Purpose
Hand surgery remains one of the least racially and ethnically diverse subspecialties
in all of medicine, and minority patients demonstrate overall worse health care outcomes
compared with White patients. Our purpose was to determine the frequency of race and
ethnicity reporting in randomized controlled trials (RCTs) published in journals with
an upper-extremity (UE) focus.
Methods
A systematic review was conducted in accordance with Preferred Reporting Items for
Systematic Reviews and Meta-Analyses guidelines by searching EMBASE and MEDLINE for
RCTs contained in peer-reviewed journals with an UE focus. All articles from 2000
to 2021 were included. Information such as article sample size, center type, funding,
and location was recorded. We assessed each article to determine whether demographic
information, including race and ethnicity, was reported for study participants.
Results
A total of 481 RCTs in 9 UE journals were included. For UE RCTs, 96% of studies reported
age, 90% reported sex, and 5% reported either race or ethnicity. Demographic information
about economic status, insurance status, mental health, educational level, and marital
status were each reported in <10% of RCTs. Racial representation was highest for White
participants (80%) and lowest among American Indian participants. Of studies conducted
within the United States, all racial groups except for White patients were underrepresented
compared with census data.
Conclusions
Demographic data related to race and ethnicity for patients involved in UE RCTs are
infrequently reported. When reported, the racial demographics of UE RCT patients do
not match the demographics of the patients in United States. Black patients remain
underrepresented in RCTs.
Clinical relevance
Academic journals mandating the reporting of demographic data related to race may
aid in improved reporting and allow for subsequent aggregation within systematic reviews
to assess outcomes for racial minorities.
Key words
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Article info
Publication history
Published online: January 17, 2023
Accepted:
November 16,
2022
Received:
June 21,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
