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Boyd T, Chibueze J, Pester BD, Saini R, Bar N, Edwards RR, Adams MC, Silver JK, Meints SM, Burton-Murray H. Age, Race, Ethnicity, and Sex of Participants in Clinical Trials Focused on Chronic Pain. THE JOURNAL OF PAIN 2024; 25:104511. [PMID: 38492711 PMCID: PMC11283982 DOI: 10.1016/j.jpain.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
There is limited data on equitable inclusion in chronic pain trials. We aimed to 1) identify the frequency of reporting age, race, ethnicity, and sex in clinical trials targeting chronic pain, and 2) compare sociodemographic representation to the United States (US) population. We examined US-based intervention trials for chronic pain initiated between 2007 and 2021 and registered on ClinicalTrials.gov. We 1) assessed the frequency of reporting each demographic variable, 2) compared representation with US population estimates, and 3) explored change in reporting over time. Of 501 clinical trials, the frequency of reporting was as follows: 36.9% reported older adults, 54.3% reported race, 37.4% reported ethnicity, and 100% reported sex. Rates of race and ethnicity reporting increased, but older adult age reporting decreased over time (ps < .00001). Compared to 2020 US population estimates, there was an equitable representation of older adults, under-representation of individuals identifying as American Indian or Alaska Native (.8% vs .6%), Asian (5.6% vs 2.9%), Black or African American (12.6% vs 12.2%), with more than one race (2.9% vs 1.2%), and Hispanic/Latino (16.9% vs 14.1%). There was an over-representation of individuals identifying as Native Hawaiian or Pacific Islander (.2% vs .5%) or White (70.4% vs 72.9%), and of females (50.8% vs 68.4%). Some representation rates varied by chronic pain condition. Reporting of older adult age, race, and ethnicity was low in chronic pain trials in ClinicalTrials.gov, reinforcing the need for adhering to reporting guidelines. Representation varied across trials compared with US population data, particularly among those identifying as Hispanic/Latino and certain minority racial groups. PERSPECTIVE: Despite initiatives to increase the reporting of demographic information, doing so in clinical pain trials is far from ubiquitous. Moreover, efforts to improve diversity in these trials continue to be insufficient. Indeed, Black, Indigenous, and People of Color (BIPOC) remain under-represented in clinical pain trials.
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Affiliation(s)
- Taylor Boyd
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
| | - Joseph Chibueze
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114
- Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, PA, 19140
| | - Bethany D. Pester
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
- Brigham and Women’s Hospital, 850 Boylston St, Chestnut Hill, MA, 02467
| | - Rhea Saini
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114
| | - Nir Bar
- Gastroenterology and Hepatology Department, Tel Aviv Medical center, Tel Aviv, Israel, 6423906
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 69978
| | - Robert R. Edwards
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
- Brigham and Women’s Hospital, 850 Boylston St, Chestnut Hill, MA, 02467
| | - Meredith C.B. Adams
- Department of Anesthesiology, Biomedical Informatics, Physiology & Pharmacology, and Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC, 27101
| | - Julie K. Silver
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
- Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA, 02129
| | - Samantha M. Meints
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
- Brigham and Women’s Hospital, 850 Boylston St, Chestnut Hill, MA, 02467
| | - Helen Burton-Murray
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
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Jiang TE, Edwards KA, Dildine TC, You DS, Nguyen T, Pascual AP, Falasinnu T. Trends in Patient Representation in Low Back Pain Pharmacological Randomized Clinical Trials, 2011 to 2020: A Systematic Review. THE JOURNAL OF PAIN 2024; 25:104456. [PMID: 38185211 PMCID: PMC11128353 DOI: 10.1016/j.jpain.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/17/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
Low back pain (LBP) significantly affects global health, with associated detrimental outcomes such as physical impairment, emotional distress, and exacerbated mental health symptoms. This study evaluated the representation of marginalized groups, including racialized, gender minority, pregnant/lactating, and elderly individuals in randomized controlled trials for pharmacological interventions treating LBP from 2011 to 2020. We searched Embase, MEDLINE, and CINAHL in December 2021, and 139 studies were eligible. Most trials (n = 113, 81%) reported participant sex; however, no study collected data on sexual and gender minorities, and the majority (n = 99, 71%) excluded pregnant/lactating individuals. Most trials (n = 105, 76%) reported no data on participant race or ethnicity. We limited within-country analyses of race and ethnicity to US-based trials because US-based trials were more likely to report race and/or ethnicity (48%) compared to non-US-based trials (8%). Black participants were the only racialized group whose composition was comparable to US Census estimates. About half (n = 73, 53%) of all trials had an upper age limit for eligibility (range: 40-85 years old) and 24% (n = 33) excluded adults aged >65 years. Our findings confirm that trials for pharmacological LBP interventions underreport demographic data, and the trials that include this data have unrepresentative samples. There is an urgent need for more inclusive and representative patient samples to ensure generalizability and equitable benefits. Standardizing demographic data reporting and integrating community-based participatory research methods can help foster inclusive research practices. This review was registered with prospective register of systematic reviews (PROSPERO), ID 296017. PERSPECTIVE: This systematic review investigates patient representation in pharmacological-based clinical trials for low back pain, LBP, the most prevalent pain condition worldwide. Improvements in reporting demographic data and recruiting diverse participant populations-across different racialized, gender and sexual minority, and age groups-will help clinical research generalizability and provide equitable benefits.
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Affiliation(s)
- Tiffany E Jiang
- Department of Epidemiology and Population Sciences, Stanford University School of Medicine, Stanford, California; Yale School of Medicine, New Haven, Connecticut
| | - Karlyn A Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California; The Center for Research on Health Care, University of Pittsburgh Division of General Internal Medicine, Pittsburgh, Pennsylvania
| | - Troy C Dildine
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Dokyoung S You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Thy Nguyen
- Department of Epidemiology and Population Sciences, Stanford University School of Medicine, Stanford, California
| | - Alissa P Pascual
- Department of Human Biology, Stanford University, Stanford, California
| | - Titilola Falasinnu
- Department of Epidemiology and Population Sciences, Stanford University School of Medicine, Stanford, California; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Booker SQ, Merriwether EN, Powell-Roach K, Jackson S. From stepping stones to scaling mountains: overcoming racialized disparities in pain management. Pain Manag 2024; 14:5-12. [PMID: 38193345 PMCID: PMC10825727 DOI: 10.2217/pmt-2023-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Staja Q Booker
- Department of Biobehavioral Nursing Science, University of Florida, College of Nursing, PO Box 100197, Gainesville, FL 32610, USA
| | - Ericka N Merriwether
- Department of Physical Therapy, New York University, NYU Steinhardt School of Culture, Education, & Human Development, NY 10010, USA
- Department of Medicine, NYU Grossman School of Medicine, NY 10010, USA
| | - Keesha Powell-Roach
- Department of Community & Population Health, University of Tennessee, Health Science Center, College of Nursing, College of Medicine, Genetics, Genomics & Informatics, Memphis, TN 38103, USA
| | - Simone Jackson
- Department of Biobehavioral Nursing Science, University of Florida, College of Nursing, PO Box 100197, Gainesville, FL 32610, USA
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