YNHHS researchers find racial disparities in one mechanism of assessing organ failure
Researchers at the Yale New Haven Health System and the University’s Equity Research and Innovation Center found that Black patients are given higher organ failure scores than white counterparts, potentially prompting racial disparities in resource allocation during the pandemic.
Illustration by Emily Zheng
Researchers at the Yale New Haven Health System found that Black patients have higher organ failure assessment scores than white counterparts despite similar rates of mortality, which could prompt racial disparities in resource allocation during the pandemic.
The findings were detailed in two recent studies by the same team of researchers at YNHHS, who came together through the University’s Equity Research and Innovation Center. In an email to the News, Nitu Kashyap, the associate chief medical information officer, explained that both studies were made possible by YNHHS electronic health records that calculated and preserved thousands of patient organ failure assessment scores.
“The pandemic was really highlighting existing health disparities that have already been there for decades, centuries, but [which] really became obvious and hard to look away from in the setting of the pandemic,” said Benjamin Tolchin, assistant professor of neurology at the School of Medicine and director of YNHHS’s Center for Clinical Ethics.
Tolchin, the lead author of one of the studies, explained that the inspiration for the project was the scarcity of medical resources during the beginning of the pandemic. The issue sparked discussions among healthcare institutions about how to adjust to the problem to save the most lives. According to physician assistant Mary Showstark, these resources extend beyond the medical supplies to include “space” and “staff.”
To compensate for limited resources, many health institutions at the time, including YNHHS, used the sequential organ failure assessment. The system is one of many crisis standard-of-care protocols that assigns scores to patients, taking into account the number and severity of organ malfunction in six systems — respiratory, coagulatory, liver, cardiovascular, renal and neurologic. Theoretically, patients assigned low scores might not be prioritized as much due to a predicted lower chance of survival, according to Tolchin.
Though YNHHS had always used SOFA scores for research purposes, other institutions, particularly those lacking sufficient funding, have used the protocol as a way of triaging patients suffering from COVID-19 and other diseases. However, the research team wanted to prepare, in case the pandemic’s uncertainties pressure the YNHHS to ration its resources among patients, even if it currently does not need to.
“We wanted to see if we do encounter a crisis like this where we do have to make resource allocation decisions,” Tolchin said. “ [If this is the case] would using a system like the SOFA score result in exacerbation of racial disparities?”
Racial disparities that COVID-19 perpetuated are not limited to these crises standard-of-care protocols.
Shireen Roy ’19, a medical student at the University of Washington in St. Louis and lead author on one of the studies, highlighted these racial disparities.
“From the beginning of the pandemic, we’ve seen really stark racial disparities in terms of COVID infections and outcome mortality rates…[especially] Black patients [and] patients in neighborhoods with overcrowding,” Roy said.
Associate professor in emergency medicine Karen Jubanyik, who also works in the ethics committee at the hospital, attributes these disproportionate numbers to systems that are biased against underprivileged populations.
Jubanyik said that drive-in testing requires patients to have a car and other YNHHS appointment procedures are nearly impossible to access without technology. As a result, people who cannot get tested can spread the virus to their friends and family living in the same neighborhoods, Jubanyik said.
The team of researchers in both studies explained that promoting equity in assessing likelihood of mortality is more than about implementing alternative protocols, such as age or the Acute Physiology and Chronic Health Evaluation II Score. Institutions must also investigate the accuracy of these protocols and develop new ones while keeping in mind their ethical implications.
These efforts are necessary, so that “when it comes time to put crisis standards of care into action, we can do that with confidence that we’re not going to be worsening health disparities,” Tolchin said.
The studies were published on Sept. 16 and Sept. 17 in the journal PLOS One.