Rheumatoid arthritis trials often fail to report health inequities
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Randomized controlled trials for rheumatoid arthritis in Canada often fail to report determinants of health inequity among their participants, according to data published in Arthritis Care & Research.
“We know that rheumatoid arthritis affects people of many different backgrounds and with different life circumstances,” Megan Thomas, MSc, a PhD student at the University of British Columbia, and Mary De Vera, PhD, an associate professor at the University of British Columbia and research scientist at Arthritis Research Canada, told Healio in a joint statement. “Given the importance of research in informing care for rheumatoid arthritis, we sought to answer whether the diversity that is seen in real world clinical settings is reflected in research settings.”
To examine how health equity factors are reported in randomized clinical trials for RA interventions in Canada, Thomas, De Vera and colleagues conducted a scoping review. The researchers included English-language randomized, controlled trials that evaluated interventions among patients with RA conducted in Canada and published between 1990 and 2021. Studies were retrieved from the MEDLINE, Embase and CENTRAL databases.
Every potential study was screened manually in two stages. The first stage evaluated the title and abstract, followed by a review of the full text. The authors reported that they paid close attention to PROGRESS-Plus factors being reported in the text. Those factors included place of residence, race, culture, ethnicity, language, occupation, gender, sex, religion, education, socioeconomic status, social capital, characteristics associated with discrimination, features of relationships and time-dependent relationships.
The search resulted in 6,290 unique records, of which 42 were eligible for inclusion in the analysis. Participants in these studies were mostly “middle-aged,” female and white, the authors wrote. Overall, sex and age were the most widely reported factors, appearing in 41 studies. Race was reported in 15 papers, education in 11 papers, socioeconomic status in seven studies and occupation in six studies, according to the researchers. Religion, features of relationships and time-dependent relationships were not reported in any of the included studies.
“While many rheumatologists recognize that a patient’s life circumstances play a significant role in their health outcomes, often patient characteristics are not represented in Canadian RCTs for rheumatoid arthritis, so this needs to be considered carefully when making recommendations for care,” Thomas and De Vera said. “There is more work to be done, but this was a first step to document how equity factors are currently reported for RCTs among rheumatoid arthritis patients in Canada.
“We are currently conducting similar scoping reviews for other types of inflammatory arthritis, as representation of different conditions are important in rheumatology research,” they added. “Ultimately, this work will guide how we approach conducting rheumatology research to ensure representation and diversity.”
Perspective
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Although this study took place in the Canadian health system, the United States experiences similar problems. There are many reasons people of color are under-represented in studies. These include access, as well as fear of studies considering past abuses in trials, such as in the Tuskegee Syphilis Study. This does an injustice, as at times medications have been deemed ineffective in a population due to a projection based on a low representation, only for effectiveness to be found in real world data and further study. It is crucial that, when we are doing studies on disease state and/or treatment, a true representation of the impacted population is included in order to obtain accurate information. This would help improve equity and quality care for our patients.
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