical factors such as social factors, known fall risk, medications, and comorbidities when deciding to treat osteoporosis.
Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.