Harlan Emily A, Malley Kaitlin, Quiroga Grecia, Mubarak Eman, Lama Pema, Schutz Amanda, Cuevas Adolfo, Hough Catherine L, Iwashyna Theodore J, Armstrong-Hough Mari, Valley Thomas S
Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI.
Crit Care Explor. 2025 Jan 13;7(1):e1193. doi: 10.1097/CCE.0000000000001193. eCollection 2025 Jan 1.
Hispanic individuals comprise one-fifth of the U.S. population and Hispanic patients with acute hypoxemic respiratory failure (AHRF) experience higher odds of death compared with non-Hispanic White patients. Representation of Hispanic patients in clinical trials for respiratory failure is critical to address this inequity. We conducted a systematic review to examine the inclusion of Hispanic patients in randomized controlled trials for AHRF and assessed language as a potential barrier to enrollment.
National Library of Medicine PubMed, Elsevier Embase, and Cochrane Central Register of Controlled Trials databases through January 2024.
Randomized controlled trials assessing AHRF interventions enrolling U.S. patients receiving mechanical ventilation, noninvasive mechanical ventilation, or high-flow nasal cannula were included. The systematic review was registered prospectively through PROSPERO (CRD42023437828).
Two authors independently screened studies and extracted data for each included study.
Ninety-four trials published from 1975 to 2023 were included; 33.0% (n = 31) of studies reported ethnicity, and 11.2% of participants in studies reporting race or ethnicity (1,320/11,780) were identified as Hispanic. The proportion of Hispanic-identified participants was significantly lower than the U.S. Hispanic population from 1996 to 2019 (p < 0.01). Starting in 2020, the proportion of Hispanic-identified participants was significantly higher than the U.S. population (27.8% vs. 19.1%; p < 0.01). Two studies (4.9%) reporting race or ethnicity excluded non-English speaking participants; the remainder did not specify language requirements for enrollment.
Hispanic-identified individuals were underrepresented in trials for AHRF until 2020 when Hispanic patient representation increased during COVID-19. Exclusion of participants who do not speak English may represent a barrier to trial enrollment.
西班牙裔个体占美国人口的五分之一，与非西班牙裔白人患者相比，患有急性低氧性呼吸衰竭（AHRF）的西班牙裔患者死亡几率更高。西班牙裔患者在呼吸衰竭临床试验中的代表性对于解决这种不平等至关重要。我们进行了一项系统评价，以检查西班牙裔患者在AHRF随机对照试验中的纳入情况，并评估语言是否是入组的潜在障碍。
截至2024年1月的美国国立医学图书馆PubMed、爱思唯尔Embase和Cochrane对照试验中央注册库数据库。
纳入评估AHRF干预措施的随机对照试验，这些试验纳入接受机械通气、无创机械通气或高流量鼻导管治疗的美国患者。该系统评价通过PROSPERO（CRD42023437828）进行前瞻性注册。
两位作者独立筛选研究，并为每项纳入研究提取数据。
纳入了1975年至2023年发表的94项试验；33.0%（n = 31）的研究报告了种族，在报告种族或族裔的研究中，11.2%的参与者（1320/11780）被确定为西班牙裔。1996年至2019年，被确定为西班牙裔的参与者比例显著低于美国西班牙裔人口（p < 0.01）。从2020年开始，被确定为西班牙裔的参与者比例显著高于美国人口（27.8%对19.1%；p < 0.01）。两项报告种族或族裔的研究（4.9%）排除了非英语使用者；其余研究未明确入组的语言要求。
在2020年之前，在AHRF试验中，被确定为西班牙裔的个体代表性不足，而在2019冠状病毒病期间，西班牙裔患者的代表性有所增加。排除非英语使用者可能是试验入组的一个障碍。
