This article is part of A Broad Mandate to Advance Health Equity in Patient Care.
NYU Langone’s Institute for Excellence in Health Equity has identified at least 15 clinical-decision tools nationwide with a race-based component that drive poorer outcomes for Black patients. These two calculators, employed by NYU Langone clinicians, have been revised to remove race adjustments.
Vaginal Birth After Cesarean
Until recently, this longstanding calculator predicted that Black and Hispanic women were 20 percent less likely to have a successful vaginal birth following a cesarean delivery than White women, a factor likely to impact the obstetrician’s recommendation and the birth plan chosen by people in these groups. Cesarean deliveries are more likely to cause complications, including hemorrhage, sepsis, and uterine rupture, than vaginal births. Race and ethnicity have been removed from the equation. “The problem was with the assumption that the data reflected inherent or biological differences,” says Dana R. Gossett, MD, the Stanley H. Kaplan Professor and Chair of Obstetrics and Gynecology. “The truth is that where a patient gets prenatal care, who delivers the baby, and how much counseling and support they receive are far more pertinent than the color of their skin.”
The glomerular filtration rate, or GFR, gauges kidney function by measuring blood levels of creatinine, a waste product generated by muscle and filtered by the kidneys. The GFR score has historically graded Black patients higher based on a false assumption about greater muscle mass and more creatinine production—a bias that has derailed appropriate medical intervention. NYU Langone has eliminated the race component from the calculator. “Black patients have a high burden of hypertension, which can damage the kidneys,” says Olugbenga G. Ogedegbe, MD, MPH, founder and inaugural director of NYU Langone’s Institute for Excellence in Health Equity. “The bias in this algorithm may prevent them from getting the specialty care they need.”