Racial Representation Research Articles

Abstract 4137516: Disparities in Participation: Analyzing Age, Sex, Race, and Ethnicity in Atrial Fibrillation Clinical Trials in the United States

Introduction: Atrial fibrillation (AF) is a prevalent cardiovascular disease that significantly impacts public health in the United States. Although numerous clinical trials aim to optimize AF management, concerns about demographic disparities in trial participation persist. This study assesses the representation of age, sex, race, and ethnicity among participants in AF trials conducted in the US, highlighting potential biases that could affect the generalizability of trial outcomes. Methods: An extensive review of clinical trials registered on ClinicalTrials.gov involving patients with AF up to April 2024 was performed. The search was filtered to include all completed interventional trials across phases 2 to 4 without restrictions on the initiation or completion dates. Data were extracted concerning mean age, age distribution, sex, and the racial and ethnic composition of the trial participants. Results: From the 173 trials analyzed, a total of 1,355,239 participants were included, with an average age of 64.7 years. The demographic breakdown revealed a participant pool consisting predominantly of older adults (>65 years: 70.8%), with a significant underrepresentation of the younger age group (18-65 years: 29.2%). Males constituted 65.2% of the trial population, highlighting a gender imbalance. Racially, 74.1% of participants were White, while African Americans (7.7%) and Asians (5.9%) and other racial groups were notably underrepresented. Ethnic disparities were also evident, with Hispanic participants making up only 11.5% of the study population. Conclusion: The findings demonstrate significant disparities in the age, sex, race, and ethnic backgrounds of AF clinical trial participants in the US. These imbalances could potentially limit the applicability of trial results across the broader, diverse population. Efforts to enhance the diversity of clinical trial cohorts are essential to ensure more equitable health outcomes and the universal applicability of clinical research findings. Future strategies should focus on targeted recruitment and inclusive study designs to address these disparities.

The unspoken experiences of systemic supervisors of color: A modified Delphi study.

Despite collective conversations about the need for more racial diversity, the field of couple/marriage and family therapy (C/MFT) continues to be occupied predominantly by White individuals. Within the C/MFT literature, several scholar-practitioners have highlighted what the lack of racial representation means for our profession and, more importantly, our clients. C/MFT scholars have also shed light on the distinctive experiences of racially minoritized students and therapists traversing a racially homogeneous discipline. However, a smaller, and often overlooked, demographic in these conversations is supervisors of color. This modified Delphi study enlisted the expert perspectives of eight supervisors of color who each have at least a decade of supervisory experience. Consensus among the panelists emphasized the unique, but often inadequate training needs for supervisors of color and the sociocultural factors that often affect the supervisory relationship. This study provides implications that are critical to fostering the professional development of systemic supervisors of color.

Disney in Black and White: An Analysis of Race Representation Within Disney Animated Films From 1937 to 2021

This study examined Disney studios’ portrayals of race as it relates to the physical, mental, and social characteristics of major characters ( N = 319) within Disney animated films released from 1937 to 2021 ( N = 59). Findings revealed most of the characters featured were portrayed as White (68.3%) whereas BIPOC characters made up 31.7% of the total. Results suggest that BIPOC characters were significantly more likely to be featured in supporting character roles, with White characters featured in both the protagonist and antagonist roles. We further observed a limited integration of characters of varying races in a singular film.

Reflecting sex, social class and race inequalities in reproduction? Study of the gender representations conveyed by 38 fertility centre websites in 8 European countries

