Study shows Hispanics, blacks substantially underrepresented in orthopaedic research

SAN ANTONIO (April 24, 2014) – In San Antonio, orthopaedic surgeons commonly treat Hispanic and black patients for a vast array of orthopaedic diseases and injuries. When these doctors turned to their specialty’s most esteemed journals to learn more about treatments and breakthroughs, they noticed little to no reference to these minority groups.

Boris A. Zelle, M.D., assistant professor of orthopaedic trauma surgery at The University of Texas Health Science Center at San Antonio and an orthopaedic trauma surgeon with UT Medicine San Antonio, decided to investigate this underrepresentation of Hispanic and black patients in orthopaedic research. He called on his longtime friend and collaborator Mohit Bhandari, M.D., Ph.D., an orthopaedic surgeon and renowned researcher who is the research chair of muscoskeletal trauma and surgical outcomes at McMaster University in Canada.

An extensive and critical review of the most pertinent orthopaedic clinical studies over a four-year period recently resulted in Dr. Zelle’s publication, “Lack of Diversity in Orthopaedic Trials Conducted in the United States,” in The Journal of Bone and Joint Surgery, the premier orthopaedic journal.

“As an academic trauma surgeon, it is my responsibility to constantly review the most pertinent literature and to be up to date. When I started practicing in San Antonio three years ago, I began reviewing the literature with the particular focus to learn more about minority patients. I noticed that study after study made no reference to race or ethnicity,” he said.

“This is important to patients because our treatment algorithms are based on information found in the best available literature,” said Dr. Zelle. “As of now, this literature is poorly representing minority patients like our patient population in San Antonio. We know that Hispanic and black patients have different outcomes after treatment of orthopaedic injuries. We know that they have different associated medical problems as well as different perceptions toward their injury and their health care providers. We need to understand all of this so we can better treat these patients.”

With assistance from Jeremy S. Somerson, M.D., an orthopaedic surgery resident; Clayton Vaughan, M.D., a medical school graduate who was a student at the time, and Christopher S. Smith, M.Sc., from McMaster University, Dr. Zelle and Dr. Bhandari reviewed 158 randomized controlled trials from 2008 to 2011 that had been published in 32 different scientific journals.

“We found that minority patients were not appropriately represented in these clinical trials,” Dr. Zelle said. “In these studies, only 4.6 percent of participants were Hispanic and 6.2 percent were African-American. That is 3.5 times less than the actual Hispanic population, and two times less than the actual African-American population in the United States.”

This research determined that orthopaedic literature is failing to represent these minority populations, he said. “The entire body of orthopaedic literature needs to be challenged as the patients enrolled in clinical studies are not representative of the current U.S. population. Centers with diverse patient populations, such as the UT Health Science Center, must be part of future multicenter trials in order to allow for enrollment of minority patients. Inclusion of Hispanic and African-American patients in research must be a clear goal.”

Dr. Zelle said the UT Health Science Center’s solution to this disparity is developing study tools designed for these populations. For example, the development of outcome questionnaires in Spanish can greatly increase the amount of Hispanic patients who participate in such studies, he said.

“By developing these outcome tools and sharing them with other universities, we will be able to increase the number of Hispanics in future clinical trials. We hope to increase the number of minority patients in orthopaedic research studies across the country. Then we will have much better information to use when treating our patients.”


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