School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2024 Sep 25;14(9):e085592. doi: 10.1136/bmjopen-2024-085592.
Despite a potentially greater burden of dementia, racial and ethnic minority populations around the world may be more likely to be excluded from research examining risk factors for incident dementia. We aimed to systematically investigate and quantify racial and ethnic minority representation in dementia risk factor research.
We performed a two-stage systematic search of databases-MEDLINE (Ovid SP), Embase (Ovid SP) and Scopus-from inception to March 2021 to identify population-based cohort studies looking at risk factors for dementia incidence. We included cohort studies which were population-based and incorporated a clinical dementia diagnosis.
Out of the 97 identified cohort studies, fewer than half (40 studies; 41%) reported the race or ethnicity of participants and just under one-third (29 studies; 30%) reported the inclusion of racial and ethnic minority groups. We found that inadequate reporting frequently prevented assessment of selection bias and only six studies that included racial and ethnic minority participants were at low risk for measurement bias in dementia diagnosis. In cohort studies including a multiethnic cohort, only 182 out of 337 publications incorporated race or ethnicity in data analysis-predominantly (90%) through adjustment for race or ethnicity as a confounder. Only 14 publications (4.2% of all publications reviewed) provided evidence about drivers of any observed inequalities.
Racial and ethnic minority representation in dementia risk factor research is inadequate. Comparisons of dementia risk between different racial and ethnic groups are likely hampered by significant selection and measurement bias. Moreover, the focus on 'adjusting out' the effect of race and ethnicity as a confounder prevents understanding of underlying drivers of observed inequalities. There is a pressing need to fundamentally change the way race, ethnicity and the inclusion of racial and ethnic minorities are considered in research if health inequalities are to be adequately addressed.
尽管痴呆症的负担可能更大，但世界各地的少数族裔人群可能更有可能被排除在研究痴呆症发病风险因素的研究之外。我们旨在系统地调查和量化痴呆症发病风险因素研究中少数族裔的代表性。
我们对数据库进行了两阶段系统搜索-MEDLINE（Ovid SP）、Embase（Ovid SP）和 Scopus-从开始到 2021 年 3 月，以确定研究痴呆症发病风险因素的基于人群的队列研究。我们纳入了基于人群且纳入临床痴呆症诊断的队列研究。
在 97 项确定的队列研究中，不到一半（40 项；41%）报告了参与者的种族或族裔，只有近三分之一（29 项；30%）报告了包括少数族裔群体。我们发现，不充分的报告经常妨碍对选择偏倚的评估，只有 6 项包括少数族裔参与者的研究在痴呆症诊断的测量偏倚方面风险较低。在包括多种族队列的队列研究中，只有 337 篇出版物中的 182 篇（分析数据时纳入种族或族裔）主要通过将种族或族裔作为混杂因素进行调整（90%）。只有 14 篇出版物（审查的所有出版物的 4.2%）提供了关于任何观察到的不平等现象驱动因素的证据。
痴呆症风险因素研究中少数族裔的代表性不足。不同种族和族裔群体之间痴呆症风险的比较可能受到严重的选择和测量偏倚的阻碍。此外，将种族和族裔作为混杂因素“调整掉”的重点，防止了对观察到的不平等现象的根本驱动因素的理解。如果要充分解决健康不平等问题，就迫切需要从根本上改变在研究中考虑种族、族裔以及纳入少数族裔的方式。