BackgroundFertility centre websites are a key sources of information on medically assisted reproduction (MAR) for both infertile people and the general public. As part of a global fertility market, they are also a window to attract potential future patients. They give formal and practical information but in the way the information is displayed, they also convey social representations, and in particular, gender representation in its intersectional dimension. The objective is to analyse the sex, class and race representations regarding reproduction and parenthood that are embedded in the content of fertility centre websites in eight European countries.MethodsThe 5 most visible fertility centres that appeared in the first places on Internet search were selected for each country under study, except for one country which has only three fertility centres. In total, 38 fertility centre websites were considered for a thematic analysis using an iterative approach and a comprehensive perspective.ResultsEach centre details its services and techniques according to the legal provisions in force in its country. However, on all the websites studied, the fertility centres demonstrate a strong gendered representation. The logos generally depict women or parts of their bodies, as do the photos, which mainly show white women with light eyes. The description of the causes of infertility and the techniques offered by the centres also highlights gender differences. Sperm donation, where MAR is reserved for heterosexual couples, is included among the techniques for women with the comment that it will enable them to fulfil their dream of becoming mothers.ConclusionsMAR, and through it the project of having a child and procreative work, is presented as a matter for white, cisgender and heterosexual women, thus fueling stratified reproduction and limiting reproductive justice. The research team formulated guidelines for fertility centres to encourage them to adopt a more inclusive approach in terms of sex, social class and race, so that the diversity of infertile people feel involved and welcome in these centres, to avoid misperceptions about infertility in the general population and to reinforce autonomy and justice in reproductive matters.

S1251 Clinical Trial Characteristics of Inflammatory Bowel Disease Trials Influencing Reporting and Representation of Race and Ethnicity on ClinicalTrials.gov

S1251 Clinical Trial Characteristics of Inflammatory Bowel Disease Trials Influencing Reporting and Representation of Race and Ethnicity on ClinicalTrials.gov

Racial representation in multicenter clinical trials leading to drug approvals for gynecological cancer indications by the US Food and Drug Administration (FDA).

66 Background: Enrollment disparities in gynecologic (Gyn) cancer clinical trials in the United States (US) are well-documented. However, there is limited data evaluating how recruitment sites in international clinical trials contribute to racial representation, specifically in Gyn cancers. Here, we examined racial enrollment and geographic location in clinical trials that have led to approval for Gyn cancer applications. Methods: Agents approved by the FDA for Gyn cancer treatment and corresponding clinical trials were identified from the FDA Drug Approvals and Databases. Enrollment data were abstracted from ClinicalTrials.gov then cross-checked with published manuscripts and FDA labels. Using Gyn disease site prevalence from the 2021 SEER database, we calculated expected enrollment proportions by race and compared these to actual clinical trial enrollment data. The binomial test was used to compare expected vs. observed proportions with White patients as the reference group. Results: From 2014 to 2024, 9 drugs received 22 FDA approvals for ovarian (n=13), endometrial (n=4), or cervical cancer (n=5). These approvals were based on 28 clinical trials enrolling a total of 13,763 patients (75.7% White, 3.4% Black, 12.0% Asian, 8.9% Other/Unknown). These trials included 1 (3.6%) US only study, 3 (10.7%) non-US, primarily Europe-based studies (PAOLA-1, AURELIA, STUDY42 [Europe + Australia]), and 24 (85.7%) international studies across the US and 46 other countries. Considering the distribution of race (White: 86.3%, Black: 8.4%, Asian: 4.9%) of Gyn cancers in the US, Black patients had lower enrollment (45% of expected enrollment) vs. White patients (95% of expected enrollment, P<0.0001). African countries were rarely included among the recruitment sites. Two international trials reported patient recruitment from South Africa (3.2% Black, 6/188 patients, 38% of expected enrollment).However, Asian patients had higher enrollment (269% of expected enrollment, P<0.0001) compared to White patients. In 13 trials that included study sites in East Asia, Asian patients comprised 16% of the trial population (1310/8205 patients; 327% of expected enrollment) vs. 3.2% in trials that did not open in Asia (n=15) (181/5558 patients; 67% of expected enrollment). Conclusions: Black patients were underrepresented in pivotal trials that led to FDA approvals for Gyn cancers. Overrepresentation of Asian patients was likely due to international enrollment from East Asia. Post-marketing retrospective studies or additional studies focused on underrepresented groups are needed to assess true drug efficacy and safety in US populations that are disproportionately affected by Gyn cancer mortality.

