Abstract
Purpose
The use of patient race in medicine is controversial for its potential either to exacerbate
or address health disparities. Polygenic risk scores (PRSs) have emerged as a tool
for risk stratification models used in preventive medicine. We examined whether PRS
results affect primary care physician (PCP) medical decision-making and whether that
effect varies by patient race.
Methods
Using an online survey with a randomized experimental design among PCPs in a national
database, we ascertained decision-making around atherosclerotic cardiovascular disease
prevention and prostate cancer screening for case scenario patients who were clinically
identical except for randomized reported race.
Results
Across 369 PCPs (email open rate = 10.8%, partial completion rate = 93.7%), recommendations
varied with PRS results in expected directions (low-risk results, no available PRS
results, and high-risk results). Still, physicians randomized to scenarios with Black
patients were more likely to recommend statin therapy than those randomized to scenarios
with White patients (odds ratio = 1.74, 95% CI = 1.16-2.59, P = .007) despite otherwise identical clinical profiles and independent of PRS results.
Similarly, physicians were more likely to recommend prostate cancer screening for
Black patients than for White patients (odds ratio = 1.58, 95% CI = 1.06-2.35, P = .025) despite otherwise identical clinical and genetic profiles.
Conclusion
Despite advances in precision risk stratification, physicians will likely continue
to use patient race implicitly or explicitly in medical decision-making.
Keywords
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Article info
Publication history
Published online: February 04, 2023
Accepted:
February 1,
2023
Received in revised form:
February 1,
2023
Received:
July 24,
2022
Identification
Copyright
Published by Elsevier Inc. on behalf of American College of Medical Genetics and Genomics.
