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Black representation in critical care randomized controlled trials: a meta-epidemiological study
Cheikh Tchouambou Youmbi1,2, Tyler Jordan Gilman1, Ines Carole Ndzana Siani3
1McMaster Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Summary
Black individuals are under-represented in critical care research, impacting study generalizability. Targeted interventions are needed to improve Black representation in randomized controlled trials (RCTs) across US and Canadian sites.
Area of Science:
- Critical care medicine
- Clinical trial methodology
- Health equity research
Background:
- Under-representation of Black people in critical care research limits the generalizability of findings.
- Ensuring diverse participant populations in clinical trials is crucial for equitable healthcare.
- Randomized controlled trials (RCTs) are essential for advancing critical care but may not reflect the diversity of patient populations.
Purpose of the Study:
- To investigate the proportionate representation of Black individuals in high-impact critical care RCTs conducted in the USA and Canada.
- To compare participant demographics in RCTs with city-level population demographics.
- To identify factors influencing Black representation in critical care research.
Main Methods:
- A meta-epidemiologic study of critical care RCTs published between 2016 and 2020.
- Included RCTs enrolling critically ill adults at US or Canadian sites with available race-based demographic data.
- Compared study site demographics with city-based demographics and used meta-regression to analyze heterogeneity.
Main Results:
- 21 eligible RCTs were included in the analysis.
- Black individuals were under-represented by 6% in critical care RCTs compared to city demographics.
- The country of the study site was a significant factor influencing heterogeneity in Black representation (P = 0.02).
Conclusions:
- Black individuals are under-represented in critical care RCTs in both the USA and Canada.
- Interventions are necessary to enhance Black participation in critical care research.
- Further research is required to understand the drivers of this under-representation.
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