Reckoning with the role of race and ethnicity in health research

Jan. 13, 2021
dna strand

In a paper published last week in The New England Journal of Medicine, a team of researchers lead by CUNY SPH Distinguished Professor Luisa N. Borrell contend that, while we know that race/ethnicity is correlated with genetic ancestry, which captures information about the likelihood of having genetic variants for many diseases, we must not fail to recognize that race/ethnicity captures social exposures not captured by genetic ancestry.

“Race and ethnicity represent the biological embodiment of discrimination, socioeconomic position, access to healthcare, environmental exposures, and genetic variation, all of which are important for clinical decisions and outcomes,” Borrell explains.

The authors advise that researchers and clinicians should carefully weigh whether the inclusion of race and ethnicity is evidence-based and results in improved and fairer decisions for clinical outcomes.

To address systemic racism in the field of medicine, the researchers recommend including race/ethnicity in clinical algorithms, such as in risk scores to predict disease or response to treatment, rather than adjusting the test results for race/ethnicity.

Race/ethnicity should continue to be used in clinical and biomedical research until a better biological predictor or social risk score emerges, they say.

“The removal of race and ethnicity in medicine and biomedical research will likely increase or even create new health inequities, which we aim to address and ultimately eliminate in our society,” Borrell added.

Luisa N. Borrell, D.D.S., Ph.D.,* Jennifer R. Elhawary, M.S.,* Elena Fuentes-Afflick, M.D., M.P.H., Jonathan Witonsky, M.D., Nirav Bhakta, M.D., Ph.D., Alan H.B. Wu, Ph.D., Kirsten Bibbins-Domingo, Ph.D., M.D., José R. Rodríguez-Santana, M.D., Michael A. Lenoir, M.D., James R. Gavin III, MD, PhD., Rick A. Kittles, Ph.D. , Noah A. Zaitlen, Ph.D., David S. Wilkes, M.D., Neil R. Powe, M.D., M.P.H., M.B.A., Elad Ziv, M.D., and Esteban G. Burchard, M.D., M.P.H.* Race and Genetic Ancestry — A time for reckoning with racism. N Engl J Med. January 6, 2021, Vol 384 (1): DOI: 10.1056/NEJMms2029562

 * authors contributed equally