National Clinician Scholars Program, Veterans Affairs Ann Arbor, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Surgery, New Haven, CT.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
J Am Coll Surg. 2021 May;232(5):682-689.e5. doi: 10.1016/j.jamcollsurg.2021.01.015. Epub 2021 Mar 8.
If Asian American and Pacific Islanders (AAPIs) are not recognized within patients in health services research, we miss an opportunity to ensure health equity in patient outcomes. However, it is unknown what the rates are of AAPIs inclusion in surgical outcomes research.
Through a scoping review, we used Covidence to search MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, and CINAHL for studies published in 2008-2018 using NSQIP data. NSQIP was chosen because of its national scope, widespread use in research, and coding inclusive of AAPI patients. We examined the proportion of studies representing AAPI patients in the demographic characteristics and Methods, Results, or Discussion section. We then performed multivariable logistic regression to examine associations between study characteristics and AAPI inclusion.
In 1,264 studies included for review, 62% included race. Overall, only 22% (n = 278) of studies included AAPI patients. Of studies that included race, 35% represented AAPI patients in some component of the study. We found no association between sample size or publication year and inclusion. Studies were significantly more likely to represent AAPI patients when there was a higher AAPI population in the region of the first author's institution (lowest vs highest tercile; p < 0.001). Studies with a focus on disparities were more likely to include AAPI patients (p = 0.001).
Our study is the first to examine AAPI representation in surgical outcomes research. We found < 75% of studies examine race, despite availability within NSQIP. Little more than one-third of studies including race reported on AAPI patients as a separate group. To provide the best care, we must include AAPI patients in our research.
如果在卫生服务研究中，亚洲裔美国人和太平洋岛民（AAPIs）没有被纳入患者群体，我们就会错失确保患者结局健康公平的机会。然而，目前尚不清楚 AAPIs 纳入手术结局研究的比例是多少。
通过范围综述，我们使用 Covidence 搜索了 2008 年至 2018 年期间在 MEDLINE、EMBASE、PsycINFO、Web of Science、Scopus 和 CINAHL 上发表的使用 NSQIP 数据的研究。选择 NSQIP 的原因是其具有全国范围、在研究中广泛应用以及包括 AAPI 患者的编码。我们检查了在人口统计学特征和方法、结果或讨论部分代表 AAPI 患者的研究比例。然后，我们进行了多变量逻辑回归分析，以研究特征与 AAPI 纳入之间的关联。
在纳入审查的 1264 项研究中，有 62%的研究包括种族。总体而言，仅有 22%（n=278）的研究纳入了 AAPI 患者。在纳入种族的研究中，有 35%的研究在研究的某些部分代表了 AAPI 患者。我们没有发现样本量或发表年份与纳入之间的关联。当第一作者机构所在地区的 AAPI 人口较多时（最低与最高三分位数；p<0.001），研究更有可能代表 AAPI 患者。研究关注差异时，更有可能纳入 AAPI 患者（p=0.001）。
我们的研究首次检查了手术结局研究中 AAPI 的代表性。尽管 NSQIP 中提供了种族信息，但我们发现<75%的研究检查了种族，而只有略多于三分之一的研究将 AAPI 患者作为单独的群体进行了报告。为了提供最佳的治疗，我们必须将 AAPI 患者纳入我们的研究中。
