Less than one third of articles published in prominent surgical journals in 2019 reported the race or ethnicity of study participants, a new analysis published in JAMA Surgery has found. The frequency of race reporting was the same between journals that said they followed recommendations for quality race reporting and those that did not.
The study confirms what many researchers already thought: in terms of representing the national population in surgery literature, “it seems like we are not doing a very good job,” Richard Maduka, MD, a surgery resident at the Yale School of Medicine in New Haven, Connecticut, and lead author of the study, told Medscape Medical News.
Recommendations from the International Committee of Medical Journal Editors (ICMJE) currently advise authors to describe how they define race/ethnicity as well as explain their relevance in research. “Because the relevance of such variables as age, sex, or ethnicity is not always known at the time of study design, researchers should aim for inclusion of representative populations into all study types and at a minimum provide descriptive data for these and other relevant demographic variables,” the recommendations state.
But despite these recommendations, studies from other specialties have found low reporting of race and ethnicity in published literature. Maduka and colleagues were curious if similar trends were also present in prominent surgery journals, and if studies did report race and ethnicity, whether they followed these ICMJE guidelines.
To find out, the team analyzed studies published from January 1 to December 31, 2019 in the surgery journals JAMA Surgery, Journal of the American College of Surgeons, Annals of Surgery, Surgery, American Journal of Surgery, Journal of Surgical Research (JSR), and Journal of Surgical Education (JSE). The first five listed journals explicitly stated they followed ICMJE guidelines, while at the time of investigation, both JSR and JSE did not. The team excluded nonresearch-focused articles, including editorials and commentaries, as well as review articles, meta-analyses, care reports, and nonhuman studies.
Beyond looking for the frequency of race reporting in these journals, the authors also assessed the quality of race reporting in articles using five criteria:
Authors specified who reported the race/ethnicity of participants.
Authors explained why the specific classification option for race (whether it be race, race/ethnicity, genetic descent, or ancestry) was used.
Authors stated whether the investigator or participant defined the classification option used.
Authors explained why race was assessed.
Authors defined the variable of race.
Of the 2485 eligible studies published in 2019, 808 (32.5%) reported race and ethnicity. Comparatively, other demographic characteristics, such as age and gender, were included in over 80% of analyzed articles. There was no significant difference between race reporting between both ICMJE and non-ICMJE journals (32.8% and 32.0%, respectively), but ICMJE journals met more of the quality criteria.
Overall, 73.1% of articles in ICMJE journals met at least one of the quality criteria, compared with 37.0% of non-ICMJE journals, but just four ICMJE studies satisfied all five of the quality metrics. Non-ICMJE journals at most met three of the five metrics. The findings were published online August 18 in JAMA Surgery.
Maduka was concerned that so few studies — just 18 — defined race in the manuscript. For many studies, “race was reported simply because it was available as a variable in some big database or an EMR. It was just sort of tacked on,” he said, without considering why race should be included and why it was relevant in the study. “As we continue to push towards helping to eliminate healthcare disparities, in particular when it comes to marginalized populations, we also really need to think about how we represent that data and the quality of the data we put out there,” he added.
John Stewart, MD, MBA, a professor of surgery at the Louisiana State University (LSU) New Orleans School of Medicine and director of the LSU Louisiana Children’s Medical Center Cancer Center, said he found the results to be “disappointing, but not surprising,” in an interview with Medscape Medical News. He wrote an invited commentary for the study and was not involved with the research.
While the study highlights that the surgery field needs to increase rates of race reporting in the literature, Stewart thinks future research should go beyond that. Where people live can also have a huge effect on their health, he said, from exposure to toxins as well as external trauma. “Those exposures increase stress hormones that lead to changes in the methylation status of DNA. Hence, it can have a long-term effect on clinical outcomes,” he added. “We have to include race and ethnicity and residential histories when we really begin to understand health inequities.”
Maduka and Stewart have reported no relevant financial relationships.
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