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Race: a Complex Variable That Requires Careful Use in Research

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Race: a Complex Variable That Requires Careful Use in Research Race: A complex variable that requires careful use in research John P.A. Ioannidis, MD, DSc Professor of Medicine, of Epidemiology and Population Health, and (by courtesy) of Biomedical Data Science and of Statistics Co-Director, Meta-Research Innovation Center at Stanford (METRICS) Stanford University Einstein fellow and Director, Meta-Research Innovation Center Berlin (METRIC B), Berlin Institute of Health Race and racism • Differences observed in research studies between “races” may result from the multifarious consequences of long- entrenched and continuously transformed racism. • As the crisis of COVID19 has revealed once again, longstanding effects of racism have tremendous effects on the propagation of inequalities and injustice at all levels, including health and health care. • Racism, tragically, remains a chronic and acute problem of modern societies and the use of race in medical research and practice is now being brandished as a surrogate for racism. • Eradicating racism should be a moral imperative in medicine. School of thought 1: improve • A series of initiatives, including self- identification • Especially in clinical trials and registries • Also in specifications of requirements for publicly funded research • Modest progress in ensuring that more attention is given towards obtaining more data on minorities. A prolific literature • Search of Pubmed with “race OR ethnicity” yields 518842 items • Even focused items like “African American” and “Hispanic OR Latino” yield 44674 and 61933 items, respectively (searches as of 12/21/2020). • Many researchers on race are inspired to diminish inequalities and injustices School of thought 2: abandon • “Race” is a painful historical relic and lost cause. • Efforts should be diverted towards finding variables that are more robust and informative, both for the biological constructs (e.g. genetic ancestry) and the sociological (e.g discrimation, deprivation, socioeconomic status) constructs for which race has failed to provide useful, reproducible insights. Genetics: worsening inequalities? Middle ground between improvement and elimination • The research corpus can be separated into two components: • past research investigations in which race is already incorporated in medical textbooks, clinical algorithms, guidelines, recommendations, and other evidence which may or may not be applied in practice • and future research investigations. Past research • Much race research represents spurious, non-usable biomedical evidence. • Expert specialty medical societies and methodologists should jointly systematically re-examine evidence involving race already accepted as core knowledge. • For some applications, race may continue to be the best variables to capture the influence on health. • For other situations, “race” variables have become obsolete (no longer be relevant in the current social and biological science landscape). • Some “race” variables may continue to offer incremental, useful information, including the further elucidation of health disparities. However, other, better variables should be developed to replace race per se. Future research • Execute a systematic review of prior research as race may have been exhausted as a tool and is futile to study again, or may offer insight for how a new study may best leverage past work, or create novel hypotheses • Consider collateral, explanatory biological and sociological variables appropriate to include in the same investigation; and how standardization, accuracy, and relevance may be enhanced in explaining race-based signals • In any comparative analyses, investigators should consider whether White race should be the reference standard. • Carefully consider the potency of any race-related research and gauge a holistic portfolio of clinical and social consequences including the amelioration or aggravation of existing inequalities. .
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