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Randomized Controlled Trial
. 2023 Apr;25(4):100800.
doi: 10.1016/j.gim.2023.100800. Epub 2023 Feb 4.

Primary care physician use of patient race and polygenic risk scores in medical decision-making

Benjamin J Kerman  1 , Charles A Brunette  2 , Elizabeth J Harris  3 , Ashley A Antwi  2 , Amy A Lemke  4 , Jason L Vassy  5
Affiliations
Randomized Controlled Trial

Primary care physician use of patient race and polygenic risk scores in medical decision-making

Benjamin J Kerman et al. Genet Med. 2023 Apr.

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: Cardiovascular disease; Health disparities; Polygenic risk scores; Prevention; Prostate cancer.

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Conflict of interest statement

Conflict of Interest C.A.B., A.A.A., and J.L.V. are employees of the United States Department of Veterans Affairs. The views expressed in this manuscript do not represent those of the US government or United States Department of Veterans Affairs. All other authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Physician agreement with initiating statin therapy for ASCVD risk reduction by PRS result and race of scenario patient
Figure 2.
Figure 2.
Physician recommendation for whether and at what age to recommend prostate cancer screening by PRS result and race of scenario patient
See this image and copyright information in PMC

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