美国生殖医学中的种族与民族差异：当代表高质量证据的叙述性综述

关于在医学研究中是否以及如何使用种族和民族的争论日益激烈，包括将种族视为生物实体、社会构建或种族主义的代理的概念性问题。本叙述性综述的目标是识别和综合报道的产科与妇科（ob/gyn）中的种族和民族不平等现象，并提出针对性研究的建议。通过对影响力最大的8份ob/gyn核心期刊进行可复现的检索，筛选出2010年1月1日至2023年6月30日发表的，包含与种族和民族差异、偏见、偏执、差异和不平等相关关键词的文章（共318篇）。对数据进行了提取和总结，归纳为四个主题：1）就医途径，2）遵循国家指南，3）临床结局，4）临床试验多样性。每个主题下的研究按主题组织，包括：i）产科，ii）生殖医学，iii）妇科癌症，iv）其他。还开发了交互式表格，包含每篇文章的研究时间、对象、地点和结果数据，读者可按期刊、出版年份、种族和民族、主题筛选。大量研究显示，少数族裔在生殖结果方面存在不良差异，例如：非白人患者的孕产期发病率和死亡率更高；黑色、拉丁裔和亚裔患者在辅助生殖成功率方面较低；非白人患者在妇科肿瘤的生存率较低，且获得指南一致性护理的可能性较低。结论认为，许多在ob/gyn领域的种族与民族不平等不能完全归因于患者特征或医疗准入。基于生物差异解释差异的研究误导了“种族是生物特质”的观念。未来需要更多研究拆解“种族”概念，评估干预措施的有效性以减少这些差异。

There has been increasing debate around how or if race and ethnicity should be used in medical research-including the conceptualization of race as a biological entity, a social construct, or a proxy for racism. The objectives of this narrative review are to identify and synthesize reported racial and ethnic inequalities in obstetrics and gynecology (ob/gyn) and develop informed recommendations for racial and ethnic inequity research in ob/gyn. A reproducible search of the 8 highest impact ob/gyn journals was conducted. Articles published between January 1, 2010 and June 30, 2023 containing keywords related to racial and ethnic disparities, bias, prejudice, inequalities, and inequities were included (n=318). Data were abstracted and summarized into 4 themes: 1) access to care, 2) adherence to national guidelines, 3) clinical outcomes, and 4) clinical trial diversity. Research related to each theme was organized topically under the headings i) obstetrics, ii) reproductive medicine, iii) gynecologic cancer, and iv) other. Additionally, interactive tables were developed. These include data on study timeline, population, location, and results for every article. The tables enable readers to filter by journal, publication year, race and ethnicity, and topic. Numerous studies identified adverse reproductive outcomes among racial and ethnic minorities as compared to white patients, which persist despite adjusting for differential access to care, socioeconomic or lifestyle factors, and clinical characteristics. These include higher maternal morbidity and mortality among Black and Hispanic/Latinx patients; reduced success during fertility treatments for Black, Hispanic/Latinx, and Asian patients; and lower survival rates and lower likelihood of receiving guideline concordant care for gynecological cancers for non-White patients. We conclude that many racial and ethnic inequities in ob/gyn cannot be fully attributed to patient characteristics or access to care. Research focused on explaining these disparities based on biological differences incorrectly reinforces the notion of race as a biological trait. More research that deconstructs race and assesses efficacy of interventions to reduce these disparities is needed.