Parent perceptions of various treatment approaches for PANS and PANDAS

Pediatric autoimmune neuropsychiatric disorder (PANDAS) is characterized by sudden, dramatic onset obsessive-compulsive disorder (OCD) following a Group A Streptococcus infection. Pediatric acute neuropsychiatric syndrome (PANS) refers to sudden, dramatic onset OCD and/or restricted eating triggered by infections and other inflammatory reactions. A variety of treatments have been utilized for PANS/PANDAS; however, there is no “gold standard” intervention protocol. Parental expectations of a given treatment have been found to improve a child's overall treatment experience; however, parent attitudes towards PANS/PANDAS treatments are unknown, which was the purpose of this study. An online survey was distributed to 208 parents of children with self-reported PANS/PANDAS. Treatments were grouped together within overarching categories (i.e., psychotherapy, psychiatric/psychotropic, inflammation/infection mitigation, supplements, lifestyle changes, and surgery). Categorically, parents rated inflammation/infection mitigation interventions and lifestyle changes as most appropriate, and psychiatric/psychotropic interventions as least appropriate. At the individual level, treatments including antibiotics, non-steroidal anti-inflammatory drugs, intravenous immunoglobulin, and family counseling received ratings between “appropriate” and “extremely appropriate” Alternatively, treatments including deep brain stimulation, transcranial magnetic stimulation, antidepressant medications, and exposure and response prevention received ratings between “inappropriate” and “extremely inappropriate.” Study limitations include a lack of gender and race representation in our sample. Findings indicate a need for dissemination of current, relevant research to the parent population as well as further examination of the parent experience throughout onset, diagnosis, and treatment.

Evaluating the Performance and Bias of Natural Language Processing Tools in Labeling Chest Radiograph Reports.

Background Natural language processing (NLP) is commonly used to annotate radiology datasets for training deep learning (DL) models. However, the accuracy and potential biases of these NLP methods have not been thoroughly investigated, particularly across different demographic groups. Purpose To evaluate the accuracy and demographic bias of four NLP radiology report labeling tools on two chest radiograph datasets. Materials and Methods This retrospective study, performed between April 2022 and April 2024, evaluated chest radiograph report labeling using four NLP tools (CheXpert [rule-based], RadReportAnnotator [RRA; DL-based], OpenAI's GPT-4 [DL-based], cTAKES [hybrid]) on a subset of the Medical Information Mart for Intensive Care (MIMIC) chest radiograph dataset balanced for representation of age, sex, and race and ethnicity (n = 692) and the entire Indiana University (IU) chest radiograph dataset (n = 3665). Three board-certified radiologists annotated the chest radiograph reports for 14 thoracic disease labels. NLP tool performance was evaluated using several metrics, including accuracy and error rate. Bias was evaluated by comparing performance between demographic subgroups using the Pearson χ2 test. Results The IU dataset included 3665 patients (mean age, 49.7 years ± 17 [SD]; 1963 female), while the MIMIC dataset included 692 patients (mean age, 54.1 years ± 23.1; 357 female). All four NLP tools demonstrated high accuracy across findings in the IU and MIMIC datasets, as follows: CheXpert (92.6% [47 516 of 51 310], 90.2% [8742 of 9688]), RRA (82.9% [19 746 of 23 829], 92.2% [2870 of 3114]), GPT-4 (94.3% [45 586 of 48 342], 91.6% [6721 of 7336]), and cTAKES (84.7% [43 436 of 51 310], 88.7% [8597 of 9688]). RRA and cTAKES had higher accuracy (P < .001) on the MIMIC dataset, while CheXpert and GPT-4 had higher accuracy on the IU dataset. Differences (P < .001) in error rates were observed across age groups for all NLP tools except RRA on the MIMIC dataset, with the highest error rates for CheXpert, RRA, and cTAKES in patients older than 80 years (mean, 15.8% ± 5.0) and the highest error rate for GPT-4 in patients 60-80 years of age (8.3%). Conclusion Although commonly used NLP tools for chest radiograph report annotation are accurate when evaluating reports in aggregate, demographic subanalyses showed significant bias, with poorer performance in older patients. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Cai in this issue.

Disparities in the Representation of Sex, Race and Ethnicity in Tension-Type Headache Clinical Trials.

