Racial representation still lacking in vitiligo clinical trials

Key takeaways:

• The analyzed vitiligo studies included 25.43% non-white and 20.4% Hispanic patients.
• Black, Alaska Native and Native Hawaiian/Pacific Islander patients were significantly underrepresented.

Certain racial groups continue to be underrepresented in vitiligo clinical trials, according to a study.

“Darker-skinned individuals affected by vitiligo may experience more concern and stigma regarding their appearance due to the increased visibility of the condition,” Swathi Holla, MS, of Baylor College of Medicine, and colleagues wrote, explaining that, in addition to race, ethnicity can also be an impacting factor in vitiligo depending on a patient’s cultural practices and assimilation into Western culture. “Given these differences, recruiting racially and ethnically diverse participants who are representative of the United States population is crucial to ensuring the generalizability of vitiligo research.”

Considering prior evidence that has shown a lack of diversity in dermatology clinical trials, the authors set out to evaluate if vitiligo studies are accurately representing the U.S. population.

Of the 15 studies that met inclusion criteria for their retrospective study, only nine reported participants of diverse racial and ethnic backgrounds and just four reported Fitzpatrick skin type. Of the 1,510 participants in these studies, 25.43% were non-white and 20.4% were Hispanic.

The authors stated that these rates still do not accurately reflect the representation in the U.S. According to the 2022 U.S. Census Population Estimates, as used in this study for comparison, the population is 75.5% white, 6.3% Asian, 13.6% Black, 1.3% American Indian/Alaska Native and 0.3% Native Hawaiian/Pacific Islander. Also, those with Hispanic ethnicity represent 19.1%.

The study showed that white individuals were accurately represented in vitiligo trials at 74.57%, whereas Asian individuals were overrepresented at 9.93% and Hispanic participants were well represented at 20.4%.

According to the authors, the representation of Hispanic patients in vitiligo trials may be skewed due to a general underestimate of Hispanic individuals residing in the U.S.

“We found that U.S. vitiligo trials include appropriate representation of Hispanic participants according to the U.S. census, although census numbers may not be accurate due to the undercounting of Hispanics,” they wrote.

On the other hand, Black, Alaska Native and Native Hawaiian/Pacific Islander patients were significantly underrepresented at 6.62%, 0.331% and 0.132%, respectively. According to the authors, reasons for this underrepresentation may be due to a lack of diversity in the dermatology workforce, mistrust in clinical research among these groups and the lack of improvement in cultural competence among researchers.

“Given that the impact of vitiligo varies by demographic group and skin color, investigators must aim to include a more diverse and representative population in future vitiligo clinical trials to allow for better generalizability of results to all affected individuals,” the authors concluded.