Responding To Racial Disparities In Health – Problem Statement

Racial and ethnic disparities and biases are pervasive throughout the United States healthcare system and have profound, long-lasting impacts on the health and wellness of people of color. A long history of systemic and institutionalized racism in the United States has created social and structural barriers that contribute to these disparities.¹

People of color – especially Black people – are statistically more likely to suffer from a wide range of chronic and infectious diseases and other health conditions, including cardiovascular disease, stroke, diabetes, kidney disease, cancer, and chronic lower respiratory disease. These diseases are some of the leading causes of death and disability in the United States.²

Medical devices and diagnostic tests play a critical role in the prevention, detection, and treatment of many acute and chronic conditions. Research has shown that people of color are less likely than white patients to have access to certain medical technologies, or undergo procedures that use medical technologies, than white patients.¹ Examples include:

• Black patients with symptomatic severe aortic valve stenosis were less likely to receive transcatheter aortic valve replacement, which is a life-saving treatment for this deadly, but curable, condition.³
• Blacks, Hispanics, and Asian/Pacific Islanders were less likely to undergo mechanical thrombectomy following an acute ischemic stroke than white patients.⁴
• Black and Hispanic people with type 1 diabetes were less likely to use insulin pumps or continuous glucose monitors to manage their diabetes than white patients.⁵
• Black and Hispanic people were underrepresented in the home dialysis population.⁶
• Black and Hispanic women with symptoms and diagnoses indicating the need for total knee arthroplasty were significantly less likely to undergo the procedure than white women.⁷

The reasons for this lack of access are manifold and include disparities in the social determinants of health, bias in the healthcare system, lack of access to health care, lack of access to technology, and lack of education about treatment options, to name a few.

In addition, people of color are often underrepresented, or excluded, in clinical trials of medical devices and technologies.⁸ This circumstance makes it difficult to determine which devices are applicable, safe, and effective for certain groups. It is especially significant for technologies that alleviate conditions that disproportionately affect people and communities of color.

The Advanced Medical Technology Association (AdvaMed) and its members have an important role to play in the effort to improve patient outcomes by advancing health equity. We are working collectively, with intentionality, to increase education and awareness of the societal benefits of ensuring access to medical devices by patients of color. We are seeking reforms that support the ultimate goal of ensuring all Americans have access to high quality health care. We are also seeking to improve how medical devices and technologies are designed, developed, researched, tested, and used in different populations. By working collectively, our industry is doing its part to mitigate the adverse impacts of health disparities among people and communities of color and to contribute to a more equitable and just society by championing inclusive practices, access, and treatments.

Learn about AdvaMed’s Health Equity Initiative.

Citations

1. Doubeni CA, Simon M, Krist AH. Addressing Systemic Racism Through Clinical Preventive Service Recommendations From the US Preventive Services Task Force. JAMA. 2021;325(7):627–628. doi:10.1001/jama.2020.26188
2. Leading Causes of Death. U.S. Centers for Disease Control and Prevention. Published December 2, 2020. Accessed January 24, 2021. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
3. Matthew Brennan J, Leon MB, Sheridan P, et al. Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era. J Am Heart Assoc. 2020;9(16):e015879. doi:10.1161/JAHA.119.015879
4. Attenello FJ, Adamczyk P, Wen G, et al. Racial and socioeconomic disparities in access to mechanical revascularization procedures for acute ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23(2):327-334. doi:10.1016/j.jstrokecerebrovasdis.2013.03.036
5. Agarwal S, Schechter C, Gonzalez J, Long JA. Racial-Ethnic Disparities in Diabetes Technology Use Among Young Adults with Type 1 Diabetes [published online ahead of print, 2020 Dec 1]. Diabetes Technol Ther. 2020;10.1089/dia.2020.0338. doi:10.1089/dia.2020.0338
6. Wallace EL, Lea J, Chaudhary NS, et al. Home Dialysis Utilization Among Racial and Ethnic Minorities in the United States at the National, Regional, and State Level. Perit Dial Int. 2017;37(1):21-29. doi:10.3747/pdi.2016.00025
7. Cavanaugh AM, Rauh MJ, Thompson CA, et al. Racial and ethnic disparities in utilization of total knee arthroplasty among older women. Osteoarthritis Cartilage. 2019;27(12):1746-1754. doi:10.1016/j.joca.2019.07.015
8. Fox-Rawlings SR, Gottschalk LB, Doamekpor LA, Zuckerman DM. Diversity in Medical Device Clinical Trials: Do We Know What Works for Which Patients?. Milbank Q. 2018;96(3):499-529. doi:10.1111/1468-0009.12344