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Pulse oximeters less accurate for people of color, study says

The disparity caused patients of color to receive less supplemental oxygen compared with white patients


A nurse adjusts a pulse oximeter on a patient.

File photo/Alessandra Tarantino/Associated Press

Joseph Ostapiuk
Staten Island Advance, N.Y.

STATEN ISLAND, N.Y. — Pulse oximeters became essential tools amid the COVID-19 pandemic, as the disease caused respiratory failure and required patients to receive supplemental treatment.

A new study, however, added to a growing body of evidence that found the devices deliver inaccurate readings more often for people of color, crippling physicians’ ability to make clinical decisions like sending someone to the intensive care unit.

The disparity, the researchers said, caused those patients to receive less supplemental oxygen compared to white patients.

“Racial disparities and inequities in the U.S. health care system have been well documented, with a surge of such reports emerging from the COVID-19 pandemic,” Dr. Qi Duan, program director in the Division of Health Informatics Technologies at the National Institute of Biomedical Imaging and Bioengineering, said in a release.

“This study offers one potential explanation for suboptimal care among minority patients, and provides further evidence that medical devices designed for healthy, white individuals may not perform adequately across all patient populations,” added Duan, who was not involved in the research.

Because pulse oximeters operate by analyzing the body’s absorption of red and infrared light, skin color can affect the device’s reading.

Earlier this year, the United States Food and Drug Administration said it will continue to evaluate information surrounding the accuracy and performance of pulse oximeters. The agency said a public meeting on the topic is planned for later this year.

The latest research, published in JAMA Internal Medicine, pored over data from 3,069 ICU patients from a Boston hospital, including more than 300 patients of color.

The scientists found oxygen readings were, on average, significantly higher in non-white patients — leading to more white patients receiving supplemental oxygen. Patients with higher oxygen readings are less likely to receive that oxygen and more likely to receive more minor treatment or be discharged home.

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The findings, the researchers said, presented how pulse oximeters — vital tools that can affect patient outcomes — were inherently biased and caused health discrepancies based on race.

“We need to understand the drivers of health care disparities, and it turns out that one potential driver is the technology that clinicians rely on to triage patients and guide care,” Dr. Leo Anthony Celi, a senior author of the study, said in the release.

“It is important to reflect on the design and development of medical products — not just medical devices, but also drugs and interventions,” said Celi. “We need to be mindful that medical products developed using non-inclusive populations can contribute to the existing disparities that we are observing in the medical setting.”

First study author Dr. Eric Gottlieb, a lecturer at MIT and a physician at Mount Auburn Hospital in Massachusetts, said the eye-opening findings show how more attention needs to be placed on the tools that affect “concrete medical decisions.”


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