Study: Implicit bias linked to low-value vascular procedures, worse outcomes for Black patients

Editor's Note

Reducing the negative influence of implicit bias requires system-level interventions to ensure procedures align with best practices for all patients, according to results of new research on outcomes for vascular surgery patients.

Published February 26 in JAMA Surgery, the study showed that implicit racial bias among vascular specialists is associated with higher rates of unnecessary and potentially harmful surgical interventions for Black patients with claudication. The findings are based on a survey of 218 vascular specialists from the Vascular Quality Initiative (VQI), linking their results on an implicit association test (IAT) measuring racial bias to their treatment decisions for 6,588 patients with claudication. Researchers examined whether physician bias influenced the likelihood of performing infrapopliteal interventions, which are not guideline-supported for claudication and carry a higher risk of amputation.

Specific findings include:

• 72% of vascular specialists demonstrated a pro-White bias, while 17% showed no bias, and 11% had a pro-Black bias.
• Black patients treated by specialists with a pro-White bias were significantly more likely to receive infrapopliteal procedures than the overall patient sample (adjusted odds ratio [AOR], 1.67; 95% CI, 1.12-2.48).
• Black patients treated by pro-White bias specialists had more than twice the odds of undergoing a major amputation within a year compared to White patients (AOR, 2.34; 95% CI, 1.20-4.55). However, when treated by a physician with no bias, Black patients had similar odds of amputation (AOR, 1.29; 95% CI, 0.33-4.99) as White patients.
• Specialists with no demonstrated bias were less likely to perform unnecessary infrapopliteal procedures on either Black or White patients, reducing treatment disparities.

These findings suggest that physicians who treat patients with vascular diseases must consider their own practices and where they may be falling short of standards, particularly for their Black patients, researchers write. They suggest implementing real-time monitoring systems to flag inappropriate procedures, fostering accountability, and integrating structured decision-making frameworks to reduce disparities in vascular care.