Racial/Ethnic Bias Found in Asthma Clinical Trials Used to Update NHLBI Guideline

AAAAI 2022

In the majority of studies that reported racial/ethnic data, White participants were highly overrepresented and Black/Hispanic/all Other underrepresented.

Less than one-third of clinical trials used to guide the recent 2020 focused update to the National Heart Lung, and Blood Institute asthma management guidelines reported the racial/ethnic demographics of participants. Moreover, in the set of papers that did report these data, nearly three-quarters of participants identified as White.

The findings were presented during a poster session at the 2022 American Academy of Asthma, Allergy, and Immunology Annual Meeting, held February 25-28, in Phoenix, AZ, and virtually.

“Black/African American and Hispanic people in the United States are disproportionately impacted by asthma with increased prevalence, morbidity, and mortality,” the authors write in the study abstract. However, they stress, the same groups are frequently underrepresented in asthma clinical and translational research creating an additional impediment to health care equity.

To help illustrate another way these inequities are perpetuated, the research team, led by Esosa Adah, MD, of Children's Mercy Hospital, Kansas City, identified papers that described clinical trials included in the NHLBI asthma management focused update then determined the frequency (%) of papers that reported sample racial/ethnic demographics and the percentage of identified racial/ethnic groups among the studies, according to the study abstract.

Among the 45 papers the team reviewed, only 36% (16/45) reported any racial demographics. They found that while the 6 trials conducted only in the US did include data on race/ethnicity, only 2 of those reported demographics for the group identified as White. When Adah et al analyzed the set of all the studies that did report race and ethnicity, 70.8% (n=31 675) of participants identified as White, 10.4% (n=4653) as Black, and 0.2% (n=91) as Hispanic. American Indian/Alaskan Native/Native Hawaiian/Pacific Islander was claimed by 2.6% of this group of studies and “other” was selected by 6.1%, the abstract states.

Study authors observed variations in demographic representation between US and non-US trials and also between pediatric-only and non-pediatric studies.

The authors reiterate that less than half the papers describing clinical trials of patients with or treated for asthma included information on racial/ethnic makeup of the study cohort. Among trials in which the data were reported, White participants were generally overrepresented and Black and Hispanic populations were underrepresented. They state: “Intentional inclusion efforts are needed to increase the racial/ethnic diversity of trials informing national asthma guidelines. These factors should also be considered when developing such guidelines.”

Reference: Adah E, Jones B, Staggs V. The racial and ethnic makeup of the asthma clinical trials informing Racial and Ethnic Makeup of the Asthma Clinical Trials informing the 2020 NHLBI asthma guidelines update. J All Clin Immunol. 2022;149(suppl). Abstract 266.