Study: Pulse oximetry may overestimate blood oxygen reading in people of color

Editor's Note

In a JAMA Internal Medicine study involving more than 7,000 COVID-19 patients, titled “Racial and Ethnic Discrepancy in Pulse Oximetry and Delayed Identification of Treatment Eligibility Among Patients With COVID-19” and published in May 2022, researchers found that pulse oximetry, which measures blood oxygen saturation levels and is a “gatekeeper” in treatment decisions for COVID-19, overestimates levels in Asian, Black, and non-Black Hispanic patients, HealthLeaders June 6 reports.

The study analyzed data from 5 facilities in the Johns Hopkins Health System, including more than 1,200 COVID-19 patients who had blood oxygen saturation levels measured by both pulse oximetry and arterial blood gas testing, as well as from more than 6,500 COVID-19 patients with pulse oximetry measurements showing predicted overestimation of arterial oxygen saturation levels.

Here are two key findings, per HealthLeaders:

• When compared to White COVID-19 patients, pulse oximetry overestimated blood oxygen levels by 1.7% for Asian patients, 1.2% for Black patients, and 1.1% for non-Black Hispanic patients.
• Black patients and non-Black Hispanic patients were less likely to have their treatment eligibility recognized by pulse oximetry (29% and 23% less likely, respectively) than White COVID-19 patients.

“Bias in pulse oximetry could contribute to health disparity in care for COVID-19 and other respiratory conditions,” the study's authors wrote, noting that “differential inaccuracies in pulse oximetry should be examined as a potential explanation for disparities in COVID-19 outcomes and may have implications for the monitoring and treatment of other respiratory illnesses."