Abouzar Nazari, Maede Hoseinnia, Asiyeh Pirzadeh, Arash Salahshouri
The Correlation Among COVID-19 Vaccine Acceptance, the Ability to Detect Fake News, and e-Health Literacy
Health literacy research and practice
lack racial ethnic representation clinical trials may limit generalizability orthopaedic evidence base applies patients underrepresented minority populations perpetuate existing disparities use complications functional outcomes although commentators implied need mandatory race ethnicity reporting across orthopaedic trials usefulness race ethnic reporting likely depends specific topic prior evidence disparities individualized study hypotheses systematic review asked 1 proportion orthopaedic clinical trials report race ethnicity data studies many report data regarding social covariates genomic testing 2 trends associations exist racial ethnic reporting among trials 2000 2020 3 racial ethnic representation united states trial participants compared reported united states census performed systematic review randomized controlled trials human participants published three leading generalinterest orthopaedic journals focus clinical research journal bone joint surgery american volume clinical orthopaedics related research osteoarthritis cartilage searched pubmed embase databases using following inclusion criteria englishlanguage studies human studies randomized controlled trials publication date 2000 2020 published clinical orthopaedics related research journal bone joint surgery american volume osteoarthritis cartilage primary outcome measures included whether studies reported participant race ethnicity social covariates insurance status housing homelessness education literacy transportation income employment food security nutrition genomic testing secondary outcome measure racial ethnic categorical distribution trial participants included studies reporting race ethnicity search 1043 randomized controlled trials 184643 enrolled patients met inclusion criteria among studies 21 223 1043 small 50 sample size 56 581 1043 medium 50 200 sample size 23 239 1043 large 200 sample size fourteen percent 141 1043 based northeast united states 92 96 1043 midwest 47 49 1043 west 72 75 1043 south 65 682 1043 outside united states calculated overall proportion studies meeting inclusion criteria reported race ethnicity among subset studies reporting race ethnicity determined overall rate distribution social covariates genomic testing reporting calculated proportion studies reporting race ethnicity also reported difference outcome race ethnicity calculated proportion studies reporting race ethnicity year study period also calculated proportions 95 cis individual patients racial ethnic category studies meeting inclusion criteria study period 2000 2020 85 89 1043 studies reported race ethnicity trials reporting factor 45 four 89 reported insurance status 15 13 89 reported income 45 four 89 reported housing homelessness 18 16 89 reported education literacy 0 0 89 reported transportation 22 two 89 reported food security nutrition trial participants seventyeight percent 69 89 trials reported social covariates 22 20 89 reported least one however 0 0 89 trials reported genomic testing additionally 56 five 89 trials reported difference outcomes race ethnicity proportion studies reporting race ethnicity increased average 06 annually 95 ci 02 10 p 002 controlling potentially confounding variables funding source found studies increased sample size likely report data race ethnicity location north america overall europe asia australia new zealand compared northeast united states less likely specialtytopic studies compared general orthopaedics research less likely sample united states trials contained 189 white participants reported united states census 95 ci 184 194 p 0001 50 fewer black participants 95 ci 46 53 p 0001 170 fewer hispanic participants 95 ci 168 171 p 0001 53 fewer asian participants 95 ci 52 54 p 0001 75 participants groups 95 ci 72 79 p 0001 reporting race ethnicity data orthopaedic clinical trials low compared medical fields although proportion diseases warranting reporting might lower orthopaedics investigators initiate discussions race ethnicity reporting early stages clinical trial development surveying available published evidence relevant health disparities social determinants warranted genomic risk factors decision include exclude race ethnicity data study protocols based specific hypotheses necessary statistical power appreciation unmeasured confounding future studies evaluate costefficient mechanisms obtaining baseline social covariate data investigate researcher perspectives current administrative workflows decisionmaking algorithms race ethnicity reporting