Racial Disparities in Pulse Oximetry Cannot Be Fixed With Race-Based Correction

TL;DR

This paper demonstrates that race-based corrections do not eliminate disparities in pulse oximetry accuracy, highlighting the need for alternative approaches to ensure racially equitable blood oxygen measurement.

Contribution

It characterizes the distribution and variance of pulse oximetry measurements across races, showing race-based corrections are insufficient for equitable hypoxemia detection.

Findings

Pulse oximetry measurements have higher variance for Black patients.

Race-based correction factors do not achieve equal hypoxemia detection performance.

Racial disparities in pulse oximetry cannot be fixed with simple race-based adjustments.

Abstract

Studies have shown pulse oximeter measurements of blood oxygenation have statistical bias that is a function of race, which results in higher rates of occult hypoxemia, i.e., missed detection of dangerously low oxygenation, in patients of color. This paper further characterizes the statistical distribution of pulse ox measurements, showing they also have a higher variance for patients racialized as Black, compared to those racialized as white. We show that no single race-based correction factor will provide equal performance in the detection of hypoxemia. The results have implications for racially equitable pulse oximetry.