Ethnic minority people, women and people from disadvantaged communities are at risk of poorer health care because of biases within medical tools and devices, a new report has revealed.
The Equity in Medical Devices: Independent Review, among other things, raised concerns about devices that use artificial intelligence (AI), as well as those that measure oxygen levels.
The team behind the review said urgent action was needed.
“We want an equity lens across the entire life cycle of medical devices, from initial testing, to recruiting patients in the hospital or in the community, to the early phase studies and the implementation in the field after they are licensed,” he said. said Prof Frank Kee, director of the center for public health at Queen’s University Belfast, and a co-author of the review.
Junior Health Minister Andrew Stephenson said: “Making sure the healthcare system works for everyone, regardless of ethnicity, is vitally important to our values as a nation. It supports our wider work to create a fairer and simpler NHS,” he said.
The government-commissioned review was set up by Sajid Javid in 2022 when he was health secretary after concerns were raised about the accuracy of pulse oximeter readings in black and ethnic minority people.
The widely used devices were thrust into the spotlight because of their importance in healthcare during the Covid pandemic, where low oxygen levels were an important sign of serious illness.
The new report confirmed concerns that pulse oximeters overestimate the amount of oxygen in the blood of dark-skinned people, noting that while there was no evidence that this affected care in the NHS, harm was found in the US with such biases leading to to delayed diagnosis and treatment, as well as worse organ function and death, in black patients.
The team emphasizes that they are not calling for the devices to be avoided. Instead, the review suggests a number of measures to improve the use of pulse oximeters in people of different skin colours, including the need to look at changes in readings rather than single readings, while also providing advice on how to use new devices. develop and test. to ensure they work well for patients of all ethnicities.
Concerns about AI-based devices were also highlighted by the report, including the potential for such technology to exacerbate the underdiagnosis of heart conditions in women, lead to discrimination based on patients’ socioeconomic status and lead to underdiagnosis of skin cancer. in people with darker skin tones. Concerns about the latter, they say, are due to the fact that AI devices are largely trained on images of lighter skin tones.
The report also noted problems with polygenic risk scores – which are often used to provide a measure of an individual’s disease risk due to their genes.
“Major genetic data sets using polygenic risk scores are overwhelmingly on people of European descent, which means they may not apply to people of other ancestries,” said Enitan Carrol, professor of pediatric infection at the University of Liverpool and a co-author of the review.
However, attempts to correct biases can also be problematic. Among examples highlighted by the report are race-based corrections applied to measurements from devices known as spirometers used to assess lung function and diagnose respiratory conditions, which themselves contain biases.
Prof Habib Naqvi, CEO of the NHS Race and Health Observatory, welcomed the findings, adding that the review recognizes the need for immediate amendments, fairness assessments and stricter guidance and regulation around pulse oximeters and other medical devices.
“Access to better health should not be determined by your ethnicity nor by the color of your skin; therefore medical devices must be fit for purpose for all communities,” he said
“It is clear that the lack of diverse representation in health research, the absence of robust equity considerations, and the scarcity of co-production approaches, has led to racial bias in medical devices, clinical assessments, and in other health care interventions.”