While tension-type headache (TTH) is the most common primary headache disorder, its effect according to sex, race and ethnicity remains unclear. We investigated disparities in sex, racial and ethnic representation in TTH clinical trials with comparison to global disease burdens. In this cross-sectional analysis, TTH clinical trials had female overrepresentation and racial and ethnic minority underrepresentation, which may affect understanding of the impact of TTH on different populations and personalized treatment development. Trial enrollment that is diverse and reflective of global disease burdens is crucial for improving study generalizability, understanding of diverse clinical presentations, and ensuring healthcare equity.

Diverse Face Images (DFI): Validated for racial representation and eye gaze.

Face processing is a central component of human communication and social engagement. The present investigation introduces a set of racially and ethnically inclusive faces created for researchers interested in perceptual and socio-cognitive processes linked to human faces. The Diverse Face Images (DFI) stimulus set includes high-quality still images of female faces that are racially and ethnically representative, include multiple images of direct and indirect gaze for each model and control for low-level perceptual variance between images. The DFI stimuli will support researchers interested in studying face processing throughout the lifespan as well as other questions that require a diversity of faces or gazes. This report includes a detailed description of stimuli development and norming data for each model. Adults completed a questionnaire rating each image in the DFI stimuli set on three major qualities relevant to face processing: (1) strength of race/ethnicity group associations, (2) strength of eye gaze orientation, and (3) strength of emotion expression. These validation data highlight the presence of rater variability within and between individual model images as well as within and between race and ethnicity groups.

The Impact of the 2020 BLM Resurgence on the Racial Representations of Ads and Ad Evaluations: Analysis of Super Bowl Ads

Using ads from four Super Bowl broadcasts (2019–2022), we examined the impacts of the 2020 Black Lives Matter (BLM) resurgence on the ad representations of diverse racial groups and the evaluations of ads featuring Black models. Findings show increases in quantitative representations (number and duration) for Black ad models, but this improvement was not linked to qualitative representations (portrayal, prominent role, and hierarchy status). Findings also show the limited influence of the 2020 BLM resurgence on evaluations of advertisements featuring Black models. We also examined how the impact of the 2020 BLM resurgence on advertising shifted from 2021 to 2022.

Promoting Multicultural Learning: An Investigation of Race Representation in Turkish Secondary School EFL Coursebooks

Promoting Multicultural Learning: An Investigation of Race Representation in Turkish Secondary School EFL Coursebooks

Rethinking gendered anti-Muslim racism in a relational matrix of race and gender

Gendered ideas of Muslims and Islam are one of the central organising principles of anti-Muslim racism. However, discussions around gendered anti-Muslim racism often ignore ‘Muslim men’ as a gendered category despite ideas about ‘Muslim women’ being constructed in direct relation to (often implicitly assumed presence of) their male counterparts. As problematised by Alimahomed-Wilson (2020), historical anti-Muslim racist representations of Muslim men as violent and oppressive have not been often considered in these gendered perspectives, but instead treated as a ‘gender-neutral’ facet of anti-Muslim racism. Developing on previous works, our research findings highlight that anti-Muslim racism is inherently gendered, not only because women are disproportionately targeted in Islamophobic attacks but because of its gendered essence. Informed by feminist scholars, our understanding of gender is a relational matrix between men and women upon which we elaborate this gendered foundation of anti-Muslim racism. Anti-Muslim racist ideologies are premised on myths and stereotypical ideas which claim that: 1) Islam is an inherently misogynistic religion; 2) ‘Muslim men’ are therefore inherently violent and oppressive, primarily towards Muslim women, but also backwards and unable to govern themselves or their communities and, as such, are in need of correction or control (Abu-Lughod, 2013; Farris, 2017; Kumar, 2012; inter alia). In this article, building on the previous analyses of the gendered aspect of anti-Muslim racism and our research findings based on fieldwork with Muslim communities in Ireland (n = 193), we argue that anti-Muslim racism is gendered not only because it affects women more, but also because: 1) its underlying gendered racial ideology constructs Muslim women as the passive Other of assumed ‘violent Muslim masculinity’; 2) ‘Western liberal’ anti-Muslim discourses, claiming to be vying for the liberation of all women, assume it as their ‘duty’ to save ‘Muslim women’; 3) with ‘white feminism’ often providing the moral ground for this saviour image, ignoring Muslim women's emancipatory agency and politics.

