Scool of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK.
BMJ Glob Health. 2021 Nov;6(11). doi: 10.1136/bmjgh-2021-005537.
Black, Asian and minority ethnic (BAME) people are disproportionately affected by COVID-19. Respiratory protective equipment (RPE) has conventionally been developed for a predominantly white male population that does not represent the healthcare workforce. The literature was reviewed to determine the protection offered to female and BAME users.
Five databases were searched. Eligible studies related to respirator fit in the context of anthropometrics, gender and ethnicity. Meta-analysis was performed for gender-based anthropometric differences. A priori protocol registration was not performed.
32 studies were included and anthropometric data was extracted from 15 studies. Meta-analysis revealed 14 anthropometric measurements were significantly smaller for females. Mean differences ranged from 0.37 mm to 22.05 mm. Gender-based anthropometric differences did not always translate to lower fit factor scores, with 12 studies reporting worse performance and fit for females and 10 reporting no gender effect. No studies provided disaggregate anthropometric data by ethnic group. Pass rates (PR) were low or moderate in 12 BAME or mixed-ethnicity cohorts. 14 studies reported associations between facial dimensions (FD) and respirator fit. Three comparative studies showed lower PR among selective BAME people. 18 studies reported RPE performance differed with model and design. Most studies did not prespecify inclusion/exclusion criteria. Small sample size and lack of justification or power calculations was a concern. Significant heterogeneity in study designs limited comparisons, particularly relating to respirator selection or availability and defining study outcomes relating to RPE performance.
The literature reports on largely Caucasian or single ethnic populations, and BAME people remain under-represented, limiting comparisons between ethnic groups. Facial anthropometrics vary between gender and likely between ethnicity, which may contribute to lower PR among females and ethnic minorities, particularly Asians. There is a need for studies including a broader spectrum of ethnicities and for consideration of female and BAME users during RPE development.
黑人和少数族裔（BAME）人群受到 COVID-19 的影响不成比例。呼吸防护设备（RPE）传统上是为主要是白人男性人口开发的，而这些人并不代表医疗保健人员。本文综述了女性和 BAME 用户使用的防护设备的保护作用。
检索了五个数据库。合格的研究与人体测量学、性别和种族背景下的呼吸器适配有关。对基于性别的人体测量学差异进行了荟萃分析。没有预先进行方案注册。
共纳入 32 项研究，从 15 项研究中提取了人体测量学数据。荟萃分析显示，女性的 14 项人体测量学测量值明显较小。平均差异范围为 0.37 毫米至 22.05 毫米。基于性别的人体测量学差异并不总是转化为较低的适配因子分数，有 12 项研究报告女性的性能和适配性较差，10 项研究报告没有性别效应。没有研究按族裔群体提供离散的人体测量学数据。12 个 BAME 或混合族裔队列的通过率（PR）较低或中等。14 项研究报告了面部尺寸（FD）与呼吸器适配之间的关系。三项比较研究表明，选择性 BAME 人群的 PR 较低。18 项研究报告 RPE 的性能因型号和设计而异。大多数研究没有规定纳入/排除标准。样本量小，缺乏依据或功效计算是一个问题。研究设计的显著异质性限制了比较，特别是与呼吸器的选择或可用性以及定义与 RPE 性能相关的研究结果有关。
文献主要报告了白种人或单一族裔人群的情况，而 BAME 人群的代表性仍然不足，限制了不同族裔群体之间的比较。性别之间和可能种族之间的面部人体测量学差异可能导致女性和少数族裔（特别是亚洲人）的 PR 较低。需要开展包括更广泛族裔群体的研究，并在 RPE 开发过程中考虑女性和 BAME 用户。
