For decades, race-based corrections in clinical algorithms have shaped how diseases are diagnosed and treated in the U.S. and U.K.—often to the detriment of Black and other minority patients. A recent review traces the origins of these adjustments to the 19th-century spirometer, which falsely attributed lower lung capacity in Black Americans to biology rather than environmental hardship. That flawed logic still echoes in modern medicine.
Algorithms used to estimate kidney function, determine birth plans, and assess cardiovascular risk have routinely adjusted values based on race. For Black patients, this has meant delayed diagnoses, reduced access to transplants, and exclusion from clinical trials. “Race correction artificially elevated kidney function in Black patients,” the authors note, “delaying disease diagnosis and eligibility for transplants.”
Even when race is removed from algorithms, bias can persist through proxies like insurance status or comorbidity patterns. The review warns that “algorithms trained on electronic healthcare records may inherit biases from historical underdiagnosis or undertreatment of racialized groups.”
Efforts to replace race with biomarkers or social determinants of health show promise but are not without challenges. Race-neutral lung function equations, for example, improved transplant access for Black patients but also raised concerns about overdiagnosis and job disqualification.
The authors call for inclusive algorithm design, transparent reporting, and education that frames race as a sociopolitical construct—not a biological fact. Without these reforms, clinical algorithms risk reinforcing the very disparities they aim to solve.
See: “Clinical Algorithms and the Legacy of Race-Based Correction” (July 12, 2025)
