Dermatological clinical trials lack racial, ethnic diversity
Click Here to Manage Email Alerts
Key takeaways:
- Those who were Black, American Indian/Alaskan Native and two or more races were underrepresented in dermatological trials.
- Black individuals were underrepresented regardless of higher rates of disease.
Individuals with skin of color were underrepresented in dermatological clinical trials, with those who were Black or African American being most underrepresented regardless of disease prevalence, according to a study.
In a statement to Healio, study authors Jessica Mineroff, BS, Julie K. Nguyen, MD, and Jared Jagdeo, MD, MS, said representation in clinical trials is critical to providing high quality care to patients from all backgrounds.
“Skin conditions often present differently in patients with varied racial and ethnic backgrounds,” the authors continued. “Racial and ethnic differences can also impact how patients respond to treatments.”
Mineroff, of the department of dermatology at The State University of New York (SUNY), Downstate Health Sciences University, and Nguyen and Jagdeo, also of SUNY as well as the dermatology service at Veterans Affairs New York Harbor Healthcare System, conducted a study evaluating the representation of historically underrepresented groups in dermatology clinical trials.
The study used data from 246 trials conducted from 2017 to 2021. All trials fell between phase 1 through phase 4, were completed and had available results.
Results showed that 87.4% of the trials reported racial data, 61.8% reported ethnic data and 5.3% reported Fitzpatrick skin type.
The researchers compared representation estimates from U.S. Census data with the patient percentage across the 215 included studies. They found that Black/African American (13.6% vs. 7.9%), American Indian/Alaskan Native (1.3% vs. 1.1%) and individuals who identified as two or more races (2.9% vs. 1%) were underrepresented in clinical trials, whereas white (75.8% vs. 78.5%) and Asian (6.1% vs. 8.7%) races were overrepresented. In contrast, Native Hawaiian and Pacific Islander individuals were accurately represented.
Additionally, those who were of Hispanic or Latino ethnicities were also underrepresented when comparing U.S. Census population data with the 152 trials that included ethnicity information (18.9% vs. 14.1%).
Of the studies that included racial diversity, only 21.9% included representation of Black individuals that was equal to or greater than U.S. Census population data. Furthermore, the study found that Black individuals were underrepresented in areas where they experienced higher rates of disease, such as in studies including acne (12.6%), atopic dermatitis (11.6%), alopecia (7.9%) and certain types of human papillomavirus infections (6.8%).
Compared with their rate of prevalence, Black individuals were also underrepresented in psoriasis (2.9%), rosacea (0.6%) and cosmetic indications (8.1%).
While the low representation of Black individuals among melanoma and nonmelanoma skin cancer trials is due to the fact that white individuals experience much higher rates of skin cancer, according to the researchers, Black individuals tend to be diagnosed at a later stage with lower survival rates. Therefore, the authors emphasized that representation is still heavily important in this area.
Study limitations included the decreased number of clinical trials during the COVID-19 pandemic, according to the researchers.
“Dermatology clinical trials may still lack adequate representation of racial and ethnic minority patients,” Mineroff, Nguyen and Jagdeo told Healio. “Clinicians can make greater efforts to enroll their racial and ethnic minority patients in clinical trials to help achieve diversity, inclusion and equity in dermatology clinical trials.”