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Use of Race in Pediatric Clinical Practice GuidelinesA Systematic Review

To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How is race used in pediatric clinical practice guidelines?

Findings  In this systematic review including 126 pediatric clinical practice guidelines, race was frequently used in pediatric clinical practice guidelines in a way that could negatively affect health care inequities.

Meaning  The use of race in pediatric national guidelines should be improved to prevent the perpetuation of racial inequity and health care inequities.

Abstract

Importance  National clinical practice guidelines (CPGs) guide medical practice. The use of race in CPGs has the potential to positively or negatively affect structural racism and health inequities.

Objective  To review the use of race in published pediatric CPGs.

Evidence Review  A literature search of PubMed, Medscape, Emergency Care Research Institute Guidelines Trust, and MetaLib.gov was performed for English-language clinical guidelines addressing patients younger than 19 years of age from January 1, 2016, to April 30, 2021. The study team systematically identified and evaluated all articles that used race and ethnicity terms and then used a critical race theory framework to classify each use according to the potential to either positively or negatively affect structural racism and racial inequities in health care.

Findings  Of 414 identified pediatric clinical practice guidelines, 126 (30%) met criteria for full review because of the use of race or ethnicity terms and 288 (70%) did not use race or ethnicity terms. The use of a race term occurred 175 times in either background, clinical recommendations, or future directions. A use of race with a potential negative effect occurred 87 times (49.7%) across 73 CPGs and a positive effect 50 times (28.6%) across 45 CPGs.

Conclusions and Relevance  In this systematic review of US-based pediatric CPGs, race was frequently used in ways that could negatively affect health care inequities. Many opportunities exist for national medical organizations to improve the use of race in CPGs to positively affect health care, particularly for racial and ethnic minoritized communities.

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Article Information

Accepted for Publication: January 19, 2022.

Published Online: June 6, 2022. doi:10.1001/jamapediatrics.2022.1641

Corresponding Author: Courtney A. Gilliam, MD, Division of Hospital Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105 (courtney.gilliam@seattlechildrens.org).

Author Contributions: Dr Gilliam had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Gilliam and Lindo are co–first authors.

Concept and design: Gilliam, Lindo, Tieder.

Acquisition, analysis, or interpretation of data: Gilliam, Cannon, Kennedy, Jewell, Tieder.

Drafting of the manuscript: Gilliam, Lindo, Jewell, Tieder.

Critical revision of the manuscript for important intellectual content: Gilliam, Lindo, Cannon, Kennedy, Tieder.

Statistical analysis: Gilliam, Tieder.

Administrative, technical, or material support: Lindo, Cannon, Kennedy, Jewell.

Supervision: Lindo, Tieder.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We acknowledge Emily Patridge, MLS, the University of Washington Health Sciences Library, Seattle for additional guidance in literature review and David de Regt for developing the electronic method for searching the eligible articles for race terms. Neither received compensation for this work.