Racial and Socioeconomic Disparities in Pediatric Asthma Emergency Care

The aim of this paper is to build a model to compare the relative impact of race and ethnicity and insurance type on pediatric Emergency Department utilization for asthma. A binary logistic regression model using relevant variables from 2022 NHIS survey data was conducted to compare asthma ED visit odds ratios of racial and ethnic minorities and publicly insured children. The results suggest that insurance type has slightly greater influence over asthma ED visits than race and ethnicity. Publicly insured children had the highest unadjusted odds ratio (1.88 [CI 95% 1.09-3.24)]) followed by Non-Hispanic Black children (1.80 [0.92-3.52]) and Hispanic children (1.51 [0.80-2.86]). The data are possibly biased toward exclusion of well-controlled asthmatics that may affect the resulting odds ratios. More socioeconomic variables would provide a more complete analysis. The paper has direct implications for health service providers and policymakers. Providers are encouraged to provide equitable, culturally competent care to asthmatics and policymakers are encouraged to embrace policies that promote better access for Medicaid beneficiaries, improved air quality and housing conditions for low-income children, and better racial representation in the provider workforce. The paper collates many existing sources of research on asthma disparities as a backdrop for examination of recent survey data pertaining to differences in asthma ED utilization between populations. It supports existing theories and work being done to mitigate poor asthma outcomes in children that are exacerbated by biological and systemic factors.

A Decolonial Analysis of the Representation of Race and Ethnicity in Management Textbooks

A Decolonial Analysis of the Representation of Race and Ethnicity in Management Textbooks

Impact of racial representation in curriculum content on student identity and performance

Impact of racial representation in curriculum content on student identity and performance

Enrollment of underserved racial and ethnic populations in pediatric asthma clinical trials

BackgroundLimited data exist on enrollment trends of historically underserved racial and ethnic children in clinical trials. ObjectiveWe sought to evaluate documentation and representation of race and ethnicity in pediatric asthma clinical trials in the US. MethodsThis is a cross-sectional study of US-based interventional trials studying pediatric asthma completed between 2008 and 2022 and registered on ClinicalTrials.gov. Enrollment disparities were assessed using the enrollment prevalence difference (EPD) measure – the median difference between the proportion of participants enrolled and asthma prevalence in the US population by race and ethnicity. ResultsOf the 67 trials reviewed, 53 (79.2%) and 36 (53.7%) reported on race and ethnicity in ClinicalTrials.gov, respectively. Most participants were White (39.1%), Black (37.1%), and non-Hispanic (66.1%). Black, Hispanic, Multiracial, and White children were enrolled in expected proportions based on their contribution to asthma burden. However, American Indian or Alaska Native (AI/AN) (EPD: -1, 95% CI: -1, -1) and Asian children (EPD: -3, 95% CI: -3, -3) were underrepresented, relative to disease burden in these respective groups. Fewer Black children were enrolled in drug or device trials (β=-0.80; 95% CI -1.60, -0.01) than in other trials. Fewer Hispanic children were enrolled in early phase than late phase trials (β=-2.42; 95% CI -3.66, -1.19). ConclusionsEnrollment in pediatric asthma trials conducted in the US was commensurate with the demographics of children affected by asthma for most racial and ethnic groups, but AI/AN and Asian children were underrepresented. Concerted efforts are needed to promote inclusion of these underserved groups in future trials.

Failure to progress: breast and prostate cancer cell lines in developing targeted therapies.

