From the Orthopaedic Institute for Children/UCLA, Los Angeles, CA (Beck), the Benioff Children's Hospital/UCSF, San Francisco, CA (Pandya), the NYU Langone Health, New York, NY (Carter), and the Tulane University School of Medicine, New Orleans, LA (Mulcahey).
J Am Acad Orthop Surg. 2021 May 15;29(10):e479-e487. doi: 10.5435/JAAOS-D-20-01087.
As disparities in healthcare access and outcomes have been increasingly identified across medical specialties, the importance of recognizing and understanding the diversity of our patient populations and the influence of individual characteristics such as age, sex, gender, race, and ethnicity on clinical outcomes has been emphasized. Orthopaedic literature has advanced dramatically in the quality and quantity of research generated over the past 25 years, yet a consistent, sustained focus on studying musculoskeletal health in the context of these unique patient-specific variables has not been maintained. The result of this inattention may be the provision of orthopaedic care that is ill-suited for the individual patient whose biologic characteristics, life experiences, and cultural constructs differ from that of the typical research subject. The recent proliferation of meta-analyses-whose intention is to optimize statistical power-likely compounds the problem because improper, inconsistent, or absent categorization of patients in research articles precludes meaningful subgroup analysis. This article describes the current variability in demographic reporting in the orthopaedic literature, highlights the importance of complete, consistent demographic reporting and subgroup analysis, and reviews specific examples of orthopaedic conditions that illustrate how clinical outcomes may be affected by patient-specific variables such as age, sex, gender, race, and ethnicity.
由于医疗保健机会和结果的差异在各个医学专业中越来越明显，因此，认识和理解我们患者群体的多样性以及年龄、性别、性别、种族和民族等个体特征对临床结果的影响的重要性已经得到强调。在过去的 25 年中，骨科文献在研究的质量和数量上都有了显著的进步，但在这些独特的患者特定变量的背景下，始终如一地、持续地关注研究肌肉骨骼健康的问题并没有得到维持。这种关注不足的结果可能是提供了不适合个体患者的骨科护理，因为患者的生物学特征、生活经历和文化结构与典型的研究对象不同。最近，荟萃分析的大量出现——其目的是优化统计能力——可能使问题更加复杂，因为研究文章中患者分类不当、不一致或缺失会妨碍有意义的亚组分析。本文描述了骨科文献中人口统计学报告的当前变异性，强调了完整、一致的人口统计学报告和亚组分析的重要性，并回顾了具体的骨科疾病示例，说明年龄、性别、性别、种族和民族等患者特定变量如何影响临床结果。