References
1.
Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice Guidelines.  Clinical Practice Guidelines We Can Trust. National Academies Press; 2011. doi:10.17226/13058
2.
Williams  DR , Lawrence  JA , Davis  BA .  Racism and health: evidence and needed research.   Annu Rev Public Health. 2019;40:105-125. doi:10.1146/annurev-publhealth-040218-043750PubMedGoogle ScholarCrossref
3.
Gee  GC , Ford  CL .  Structural racism and health inequities: old issues, new directions.   Du Bois Rev. 2011;8(1):115-132. doi:10.1017/S1742058X11000130PubMedGoogle ScholarCrossref
4.
Bailey  ZD , Krieger  N , Agénor  M , Graves  J , Linos  N , Bassett  MT .  Structural racism and health inequities in the USA: evidence and interventions.   Lancet. 2017;389(10077):1453-1463. doi:10.1016/S0140-6736(17)30569-XPubMedGoogle ScholarCrossref
5.
The American College of Obstetricians and Gynecologists. Joint statement: collective action addressing racism. Accessed May 10, 2022. https://www.acog.org/news/news-articles/2020/08/joint-statement-obstetrics-and-gynecology-collective-action-addressing-racism
6.
Trent  M , Dooley  DG , Dougé  J ; Section on Adolescent Health; Council on Community Pediatrics; Committee on Adolescence.  The impact of racism on child and adolescent health.   Pediatrics. 2019;144(2):e20191765. doi:10.1542/peds.2019-1765PubMedGoogle ScholarCrossref
7.
O’Reilly  KB .  AMA: racism is a threat to public health.  Updated November 16, 2020. Accessed January 6, 2021. https://www.ama-assn.org/delivering-care/health-equity/ama-racism-threat-public-health
8.
US Centers for Disease Control Prevention.  Racism and Health.  Updated April 12, 2022. Accessed April 20, 2021. https://www.cdc.gov/healthequity/racism-disparities/index.html
9.
Boyd  RW , Lindo  EG , Weeks  LD , McLemore  MR .  On racism: a new standard for publishing on racial health inequities.  Updated July 2, 2020. Accessed April 1, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/
10.
Neal  RE .  US House of Representatives Committee on Ways and Means: letter to health stakeholders.  Accessed October 6, 2020. https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/ClinicalCorrectorsinvitation_final.pdf
11.
Tsai  J , Crawford-Roberts  A .  A call for critical race theory in medical education.   Acad Med. 2017;92(8):1072-1073. doi:10.1097/ACM.0000000000001810PubMedGoogle ScholarCrossref
12.
Bridges  KM , Keel  T , Obasogie  OK .  Introduction: critical race theory and the health sciences.   Am J Law Med. 2017;43(2-3):179-182. doi:10.1177/0098858817723657PubMedGoogle ScholarCrossref
13.
Ford  CL , Airhihenbuwa  CO .  Critical race theory, race equity, and public health: toward antiracism praxis.   Am J Public Health. 2010;100(suppl 1):S30-S35. doi:10.2105/AJPH.2009.171058PubMedGoogle ScholarCrossref
14.
Moher  D , Liberati  A , Tetzlaff  J , Altman  DG ; PRISMA Group.  Preferred Reporting Items for Systematic Reviews and Meta-analyses: the PRISMA statement.   PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097PubMedGoogle ScholarCrossref
15.
Canadian Agency for Drugs and Technologies in Health.  CADTH’s database search filters.  Accessed April 1, 2020. https://www.cadth.ca/resources/finding-evidence/strings-attached-cadths-database-search-filters
16.
Leclercq  E , Leeflang  MM , van Dalen  EC , Kremer  LC .  Validation of search filters for identifying pediatric studies in PubMed.   J Pediatr. 2013;162(3):629-634.e2. doi:10.1016/j.jpeds.2012.09.012PubMedGoogle ScholarCrossref
17.
Ouzzani  M , Hammady  H , Fedorowicz  Z , Elmagarmid  A .  Rayyan-a web and mobile app for systematic reviews.   Syst Rev. 2016;5(1):210. doi:10.1186/s13643-016-0384-4PubMedGoogle ScholarCrossref
18.
National Institute on Minority and Health Disparities. Overview. National Institute of Health. Published 2021. Updated 2021-05-05. Accessed date. https://www.ncbi.nlm.nih.gov/pubmed/
19.
Arday  J , Mirza  HS .  Dismantling Race in Higher Education: Racism, Whiteness and Decolonising the Academy. Springer International Publishing; 2018.
20.
Iruka  IU , Lewis  ML , Lozada  FT , Bocknek  EL , Brophy-Herb  HE .  Call to action: centering blackness and disrupting systemic racism in infant mental health research and academic publishing.   Infant Ment Health J. 2021;42(6):745-748. doi:10.1002/imhj.21950PubMedGoogle ScholarCrossref
