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Owusu-Addo E, Bennor DM, Orkin AM, Chan AW, Welch VA, Treweek S, Green H, Feldman P, Ghersi D, Brijnath B. Recruitment, retention and reporting of variables related to ethnic diversity in randomised controlled trials: an umbrella review. BMJ Open 2024; 14:e084889. [PMID: 39122387 DOI: 10.1136/bmjopen-2024-084889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVE This umbrella review synthesises evidence on the methods used to recruit and retain ethnically diverse participants and report and analyse variables related to ethnic diversity in randomised controlled trials. DESIGN Umbrella review. DATA SOURCES Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO and Cochrane and Campbell Libraries for review papers published between 1 January 2010 and 13 May 2024. ELIGIBILITY CRITERIA English language systematic reviews focusing on inclusion and reporting of ethnicity variables. Methodological quality was assessed using the AMSTAR 2 tool. RESULTS Sixty-two systematic reviews were included. Findings point to limited representation and reporting of ethnic diversity in trials. Recruitment strategies commonly reported by the reviews were community engagement, advertisement, face-to-face recruitment, cultural targeting, clinical referral, community presentation, use of technology, incentives and research partnership with communities. Retention strategies highlighted by the reviews included frequent follow-ups on participants to check how they are doing in the study, provision of incentives, use of tailored approaches and culturally appropriate interventions. The findings point to a limited focus on the analysis of variables relevant to ethnic diversity in trials even when they are reported in trials. CONCLUSION Significant improvements are required in enhancing the recruitment and retention of ethnically diverse participants in trials as well as analysis and reporting of variables relating to diversity in clinical trials. PROSPERO REGISTRATION NUMBER CRD42022325241.
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Affiliation(s)
- Ebenezer Owusu-Addo
- Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Deborah M Bennor
- Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Aaron Michael Orkin
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - An-Wen Chan
- Women's College Research Institute and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivian A Welch
- Methods Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Campbell Collaboration, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | | | - Peter Feldman
- Social Gerontology, National Ageing Research Institute Inc, Parkville, Victoria, Australia
| | - Davina Ghersi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bianca Brijnath
- Social Gerontology, National Ageing Research Institute Inc, Parkville, Victoria, Australia
- The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
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Windon CC, Jackson AJ, Aguirre GA, Tucker M, Amuiri A, Hill-Jarrett T, Chen M, Pina Escuedro SD, Lieu K, Lopez L, Mei D, Tee BL, Watson CW, Agwu C, Kramer J, Lanata S. Underrepresented and Underserved Populations in Neurological Research. Semin Neurol 2024; 44:168-177. [PMID: 38485127 DOI: 10.1055/s-0044-1782516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Underserved and underrepresented populations have historically been excluded from neurological research. This lack of representation has implications for translation of research findings into clinical practice given the impact of social determinants of health on neurological disease risk, progression, and outcomes. Lack of inclusion in research is driven by individual-, investigator-, and study-level barriers as well as larger systemic injustices (e.g., structural racism, discriminatory practices). Although strategies to increase inclusion of underserved and underrepresented populations have been put forth, numerous questions remain about the most effective methodology. In this article, we highlight inclusivity patterns and gaps among the most common neurological conditions and propose best practices informed by our own experiences in engagement of local community organizations and collaboration efforts to increase underserved and underrepresented population participation in neurological research.
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Affiliation(s)
- Charles C Windon
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Ashley J Jackson
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Gloria A Aguirre
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Miwa Tucker
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Alinda Amuiri
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Tanisha Hill-Jarrett
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Miranda Chen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Stefanie D Pina Escuedro
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Kevin Lieu
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Lucia Lopez
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Diana Mei
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Boon Lead Tee
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
- Memory and Aging Center, Department of Neurology, Global Brain Health Institute, University of California, San Francisco, California
| | - Caitlin W Watson
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Chidera Agwu
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Joel Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
| | - Serggio Lanata
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
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Peebles IS, Phillips TO, Hamilton RH. Toward more diverse, inclusive, and equitable neuromodulation. Brain Stimul 2023; 16:737-741. [PMID: 37088453 DOI: 10.1016/j.brs.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/28/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023] Open
Abstract
Racial and ethnic disparities exist for many nervous system disorders that are intervention targets for neuromodulation investigators. Yet, to date, there has been both a lack of racial and ethnic diversity and a lack of emphasis on diversity in neuromodulation research. In this paper, we suggest three potential reasons for the lack of racial and ethnic diversity in neuromodulation research: 1) the lack of diversity in the neuromodulation workforce, 2) incompatibility between the technologies employed and phenotypic traits (e.g., hair texture) commonly present in minoritized populations, and 3) minoritized populations' reluctance to participate in clinical trials. We argue that increasing diversity in the neuromodulation workforce, in conjunction with mutual collaboration between current neuromodulation researchers and underrepresented communities in neuromodulation, can aid in removing barriers to diversity, equity, and inclusion in neuromodulation research. This is important, because greater diversity, equity, and inclusion in neuromodulation research brings with it the development of novel, yet safe and effective, treatment approaches for brain disorders and enhances the rigor and generalizability of discoveries in the field.
