Citing racism as the “root cause” of health disparities in the US and worldwide, the Endocrine Society issued a policy statement addressing the sources and impact of racism in endocrine health disparities. The statement was recently issued and published online in the Journal of Clinical Endocrinology & Metabolism.
Authors of the policy statement noted that endocrine health disparities can be addressed in several key areas, such as facilitating equal access of patients to care, supporting diversity among endocrinology professionals at both work and educational settings, and encouraging more diversity in clinical trial participation and the research workforce.
According to data from the Centers for Disease Control and Prevention (CDC) in 2020, racial and ethnic minority groups in the US have the highest age-adjusted prevalence of diabetes, which was observed among individuals who identify as American Indian/Alaska Native (14.7%), Hispanic/Latino (12.5%), Black (11.7%) or Asian (9.2%) compared with White (7.5%). These racial and ethnic minority groups were also found to be less likely to get routine diabetic care and have higher rates of complications and death due to the disease
In bone health, Black individuals were more likely to have longer hospital stays after hip fracture and a higher risk for disability, death, and destitution compared with White individuals. Studies have shown that osteoporosis screening rates are approximately 40% lower in communities of color.
The Society noted that the racial and ethnic makeup of endocrinology professionals often did not reflect the populations that they serve. Black, Hispanic/Latino, and Native American groups represent only 3.3%, 7.1%, and 0.1%, respectively, of the endocrinology workforce. At the educational level, the number of Black men applying to medical school has decreased since 1978, and Black and Hispanic groups at the faculty level were more underrepresented in 2016 than in 1990 across all specialties.
According to the Society’s statement, racial and ethnic disparities at the clinical trial and research levels are also considered to be a concern and may be “essential to evaluating the safety and efficacy of medical and nonmedical therapeutics.”
Black and Hispanic/Latino groups are known to be significantly underrepresented in clinical research studies, an issue the Society acknowledged has been ongoing in endocrine research. Approximately one-fifth of the new drugs have demonstrated differences in exposure and/or response across racial and ethnic groups, and subgroups within the Black population have shown different responses to medications for hypertension and heart failure, diseases that have a high mortality rates in these populations. There are also only a small number of Black participants enrolled in cardiovascular outcome trials, so “questions remain about the efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 receptor agonists in reducing cardiovascular events in type 2 diabetes”, authors of the statement said.
With regard to research, the Society said a pilot program funded by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) is working to provide administrative supplements to recruit clinical research coordinators from racial and ethnic minority backgrounds in the clinical trial workforce. The Society noted that it was important to “ensure that the research workforce reflects the racial and ethnic diversity of the populations whom their research is designed to impact.”
”As we look ahead, we must go beyond declarations and plan an ethically and structurally different path to a new future and move forward to eradicate racism in health care,” authors of the policy statement said. “Our cohesive efforts need to be conscious, deliberate, and additive to disrupt the reductive nature of race and ethnic labels and to create an avenue for equitable health for all individuals.”
Dhaliwal R, Pereira RI, Diaz-Thomas AM, Powe CE, Cardozo LLY, Joseph JJ. Eradicating racism: an Endocrine Society policy perspective. J Clin Endocrinol Metab. Published online January 13, 2022. doi:10.1210/clinem/dgab896