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Neurosurgical Randomized Trials in Low- and Middle-Income Countries.
Dylan P Griswold1,2, Ahsan A Khan3,4, Tiffany E Chao1,5
1Stanford University School of Medicine, Stanford, California.
Neurosurgery
|March 15, 2020
Summary
High-income countries (HICs) dominate neurosurgical trials, with low- and middle-income countries (LMICs) contributing significantly less. Investing in LMIC research capacity is crucial for generating globally relevant evidence.
Area of Science:
- Neurosurgery
- Clinical Trials
- Global Health Equity
Background:
- Generalizability of randomized trial findings depends on the study setting.
- The contribution of low- and middle-income countries (LMICs) to neurosurgical randomized trials remains under-described.
Purpose of the Study:
- To systematically analyze design characteristics, methodology, funding, and interventions in neurosurgical trials led by high-income countries (HICs) versus LMICs.
- To identify disparities in neurosurgical research between HICs and LMICs.
Main Methods:
- Systematic review of English-language neurosurgical trials (>5 patients) published between January 2003 and July 2016.
- Trials were identified from MEDLINE, Scopus, and Cochrane Library, with country income classification based on the World Bank Atlas method.
Main Results:
- HIC-led trials constituted 73.3% of the 397 included studies; LMIC-led trials accounted for 26.7% (71 led by China). Excluding China, LMIC leadership dropped to 8.8%.
- HIC-led trials enrolled more patients (median 92 vs. 65) and involved more sites (median 7.6 vs. 1.8) than LMIC-led trials.
- Spinal neurosurgery was the most common focus in both HIC- (68%) and LMIC-led (71.7%) trials. Over half of LMIC-led trials were institutionally funded.
Conclusions:
- A significant disparity exists in the number of published neurosurgical trials between HICs and LMICs.
- Enhancing research capacity in LMICs is essential for producing high-quality, context-specific evidence.
- Addressing this disparity is crucial for advancing global neurosurgical care and research.
