ArticleAmerican journal of epidemiology2023
Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course.
Article in American journal of epidemiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 3 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- Do Differences in Skin Pigmentation Affect Detection of Hypoxemia by Pulse Oximetry: A Systematic Review of the Literature.Clinical nursing research · 2025Pooled it
- Impact of Skin Pigmentation on Pulse Oximetry Blood Oxygenation and Wearable Pulse Rate Accuracy: Systematic Review and Meta-Analysis.Journal of medical Internet research · 2024Pooled it
- Effect of skin tone on the accuracy of the estimation of arterial oxygen saturation by pulse oximetry: a systematic review.British journal of anaesthesia · 2024Pooled it
- A wearable cuffless blood pressure monitoring system: real-time measurement using force sensing and waveform analysis.Journal of clinical monitoring and computing · 2026Article
- Bias and Fairness Across the Healthcare AI Lifecycle: A Clinician-Oriented Review.Balkan medical journal · 2026Review
- Accuracy and Bias of Pulse Oximetry in the Intensive Care Unit: A Prospective Observational Study.Nursing in critical care · 2026Observational
- Inclusion and reporting by age, sex, and ethnicity in clinical studies of high-risk medical devices approved in the European Union.European heart journal. Quality of care & clinical outcomes · 2025Article
- Race Is an Incomplete Surrogate for Skin Pigmentation in Neonates, with Potential Relevance for Pulse Oximetry.The Journal of pediatrics · 2025Article
- Skin tone corrected pulse oximetry models evaluated through reflective pulsatile Monte Carlo simulations.Biophotonics discovery · 2025Article
- Article
- Open Access Dataset and Common Data Model for Pulse Oximeter Performance Data.Scientific data · 2025Article
- Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security.The Lancet. Global health · 2025Review
- Characterization of Biological Absorption Spectra Spanning the Visible to the Short-Wave Infrared.Journal of visualized experiments : JoVE · 2025Article
- Article
- Rebooting artificial intelligence for health.PLOS global public health · 2025Article
- Laser-based pulse oximetry eliminates pigmentation effects on oxygen saturation measurements: A pilot study.PloS one · 2025Article
- Racial Biases Associated With Pulse Oximetry: Longitudinal Social Network Analysis of Social Media Advocacy Impact.Journal of medical Internet research · 2024Article
- Racial and skin color mediated disparities in pulse oximetry in infants and young children.Paediatric respiratory reviews · 2024Review
- Discrepancy between arterial oxygen saturation and pulse oximetry measurement in a Chinese pediatric patient cohort.Heliyon · 2024Article
- Racial effects on masimo pulse oximetry: impact of low perfusion index.Journal of clinical monitoring and computing · 2024Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Arterial blood oxygen saturation as measured by pulse oximetry (peripheral oxygen saturation (SpO2)) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect the course of coronavirus disease 2019 (COVID-19) treatment. We analyzed pulse oximeter accuracy and its association with COVID-19 treatment outcomes using electronic health record data from Sutter Health, a large, mixed-payer, integrated health-care delivery system in Northern California. We analyzed 2 cohorts: 1) 43,753 non-Hispanic White (NHW) or non-Hispanic Black/African-American (NHB) adults with concurrent arterial blood gas oxygen saturation/SpO2 measurements taken between January 2020 and February 2021; and 2) 8,735 adults who went to a hospital emergency department with COVID-19 between July 2020 and February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (-3.1 percentage points), dexamethasone treatment (-3.1 percentage points), and supplemental oxygen treatment (-4.5 percentage points), as well as increased time to treatment: 37.2 minutes before dexamethasone initiation and 278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.
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