Confounding of racial and socioeconomic risk factors in epidemiological assertions sampled from Robbins and Cotran: pathologic basis of disease [abstract]
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Background: Learning the risk factors for various diseases is an important part of medical education. However, when medical texts document racial risk factors for particular diseases, that information may be misleading if race is confounded with poverty. For middle-class black Americans, the risks of many diseases may resemble those for other middle-class Americans more than those for poor blacks. Are the epidemiologies of race for some diseases actually myths, perpetuated by successive generations of medical education? Methods: To test the hypothesis that widely-used and well-respected medical textbooks contain assertions that confound race with socioeconomic risk factors, this systematic review searched Robbins and Cotran: Pathologic Basis of Disease, 8th ed.(2009) for epidemiological statements about blacks or African-Americans. (Statements pertaining to other ethnicities were not analyzed for this phase of the research.) For every statement without high-quality, non- confounded sources, DynaMed was used to survey the literature for sources against which the textbook statements were judged. Results: 44 assertions about African-American racial disparities were found in Robbins. Preliminary results are available for the statement on page 773 that esophageal squamous-cell carcinoma is “sixfold more common in African- Americans.” In fact, research that specifically controls for wealth shows that a large part of the disparity can be explained by poverty. Conclusions: Preliminary evidence shows that some assertions in medical textbooks about racial disparities in the incidence of particular diseases may confound racial with socioeconomic risk factors.