--- title: "Racial Disparities and Pulse Oximeter Device COVID-19 | Sutter Health" description: "Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course" url: "https://www.sutterhealth.org/research/publications/racial-disparities-pulse-oximeter-device-covid-19-1055312833" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Racial Disparities and Pulse Oximeter Device COVID-19 # Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course Sudat SEK, Wesson P, Rhoads KF, & et al.Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course _Am J Epidemiol. 2023;192(5):703-713. doi:10.1093/aje/kwac164_ 2022-09-29 ## Abstract Arterial blood oxygen saturation measured by pulse oximetry (SpO2) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect COVID-19 treatment course. We analyzed pulse oximeter accuracy and association with COVID-19 treatment outcomes using electronic health record (EHR) data from Sutter Health, a large, mixed-payer, integrated healthcare delivery system in northern California, United States (US). We analyzed two cohorts: (1) 43,753 concurrent arterial blood gas (ABG) oxygen saturation (SaO2)/SpO2 measurement pairs taken January 2020-February 2021 for Non-Hispanic white (NHW) or Non-Hispanic Black/African American (NHB) adults, and (2) 8,735 adults who went to the emergency department (ED) with COVID-19 July 2020-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.. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/36173743/) ![Kristen M J Azar, RN, MSN, MPH](https://dyn.mktgcdn.com/p/rFmyR1kiX8JzE5-XNwup0gVC1GRaVTlH7oSDlG0Tr5A/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Kristen M J Azar, RN, MSN, MPH Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/kristen-m-j-azar-rn-msn-mph-1049680985) ![Sylvia Sudat, Ph.D.](https://dyn.mktgcdn.com/p/2AHRaDJwevdbwzC2ecrwY3nYIxbiqxd9NbpxBlI8Kpk/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Sylvia Sudat, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/sylvia-sudat-phd-1049681027) ## Research topics - [Health Disparities](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Disparities%5C%22%22) - [Biostatistics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Biostatistics%5C%22%22) - [COVID-19](https://www.sutterhealth.org/research-search-results?query=%22%5C%22COVID-19%5C%22%22) - [EHR Data](https://www.sutterhealth.org/research-search-results?query=%22%5C%22EHR+Data%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [A multiple-imputation "forward bridging" approach to address changes in the classification of Asian race/ethnicity on the US death certificate.](https://www.sutterhealth.org/research/publications/multiple-imputationchanges-in-asian-classif-on-death-certif-1055312498) Thompson CA, Boothroyd DB, Hastings KG, Cullen MR, Palaniappan LP, Rehkopf DH. Am J Epidemiol. 187(2):347-357. doi: 10.1093/aje/kwx215. 2018 Feb 01 - Publication ### [Mind the clinical-analytic gap: electronic health records and COVID-19 pandemic response](https://www.sutterhealth.org/research/publications/electronic-health-records-covid-19-pandemic-response-1055312813) Sylvia Ek Sudat, Sarah C Robinson, Satish Mudiganti, Aravind Mani, Alice R Pressman J Biomed Inform.103715. doi: 10.1016/j.jbi.2021.103715. Online ahead of print. 2021 Feb 18 - Publication ### [Disparities In outcomes among COVID-19 patients In a large health care system In California.](https://www.sutterhealth.org/research/publications/disparities-in-covid-19-outcomes-in-large-healthcare-system-1055312778) Azar KMJ, Shen Z, Romanelli RJ, Lockhart SH, Smits K, Robinson S, Brown S, Pressman AR. Health Aff (Millwood). 101377hlthaff202000598. doi: 10.1377/hlthaff.2020.00598. \[Epub ahead of print\] 2020 May 21 - Publication ### [Relationships and resilience at work and at home: Impact of relational coordination on clinician work-life balance and well-being in times of crisis](https://www.sutterhealth.org/research/publications/relationships-resilience-impact-of-relational-coordination-on-clinician-work-life-balance-1055312859) Health Care Management Review 2022 Oct 21 - Publication ### [Incidence of lung cancer among never-smoking asian american, native hawaiian, and pacific islander females](https://www.sutterhealth.org/research/publications/lung-cancer-among-never-smoking-aanhpi-1055312793) J Natl Cancer Inst.djab143. doi: 10.1093/jnci/djab143. Online ahead of print. 2021 Aug 04 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/racial-disparities-pulse-oximeter-device-covid-19-1055312833#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Racial Disparities and Pulse Oximeter Device COVID-19"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/racial-disparities-pulse-oximeter-device-covid-19-1055312833#medicalscholarlyarticle","name":"Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course","headline":"Racial Disparities and Pulse Oximeter Device COVID-19","abstract":"Arterial blood oxygen saturation measured by pulse oximetry (SpO2) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect COVID-19 treatment course. 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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. 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