Racial bias in pulse oximetry: More statistical detail may help tackle the problem
Abstract
We were glad to see a news article1 highlighting research by Sjoding and colleagues2 which identifies a racial bias in pulse oximetry, with hypoxaemia identified less frequently in black people compared with white. The research is valuable, identifying an important matter; however, further details would aid clinical application of the findings. Useful, additional, commonly used metrics absent from the paper include bias, precision, limits of agreement, and accuracy value. A …
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Accuracy errors in pulse oximeter readings have been associated with SpO2 overestimations, especially at low saturation conditions.
“Accuracy errors in pulse oximeter readings have been associated with SpO2 overestimations, especially at low saturation conditions [23,24,73,93].”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [73]
The situation where actual oxygen saturation was <88% in patients but their measured PO calculations were >92% occurred three times more in Black patients than white.
“The situation where actual oxygen saturation was <88% in patients but their measured PO calculations were >92% occurred three times more in Black patients than white meaning that many Black patients were at increased risk of undetected hypoxemia.135,136”
From Effect of skin color on optical properties and the implications for medical optical technologies: a review (2024) · cites this paper as [136]
Skin pigmentation affects the accuracy of PO.
“A recent flurry in publications identifies that skin pigmentation affects the accuracy of PO.11,134–140”
From Effect of skin color on optical properties and the implications for medical optical technologies: a review (2024) · cites this paper as [136]
Cites
Racial bias in pulse oximetry measurement
Sjoding, M. W., Dickson, R. P., Iwashyna, T. J., Gay, S. E., & Valley, T. S. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2029240 · Cited by 1,114 · see citing works
Philip, K. E. J., Bennett, B., Fuller, S., Lonergan, B., McFadyen, C., Burns, J., Tidswell, R., & Vlachou, A. (2020) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2020-000778 · Cited by 35 · see citing works
Self-citationPulse oximetry may underestimate hypoxaemia in black patients, study finds
Dyer, O. (2020) · BMJ · doi:10.1136/bmj.m4926 · Cited by 13 · see citing works
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Cabanas, A. M., Fuentes-Guajardo, M., Latorre, K., León, D., & Martín-Escudero, P. (2022) · Sensors · doi:10.3390/s22093402 · Cited by 124 · see citing works
Racial discrepancy in pulse oximeter accuracy in preterm infants
Vesoulis, Z., Tims, A., Lodhi, H., Lalos, N., & Whitehead, H. (2022) · Journal of Perinatology · doi:10.1038/s41372-021-01230-3 · Cited by 120 · see citing works
Setchfield, K., Gorman, A., Simpson, A. H. R. W., Somekh, M. G., & Wright, A. J. (2024) · Journal of Biomedical Optics · doi:10.1117/1.jbo.29.1.010901 · Cited by 72 · see citing works
Phan, T., Rowland, R. A., Ponticorvo, A., Le, B. C., Sharif, S. A., Kennedy, G. T., Wilson, R. H., & Durkin, A. J. (2022) · Journal of Biomedical Optics · doi:10.1117/1.jbo.27.3.036002 · Cited by 18 · see citing works
- Authors
- Philip, K. E. J., Tidswell, R., & McFadyen, C.
- Affiliations
- Imperial College London (GB)
- University College London (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2021-02-02
- Volume
- 372
- Pages
- n298
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W3128610225
- Cited by
- 16
- References
- 3
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 6 · 2022: 2 · 2021: 2
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (ACF-2019-18-007)
- Medical Research Council (MR/S006737/1)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Race, Genetics, and Society
- Keywords
- pulse oximetry, racial bias, hypoxemia, Black patients, measurement accuracy, limits of agreement, bias and precision
- MeSH terms
- Race Factors, Biometry, Humans, Oximetry
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