Racial Disparities in Pulse Oximeter Inaccuracy Linked to COVID-19 Treatment Outcomes

Strategic Insights -

A recent study published in the American Journal of Epidemiology has found significant racial disparities in the accuracy of pulse oximeters, a device used to measure blood oxygen saturation, among individuals with darker skin pigmentation. The research analyzed data from Sutter Health, a large healthcare delivery system in northern California, and found that pulse oximeters systematically overestimated blood oxygenation by 1% more in non-Hispanic Black/African American individuals than in non-Hispanic white individuals. This disparity was associated with lower admission probability, dexamethasone treatment, and supplemental oxygen treatment, as well as increased time-to-treatment for patients with COVID-19.

Key Takeaways:

  • The study analyzed data from 43,753 concurrent arterial blood gas (ABG) oxygen saturation (SaO2)/pulse oximeter (SpO2) measurement pairs taken between January 2020 and February 2021.
  • Pulse oximeters systematically overestimated blood oxygenation by 1% more in non-Hispanic Black/African American individuals than in non-Hispanic white individuals.
  • For patients with COVID-19, this disparity was associated with lower admission probability (-3.1 percentage-points), dexamethasone treatment (-3.1 percentage-points), and supplemental oxygen treatment (-4.5 percentage-points).
  • The study suggests that current guidelines for development, testing, and calibration of pulse oximeters should be revisited, investigated, and revised.
  • The research was conducted by a team of authors from the University of California San Francisco (UCSF), including Paul Wesson, Sylvia E. K. Sudat, Kim F. Rhoads, Stephanie Brown, Noha Aboelata, Alice R. Pressman, Aravind Mani, and Kristen M. J. Azar.
  • The study's lead author, Paul Wesson, commented on the potential impact of these findings on COVID-19 treatment outcomes.

Statistics:

  • 43,753 concurrent arterial blood gas (ABG) oxygen saturation (SaO2)/pulse oximeter (SpO2) measurement pairs were analyzed.
  • Pulse oximeters overestimated blood oxygenation by 1% more in non-Hispanic Black/African American individuals than in non-Hispanic white individuals.
  • Lower admission probability: -3.1 percentage-points (compared to non-Hispanic white individuals).
  • Lower dexamethasone treatment: -3.1 percentage-points (compared to non-Hispanic white individuals).
  • Lower supplemental oxygen treatment: -4.5 percentage-points (compared to non-Hispanic white individuals).
  • Increased time-to-treatment for patients with COVID-19: +37.2 minutes before dexamethasone initiation and +278.5 minutes before initiation of supplemental oxygen.

Sources:

  • American Journal of Epidemiology
  • University of California San Francisco (UCSF)
  • Sutter Health
  • Oxford University Press Inc. (publisher of the American Journal of Epidemiology)
  • Paul Wesson (lead author)
  • Sylvia E. K. Sudat, Kim F. Rhoads, Stephanie Brown, Noha Aboelata, Alice R. Pressman, Aravind Mani, and Kristen M. J. Azar (co-authors)