ARDS Studies in Critical Care Journals: How Representative Are the Patients Studied?

Purpose: Implicit bias in medicine is widespread, with minority populations historically underrepresented in research. Studies have shown racial and ethnic disparities in patient outcomes, including in acute respiratory distress syndrome (ARDS). This study examines the representation of minority patients in ARDS research in the USA. Methods: We examined the 1000 most cited ARDS studies from 2011 to 2021 in the top five critical care journals: AJRC, CHEST, Critical Care, CCM, and ICM. Results: 211 met the inclusion criteria, with 90 providing racial and ethnic demographic information for analysis. These included 17 in AJRC, 36 in CCM, 18 in CHEST, 11 in CC, and 8 in ICM. The average number of citations was 53 (±63). Publications peaked from 2015 to 2017 (15/year), while 2021 had the fewest. The mean patient count was 15,168, including 42 prospective, 29 randomized controlled, and 19 retrospective studies. Eighty-eight studies reported an average patient age of 53 years (±6), and 72% (±15%) of patients were White. Thirty-five studies reported only White patient demographics, while 53 included Black patients, 29 discussed Hispanic patients, 21 mentioned Asian patients. Most studies reported an average of 43% female participants, with no correlations found regarding White patient numbers, publication year, citations, or journals. Conclusion: A substantial number of highly cited studies about ARDS published in prominent critical care journals did not have detailed information regarding the racial composition of the patient population, and a large majority included overwhelmingly White patients and a preponderance of male gender patients.