M. Denise Daley, MD
Adjunct Assistant Professor
University of Texas Medical Branch
Houston, Texas
Does Current Pain Research Reflect Our Diverse Population?
Purpose:
As awareness of the effects of sociodemographic factors on health and disease continue to expand, there is growing recognition of the need to increase the diversity of participants in clinical studies. This may be particularly important in the field of pain medicine, given the complex nature of pain, as well as increasing evidence of the role of various sociodemographic factors in the prevalence and severity of pain. This study was conducted to examine the reporting of sociodemographic factors in recently published clinical research studies in the pain medicine literature.
Methods:
This study evaluated original clinical research studies published from January 2022 to June 2022 in two well-known pain medicine journals, Pain Medicine and Pain. All randomized clinical trials (RCTs), nonrandomized trials, and observational studies published during this time period were included. Case reports, case series, review articles, and meta-analyses were excluded. The reporting of these sociodemographic characteristics of study participants was recorded for each study: age, sex, race, ethnicity, income/socioeconomic status, education level, and urban/rural living status.
Results:
A total of 127 studies were evaluated, 46 from Pain Medicine and 81 from Pain. The studies consisted of 30 RCTs and 97 non-RCTs. Six studies (4.7%) specifically focused on diversity-related issues (eg, sex differences, racial disparities, underserved populations). Age and sex were reported in 124 of the 127 studies (97.6%). Overall, the age and sex distributions in each study appeared to reflect the objectives of the specific study.
Race was reported in 39 of the 127 studies (30.7%), and ethnicity was reported in 12 of the 127 studies (9.4%). White was the most common race, accounting for a median of 76.8% of patients (range, 21.4–100%) in each study. Ethnicity was primarily reported as Hispanic/Latino versus non-Hispanic/Latino, with Hispanic/Latino accounting for a median of 7.6% of patients (range, 1.0–26.3%) in each study. For comparison, the United States census figures from 2021 estimated that 75.8% of the population were White and 18.9% were of Hispanic/Latino ethnicity (https://www.census.gov/quickfacts/fact/table/US/RHI825221).
Income/socioeconomic status was reported in 19 of the 127 studies (15.0%). It was usually reported as annual family income, but some studies reported socioeconomic status or economic “hardship.” Education level was reported in 32 of the 114 non-pediatric studies (28.1%), and urban/rural living was reported in 4 of the 127 studies (3.2%).
Conclusion: This study revealed that current clinical studies in the field of pain medicine almost always reported age and sex of study participants, a commendable finding. However, other sociodemographic factors were reported in only 3.2–30.7% of studies. When potentially important sociodemographic information is not provided, it is difficult for clinicians to know whether the results will be applicable for a specific patient. Not surprisingly, there was considerable variation in the percentages of specific races and ethnic groups included in the studies. However, the low median Hispanic/Latino percentage suggests that this ethnic group may be underrepresented in recent clinical studies.
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