21.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Gynecology.  Practice bulletin no. 167: gynecologic care for women and adolescents with human immunodeficiency virus.   Obstet Gynecol. 2016;128(4):e89-e110.PubMedGoogle Scholar
22.
Shane  AL , Mody  RK , Crump  JA ,  et al.  2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea.   Clin Infect Dis. 2017;65(12):e45-e80. doi:10.1093/cid/cix669PubMedGoogle ScholarCrossref
23.
Bernstein  HH , Bocchini  JA  Jr ; Committee on Infectious Diseases.  The need to optimize adolescent immunization.   Pediatrics. 2017;139(3):e20164186. doi:10.1542/peds.2016-4186PubMedGoogle ScholarCrossref
24.
Kourtis  AP , Mirza  A ; Committee on Pediatric AIDS.  Contraception for HIV-infected adolescents.   Pediatrics. 2016;138(3):e20161892. doi:10.1542/peds.2016-1892PubMedGoogle ScholarCrossref
25.
Grohskopf  LA , Sokolow  LZ , Broder  KR ,  et al.  Prevention and control of seasonal influenza with vaccines.   MMWR Recomm Rep. 2016;65(5):1-54. doi:10.15585/mmwr.rr6505a1PubMedGoogle ScholarCrossref
26.
Styne  DM , Arslanian  SA , Connor  EL ,  et al.  Pediatric obesity-assessment, treatment, and prevention: an Endocrine Society clinical practice guideline.   J Clin Endocrinol Metab. 2017;102(3):709-757. doi:10.1210/jc.2016-2573PubMedGoogle ScholarCrossref
27.
Yuen  KCJ , Biller  BMK , Radovick  S ,  et al.  American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of growth hormone deficiency in adults and patients transitioning from pediatric to adult care.   Endocr Pract. 2019;25(11):1191-1232. doi:10.4158/GL-2019-0405PubMedGoogle ScholarCrossref
28.
Sklar  CA , Antal  Z , Chemaitilly  W ,  et al.  Hypothalamic-pituitary and growth disorders in survivors of childhood cancer: an Endocrine Society clinical practice guideline.   J Clin Endocrinol Metab. 2018;103(8):2761-2784. doi:10.1210/jc.2018-01175PubMedGoogle ScholarCrossref
29.
Committee on Adolescent Health Care.  Committee Opinion No 699: adolescent pregnancy, contraception, and sexual activity.   Obstet Gynecol. 2017;129(5):e142-e149. doi:10.1097/AOG.0000000000002045PubMedGoogle ScholarCrossref
30.
Grossman  DC , Curry  SJ , Owens  DK ,  et al; US Preventive Services Task Force.  Behavioral counseling to prevent skin cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(11):1134-1142. doi:10.1001/jama.2018.1623PubMedGoogle ScholarCrossref
31.
American Psychological Association.  Clinical practice guideline for multicomponent behavioral treatment of obesity and overweight in children and adolescents: current state of the evidence and research needs.  Accessed April 27, 2022. https://www.apa.org/obesity-guideline/clinical-practice-guideline.pdf
32.
Polite  BN , Adams-Campbell  LL , Brawley  OW ,  et al.  Charting the future of cancer health disparities research: a position statement from the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute.   CA Cancer J Clin. 2017;67(5):353-361. doi:10.3322/caac.21404PubMedGoogle ScholarCrossref
33.
Spina Bifida Association. Guidelines for the care of people with spina bifida. Accessed May 5, 2020. https://www.spinabifidaassociation.org/resource/guidelinespdfull/
34.
Davidson  KW , Mangione  CM , Barry  MJ ,  et al; US Preventive Services Task Force.  Actions to transform US Preventive Services Task Force methods to mitigate systemic racism in clinical preventive services.   JAMA. 2021;326(23):2405-2411. doi:10.1001/jama.2021.17594PubMedGoogle ScholarCrossref
35.
Oktay  K , Harvey  BE , Partridge  AH ,  et al.  Fertility preservation in patients with cancer: ASCO Clinical Practice Guideline update.   J Clin Oncol. 2018;36(19):1994-2001. doi:10.1200/JCO.2018.78.1914PubMedGoogle ScholarCrossref
36.
McDonald  LC , Gerding  DN , Johnson  S ,  et al.  Clinical practice guidelines for clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA).   Clin Infect Dis. 2018;66(7):e1-e48. doi:10.1093/cid/cix1085PubMedGoogle ScholarCrossref
37.
Slopen  N , Heard-Garris  N .  Structural racism and pediatric health—a call for research to confront the origins of racial disparities in health.   JAMA Pediatr. 2022;176(1):13-15. doi:10.1001/jamapediatrics.2021.3594PubMedGoogle ScholarCrossref
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