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Affiliation(s)
- Ian S Peebles
- University Center for Human Values, Princeton University, Princeton, NJ, 08544, United States.
| | - Taylor O Phillips
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, United States
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4
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Racial bias in recruitment to clinical trials on paediatric asthma. Paediatr Respir Rev 2023; 45:8-10. [PMID: 36460568 DOI: 10.1016/j.prrv.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
Asthma is now the commonest chronic disease of childhood, but not all children with asthma receive equivalent standards of medical care which influences their clinical outcomes. In this paper we sought to determine the proportion of participants in registered clinical trials relating to paediatric or adolescent asthma over the last decade that were from white and non-white backgrounds. We searched the ClinicalTrials.gov database for all completed interventional studies between the dates 1st January 2011 and 1st January 2021 that were on the topic of 'asthma', and included participants below 18 years of age. Of the 500 studies returned, 208 had results available on the ClinicalTrials.gov website. In total, of the 112,327 patients studied, almost 69 % (77,333) of the patients were described as White or Caucasian, and fewer than 13 % (14,189) were described as Black, African, or African-American. Overall, approximately 30 % of study participants - some 34,207 children - were from non-white backgrounds. To redress this imbalance, researchers designing clinical trials must ensure that their study populations are as representative of the target population for the intervention as possible.
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Robbins NM, Charleston L, Saadi A, Thayer Z, Codrington WU, Landry A, Bernat JL, Hamilton R. Black Patients Matter in Neurology: Race, Racism, and Race-Based Neurodisparities. Neurology 2022; 99:106-114. [PMID: 35851551 DOI: 10.1212/wnl.0000000000200830] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
Black people living in the United States suffer disproportionate morbidity and mortality across a wide range of neurologic conditions. Despite common conceptions to the contrary, "race" is a socially defined construct with little genetic validity. Therefore, racial health inequities in neurology ("neurodisparities") are not a consequence of biologic differences between races. Instead, racism and associated social determinants of health are the root of neurodisparities. To date, many neurologists have neglected racism as a root cause of neurologic disease, further perpetuating the problem. Structural racism, largely ignored in current neurologic practice and policy, drives neurodisparities through mediators such as excessive poverty, inferior health insurance, and poorer access to neurologic and preventative care. Interpersonal racism (implicit or explicit) and associated discriminatory practices in neurologic research, workforce advancement, and medical education also exacerbate neurodisparities. Neurologists cannot fulfill their professional and ethical responsibility to care for Black patients without understanding how racism, not biologic race, drives neurodisparities. In our review of race, racism, and race-based disparities in neurology, we highlight the current literature on neurodisparities across a wide range of neurologic conditions and focus on racism as the root cause. We discuss why all neurologists are ethically and professionally obligated to actively promote measures to counteract racism. We conclude with a call for actions that should be implemented by individual neurologists and professional neurologic organizations to mitigate racism and work towards health equity in neurology.
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Affiliation(s)
- Nathaniel M Robbins
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA.