Developing anticancer drugs from preclinical to clinical takes approximately a decade in a cutting-edge biomedical lab and still 97% of most fail at clinical trials. Cell line usage is critical in expediting the advancement of anticancer therapies. Yet developing appropriate cell lines has been challenging and overcoming these obstacles whilst implementing a systematic approach of utilizing 3D models that recapitulate the tumour microenvironment is prudent. Using a robust and continuous supply of cell lines representing all ethnic groups from all locales is necessary to capture the evolving tumour landscape in culture. Next, the conversion of these models to systems on a chip that can by way of high throughput cytotoxic assays identify drug leads for clinical trials should fast-track drug development while markedly improving success rates. In this review, we describe the challenges that have hindered the progression of cell line models over seven decades and methods to overcome this. We outline the gaps in breast and prostate cancer cell line pathology and racial representation alongside their involvement in relevant drug development.

Representation and Race in Adolescent Idiopathic Scoliosis Research: Disparities in Curve Magnitude and Follow-Up.

Prospective Cohort Study. The present study aims to determine if the racial representation of patients enrolled in a large prospective scoliosis registry is reflective of the general United States population. Further, we studied whether there was an association between race, pre-operative parameters, outcomes and loss to follow-up. Prospectively collected data for patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS) was reviewed, including self-reported race/ethnicity. The U.S. pediatric population and U.S. patients enrolled in the prospective registry were compared. The data obtained was analyzed for variations between races, for pre-operative variables and follow-up. Of the 2210 included patients in the registry 66% of patients reported as White, while 52% of the 2018 U.S. pediatric population reported as White. 15% of the registry reported as Hispanic/Latino compared to 22% of the U.S. pediatric population, 13% Black compared to 14% of the U.S. pediatric population, and 4% Asian compared to 5% of the U.S. pediatric population. Asian and White patients had statistically significant higher 2-year follow-up in all but one of six enrollment sites (P < 0.001). Native American, Other, and Hispanic/Latino patients had the highest BMIs. Native American and Black patients had the highest pre-op thoracic Cobb angles. Pre-op ages of Black, Hispanic, and Native American patients were statistically lower (P < 0.01). This study demonstrates the association between race and patient follow-up and pre-operative factors in patients who underwent surgery for AIS. Black, Native American, and Hispanic populations were underrepresented both at pre-op and follow-up when compared to their relative proportion in the U.S. pediatric population.

Representation of Racial Diversity on US Plastic Surgery Websites: A Cross-sectional Study: Racial Diversity on Plastic Surgery Websites.

The racial diversity portrayed in plastic and reconstructive surgery (PRS) media is an important indicator of an inclusive environment for potential patients. To evaluate the degree to which PRS websites demonstrate inclusivity, we assessed the racial composition of both patients and plastic surgeons depicted on the most visited academic and private PRS websites to determine the extent to which racial diversity is represented. A cross-sectional study was conducted in September 2023. The 10 most visited websites in each state were identified. Sociodemographic characteristics including race and sex of patients and plastic surgeons, as well as the type of practice, were collected. Race was classified according to individuals' Fitzpatrick Phototypes into White and non-White. Differences in patient and surgeon representation were compared to the 2020 US Census and the 2020 ASPS demographics using χ2 tests. Subgroup analyses were conducted to identify differences by type of practice and region. We analyzed a total of 2,752 patients from 462 websites belonging to 930 plastic surgeons. PRS websites were predominantly from private practices (93%). Regarding patient representation, 92.6% were female, 7.4% were male, 87.6% were White, and 12.4% were non-White. The surgeon population on the studied webpages was 75.1% male, 92.1% White, and 7.8% non-White. Statistically significant differences were found in the patient population when compared to the 2020 national (P < 0.001) and regional (P < 0.001) US Census demographics and the 2020 ASPS Statistics Report (P < 0.001). Although minority representation was significantly higher on academic websites compared to private practice (22.9% vs. 12.1%; P = 0.007), both were significantly lower than the percentage of minority patients undergoing PRS. This study illuminates racial disparities in the representation of racial groups among patients and plastic surgeons in the most frequented plastic surgery websites. Moreover, it underscores the imperative to bolster racial diversity within the digital content of both private and academic PRS websites. Greater racial representation can foster a more inclusive perception of the plastic surgery field, which may potentially broaden access to care and enrich the professional landscape.