An Antiracism Approach to Conducting, Reporting, and Evaluating Pediatric Critical Care Research

Abstract

Reporting race and ethnicity without consideration for the complexity of these variables is unfortunately common in research. This practice exacerbates the systemic racism present in healthcare and research, of which pediatric critical care is not immune. Scientifically, this approach lacks rigor, as people are grouped into socially derived categories that are often not scientifically justified, and the field is denied the opportunity to examine closely the true associations between race/ethnicity and clinical outcomes. In this Special Article for Pediatric Critical Care Medicine, we introduce an antiracism approach to conducting, reporting, and evaluating pediatric critical care research. We propose four recommendations: 1) race and ethnicity are social constructs that should be evaluated as such, with researchers considering the context and relevance of related social determinants of health; 2) race and ethnicity data should be collected with sufficient detail to allow detection of meaningful results and minimize the risk of overgeneralizing findings; 3) as health equity research evolves, the pediatric critical care research field must adapt and proactively strive for inclusivity; and 4) the research community, including investigators, authors, research ethics committees, funding organizations, professional organizations, and journal editorial boards, are all accountable for rigorously conducting and reporting race/ethnicity in research. Taking an antiracism approach to research requires the field to ask the difficult question of why racial/ethnic differences exist to eliminate healthcare disparities and optimize healthcare outcomes for all children.

Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

“…As race and ethnicity are social constructs, we attempted to use SVI to interpret the associations within the broader context of social inequities and related social determinants of health. 35 In the US, census tract of residence may explain 70% of variation in individual health outcomes, 36 and factors associated with a person's residence and socioeconomic status have been identified as independent risk factors for outcomes related to SARS-CoV-2 infection. 13,36 Our study is consistent with the findings of Javalkar et al 13 showing Black race and higher SVI to be independently associated with MIS-C. Our stratified analysis, however, further demonstrated that SVI modified the association between race and MIS-C such that non-Hispanic Black children who resided in neighborhoods with lower SVI were more likely to develop MIS-C compared with non-Hispanic White children; however, this association was attenuated among children residing in neighborhoods with moderate to high SVI.…”

Early combination therapy with immunoglobulin and steroids is associated with shorter ICU length of stay in Multisystem Inflammatory Syndrome in Children (MIS‐C) associated with COVID‐19: A retrospective cohort analysis from 28 U.S. Hospitals

“…Since the obesity comorbidity variable acted as a proxy for the missing BMI, a composite variable (obesity as diagnosed with BMI or comorbidity diagnosed by a physician) was used for analysis. Race and ethnicity were self‐reported separately and included in the analysis as a socioeconomic variable for disease outcome 20 . These were later categorized as composite index as non‐Hispanic white, non‐Hispanic black, non‐Hispanic Asian, non‐Hispanic others, and Hispanic per the current CDC reporting on race/ethnicity disparities on COVID‐19 21…”

“…Race and ethnicity were self‐reported separately and included in the analysis as a socioeconomic variable for disease outcome. 20 These were later categorized as composite index as non‐Hispanic white, non‐Hispanic black, non‐Hispanic Asian, non‐Hispanic others, and Hispanic per the current CDC reporting on race/ethnicity disparities on COVID‐19. 21…”

Adverse Childhood Experiences and Patient-Reported Outcome Measures in Critically Ill Children

“…Analyses related to race/ethnicity within our PICU cohort are limited by collection of this data by hospital registration staff at the time of admission without subsequent verification by study staff at the time of enrollment. This may have led to simplified classification and/or misclassification of some subjects ( 47 ); however the participants in our study accurately reflect the demographics of children for whom we care in our PICU. It is known that a parent or guardian’s childhood exposure to ACEs can affect their children ( 12 , 48 , 49 ).…”