| | - Larry Charleston
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Altaf Saadi
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Zaneta Thayer
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Wilfred U Codrington
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Alden Landry
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - James L Bernat
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Roy Hamilton
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
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6
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Baumer FM, Mytinger JR, Neville K, Briscoe Abath C, Gutierrez CA, Numis AL, Harini C, He Z, Hussain SA, Berg AT, Chu CJ, Gaillard WD, Loddenkemper T, Pasupuleti A, Samanata D, Singh RK, Singhal NS, Wusthoff CJ, Wirrell EC, Yozawitz E, Knupp KG, Shellhaas RA, Grinspan ZM. Inequities in therapy for infantile spasms: a call to action. Ann Neurol 2022; 92:32-44. [PMID: 35388521 DOI: 10.1002/ana.26363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/22/2022] [Accepted: 03/15/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether selection of treatment for children with infantile spasms (IS) varies by race/ethnicity. METHODS The prospective US National Infantile Spasms Consortium database includes children with IS treated from 2012-2018. We examined the relationship between race/ethnicity and receipt of standard IS therapy (prednisolone, adrenocorticotropic hormone, vigabatrin), adjusting for demographic and clinical variables using logistic regression. Our primary outcome was treatment course, which considered therapy prescribed for the first and, when needed, the second IS treatment together. RESULTS Of 555 children, 324 (58%) were Non-Hispanic white, 55 (10%) Non-Hispanic Black, 24 (4%) Non-Hispanic Asian, 80 (14%) Hispanic, and 72 (13%) Other/Unknown. Most (398, 72%) received a standard treatment course. Insurance type, geographic location, history of prematurity, prior seizures, developmental delay or regression, abnormal head circumference, hypsarrhythmia, and IS etiologies were associated with standard therapy. In adjusted models, Non-Hispanic Black children had lower odds of receiving a standard treatment course compared with Non-Hispanic white children (OR 0.42, 95% CI 0.20-0.89, p = 0.02). Adjusted models also showed that children with public (vs. private) insurance had lower odds of receiving standard therapy for treatment 1 (OR 0.42, CI 0.21-0.84, p = 0.01). INTERPRETATION Non-Hispanic Black children were more often treated with non-standard IS therapies than Non-Hispanic white children. Likewise, children with public (vs. private) insurance were less likely to receive standard therapies. Investigating drivers of inequities, and understanding the impact of racism on treatment decisions, are critical next steps to improve care for patients with IS. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Kerri Neville
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan (Michigan Medicine), Ann Arbor, MI
| | - Christina Briscoe Abath
- Department of Child Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Camilo A Gutierrez
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD
| | - Adam L Numis
- Department of Neurology, Division of Epilepsy, University of California San Francisco, San Francisco, CA
| | - Chellamani Harini
- Department of Child Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Zihuai He
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Shaun A Hussain
- Department of Pediatrics, Division of Pediatric Neurology, University of California, Los Angeles, CA
| | - Anne T Berg
- Ann & Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Catherine J Chu
- Department of Neurology, Divisions of Child Neurology and Neurophysiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Tobias Loddenkemper
- Department of Child Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Debopam Samanata
- Division of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, AR
| | - Rani K Singh
- Department of Pediatrics, Atrium Health-Levine Children's, Charlotte, NC
| | - Nilika S Singhal
- Department of Neurology, Division of Epilepsy, University of California San Francisco, San Francisco, CA
| | - Courtney J Wusthoff
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Elaine C Wirrell
- Department of Neurology, Divisions of Epilepsy and Child and Adolescent Neurology, Mayo Clinic, Rochester, MN
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology and Department of Pediatrics, Montefiore Medical Center, NY
| | - Kelly G Knupp
- Department of Pediatrics, New York-Presbyterian Komansky Children's Hospital, Weill Cornell Medicine, New York, NY
| | - Renée A Shellhaas
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan (Michigan Medicine), Ann Arbor, MI
| | - Zachary M Grinspan
- Department of Pediatrics and Neurology, University of Colorado, Aurora, CO.,Department of Healthcare Policy & Research, New York-Presbyterian Komansky Children's Hospital, Weill Cornell Medicine, New York, NY
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Abstract
PURPOSE OF REVIEW Epilepsy is a common, chronic neurologic disease with continued disparities in care. The COVID-19 pandemic and recent social movements have drawn greater attention to social determinants of health and our progress (or lack thereof) toward delivering more equitable care. RECENT FINDINGS Recent studies continue to document racial and economic disparities in diagnosis, treatment, and overall care of epilepsy and associated conditions. Notably, an increasing number of studies are attempting to design healthcare pathways and other interventions to improve access and equity in epilepsy care. SUMMARY The present literature highlights the importance of identifying and addressing the particular needs of vulnerable persons with epilepsy. Practitioners and researchers should continue to develop interventions aimed at improving care for all patients and, crucially, measure the impact of their changes to ensure that any interventions are truly advancing health equity.
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Affiliation(s)
- Leah J Blank
- Department of Neurology Division of Health Outcomes and Knowledge Translation, Department of Population Health Science and Policy, Division of Health Outcomes and Knowledge Translation, New York, New York, USA
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