Representation of Racial and Ethnic Minority Populations in Dementia Prevention Trials: A Systematic Review

Abstract

Despite older racial and ethnic minorities (REMs) being more likely to develop dementia they are underrepresented in clinical trials focused on neurological disorders. Inclusion of REMs in dementia prevention studies is vital to reducing the impact of disparities in dementia risk. We conducted a systematic review to characterize the number of REM enrolled in brain health and prevention randomized controlled trials (RCTs). RTCs published from January 1, 2004 to April 21, 2020 were included. Participants were normal cognitive adults aged 45 years and older who participated in a Phase II or Phase III U.S. based preventative trial. Analyses were performed to examine differences in trial characteristics between RCTs that did and those that did not report race/ethnicity and to calculate the pooled proportion of each racial/ethnic group in randomized brain healthy prevention trials. A total of 42 studies consisting of 100,748 participants were included in the final analyses. A total of 26 (62%) reported some racial/ethnic identity data. The pooled proportion of REM participants was 0.256 (95% CI, 0.191, 0.326). There is a lack of racial/ethnic reporting of participants and REMs remain underrepresented in brain health prevention RCTs.

Study Finds Racism; Causes Black Americans and Asians Brain to Age Faster than of other Races, Increasing Dementia Risk

“…Any arterial disease are also found to be present more commonly in non-Hispanic white (71%) and black American group (71.8%) as compared to the other groups. Ethnic comparison: As per previous studies the results also support the concept except that one study showed Asian group to have high rate of diabetes incidence 45% as compared to that found in our study 34.6% [11][12] . The health care visits of patients were studied and it was found that the highest rate of hospital visits was seen in case of white Americans (82%).…”

Ethnic minority representation in UK COVID-19 trials: systematic review and meta-analysis

“…of trials reporting as “White”, “BAME”, “non-white”, “Other” (no. participants) References Approached for inclusion 0 0 Screened for inclusion 0 7 (60,179) [ 8 , 10 , 13 , 17 , 18 , 23 , 26 ] Eligible for inclusion 0 7 (60,179) [ 8 , 10 , 13 , 17 , 18 , 23 , 26 ] Ineligible for inclusion 0 7 (60,179) [ 8 , 10 , 13 , 17 , 18 , 23 , 26 ] Enrolled in trial 17 (52,747) [ 1 – 4 , 6 , 7 , 12 , 14 – 16 , 19 , 20 , 24 , 25 , 27 – 29 ] 11 (64,722) [ 5 , 8 – 11 , 13 ...…”

“…Like other study types, RCTs also depend upon participation of all groups to improve generalisability and validity of the findings. There is growing concern about the lack of diversity in trials across health and clinical research over the last few years [ 17 – 20 ]. This may stem from anxieties around the implications of participation within ethnic minority communities, added costs of participation (such as travel and parking), language barriers, knowledge gaps and lack of diversity within the research team [ 21 – 24 ].…”

An evaluation of race-based representation among men participating in clinical trials for prostate cancer and erectile dysfunction

“…One recent review of recruitment of minorities and women in oncology trials found a decrease in recruitment of URMs in comparison to historical data [ 13 ]. Despite racial and ethnic minorities having a greater likelihood to develop certain chronic diseases, a recent systematic review found that they still remain underrepresented in clinical trials for such diseases/conditions [ 14 ]. A recent meta-analysis of trial participation among AA patients concluded that the main reasons for unwillingness to participate in trials is caused by: (1) mistrust of the healthcare system, (2) healthcare provider-related barriers, (3) familial influence, (4) socioeconomic status, (5) health literacy limitations, and (6) spirituality.…”