To the Editor
We read with interest the article by Willer et al1 describing the results of their well-designed research. We are heartened to read scholarship that focuses on perioperative disparities of care. As perioperative leaders, we believe anesthesiologists have an important role to play in eliminating health care disparities through the collection of evidence and the application of science.
We write to bring the attention of the authors, editors, and readers to 4 points that deserve clarification. First, the article refers to patients as “African American.” By contrast, the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) dataset studied by the authors uses the designation “Black or African American.”2 We suggest this designation should have been used throughout the text. Moreover, although the term “African American” is commonly used in the scientific and lay press, the term “Black” is considered more appropriate in most contexts. In addition, the 2 terms are not interchangeable.3 For example, Americans of Caribbean descent are not represented by the term “African American” but may prefer the term “Caribbean American.” Second, the abbreviation of African American to AA, although commonly used in the medical literature, is not necessary and may be perceived as disrespectful; it is not customary to abbreviate race or ethnicity. Third, capitalization of the word “Black” is acceptable and warranted because it refers to a common identity “in race, ethnic, and cultural sense.”4 Capitalization of the word “white” remains controversial, because it refers to skin color and is not associated with a unifying racial, ethnic, or cultural identity.4 Finally, the conclusion of the article and its abstract describe race as an “important determinant” of health. This phrasing is problematic, since it feeds into the erroneous myth that race is associated with biological differences. Race is a social construct and not a biological determinant of outcomes. The differences in health care outcomes are instead related to discrimination within our health care systems based on race, including health care policies and access to care. We share the authors’ call for “heightened awareness of the disparity” among our patients because of race, striving for more equitable health care in our communities through effective changes in health care policies.
Language and science are living fields with constantly evolving conventions and terminology, reflecting our collective understanding of concepts. In our commitment to health care equity, our words matter as much as our intent. We seek accuracy and rigor in reporting scientific outcomes. Likewise, we should strive for accuracy in our language choice when addressing racial inequities. A recent Health Affairs blog proposes, “standards for publishing on racial health inequities, intended for researchers, journals, and peer reviewers,”5 which we recommend as a valuable guide. We hope that Anesthesia & Analgesia continues to provide the space for rigorous scholarship on perioperative racial inequities. We also hope that all scientific publications uphold best practices on appropriate and sensitive language.
Valerie Armstead, MD, FAAP, DABA
Brenda Bucklin, MD, MEHP
Maria Bustillo, MD
Maya Jalbout Hastie, MD, EdD
Meghan Lane-Fall, MD, MSHP, FCCM
Allison Lee, MD, MS
Lisa Leffert, MD
G. Burkhard Mackensen, MD, PhD, FASE
Mohammed Minhaj, MD, MBA, FASA, FACHE
Tetsuro Sakai, MD, PhD, MHA, FASA
Tracey Straker, MD, MS, MPH, CBA, FASA
Kokila Thenuwara, MBBS, MD, MME, MHCDS
Elizabeth Whitlock, MD, MSc
Robert Whittington, MD
Jeanine Wiener-Kronish, MD
Cynthia Wong, MD
Leadership Advisory Board
Association of University Anesthesiologists
San Francisco, California
1. Willer BL, Mpody C, Tobias JD, Nafiu OO. Racial disparities in failure to rescue following unplanned reoperation in pediatric surgery. Anesth Analg. 2021;132:679–685.
2. ACS NSQIP Pediatric. User Guide for the 2018 ACS NSQIP Pediatric Participant Use Data File (PUF). ACS NSQIP. 2018. Accessed December 23, 2020. https://www.facs.org/-/media/files/quality-programs/nsqip-peds/peds_nsqip_userguide_2018.ashx
3. Associated Press. Race-Related Coverage. AP Stylebook
. 2020Accessed December 21, 2020. https://www.apstylebook.com/race-related-coverage
4. Associated Press. Explaining AP Style on Black and White. 2020. July 20, 2020. Accessed December 23, 2020. https://apnews.com/article/9105661462
5. Boyd RW, Lindo EG, Weeks LD, McLemore MR. On Racism: A New Standard for Publishing on Racial Health Inequities. Health Affairs Blog
. 2020. Accessed December 23, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/