COVID-19 exposes health inequities, underscores the need for more inclusivity in research
As evidence mounts that COVID-19 disproportionately claims the lives of people from minority communities, particularly African Americans, researchers say it is time to correct the traditional underrepresentation of these groups in research studies.
In a recent paper in The Lancet researchers at Emory University and the Universities of Aberdeen, Cambridge and Leicester in the United Kingdom said investigators must factor in participants' ethnicities when designing and reporting research including clinical trials, just as they do with age and gender.
Previous studies have shown that racial and ethnic minorities in the United States are inadequately represented in many research projects despite a higher likelihood of their being affected by the conditions being studied. Researchers say the same appears to be true for the new coronavirus and point out that of the approximately 1,500 COVID-19 studies registered on the National Institutes of Health-run clinicaltrials.gov, only a handful currently report collecting data on ethnicity.
National data shows that COVID-19 deaths among African-Americans are nearly two or more times greater than would be expected based on their share of the population. Similarly, there is a disproportionately higher incidence of coronavirus cases among Hispanics and Latinx. In the UK, more than a third of patients critically ill with COVID-19 were from racial and ethnic minority groups.
Dr. K.M. Venkat Narayan of Emory's Rollins School of Public Health, a co-author on the Lancet paper, says COVID-19 has focused attention on racial health inequities in the U.S. and elsewhere. "We need to fix this problem, and one of the ways to do that is to ensure that racial and ethnic minorities, and underserved populations are actively included in research studies."
The researchers point out that recruitment strategies that work for the majority population may be ineffective for minority communities unless it's customized. The paper notes that some of the barriers to participation in research include language challenges, low awareness or mistrust of the value of research among ethnic minorities, poor engagement from researchers, and general inaccessibility to research in impoverished and remote areas.
Another recently published paper in the Annals of Epidemiology, led by Rollins researchers, looked at county-level health outcomes in the U.S., and found that counties with disproportionately higher African-American populations accounted for 22 percent of all counties but contributed 58 percent of COVID-19 deaths nationwide. A majority of these counties were located in the American South.
Shaun Treweek et al. COVID-19 and ethnicity: who will research results apply to?, The Lancet (2020). DOI: 10.1016/S0140-6736(20)31380-5