美国生殖医学中的种族和种族差异：当代高质量证据的叙事回顾

关于如何或是否应在医学研究中使用种族和种族，包括种族作为生物实体，社会结构或种族主义代理的概念化，辩论越来越大。这篇叙述性综述的目标是确定和综合妇产科和妇科中报告的种族和种族不平等现象（OB/GYN），并为OB/GYN中的种族和种族不平等研究提出知识的建议。对8个最高影响OB/GYN期刊进行了可重现的搜索。包括在2010年1月1日至2023年6月30日之间发表的文章，其中包括与种族和种族差异，偏见，偏见，不平等和不平等有关的关键字（n = 318）。将数据抽象为4个主题：1）获得护理，2）遵守国家准则，3）临床结果，以及4）临床试验多样性。与每个主题相关的研究是在标题下局部组织的，i）妇产科，ii）生殖医学，iii）妇科癌症和iv）其他。此外，开发了交互式表。其中包括有关每篇文章的研究时间表，人口，位置和结果的数据。这些表使读者能够按日记，出版年，种族和种族以及主题过滤。与白人患者相比，许多研究确定了种族和少数民族之间的不利生殖结果，尽管调整了差异访问护理，社会经济或生活方式因素以及临床特征，但仍持续存在。这些包括黑人和西班牙裔/拉丁裔患者的孕产妇发病率和死亡率较高；黑人，西班牙裔/拉丁裔和亚洲患者的生育治疗过程中的成功降低；以及较低的生存率和较低的非白人患者妇科癌症的指南协调性护理的可能性降低。我们得出的结论是，ob/gyn中许多种族和种族不平等不能完全归因于患者特征或获得护理。研究重点是基于生物学差异来解释这些差异，这不正确地加强了种族作为生物特征的概念。需要进行更多的研究，以解构种族并评估干预措施以减少这些差异的功效。

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.