Planning: Underrepresentation

Critical Appraisal informs us that:

Data extrapolated from small study samples are especially prone to error and bias.
Clinical trial researchers have a duty to recruit a sample of volunteers that closely represent the population under study to ensure its results are generalisable.

However:

Minoritised ethnic populations are repeatedly underrepresented in research studies and trials.
Minoritised ethnic populations are disproportionately impacted by various conditions and illnesses.

How Underrepresentation impacts study validity:

External Validity

Sampling bias
Impact to generalisability - participants differ systematically from population under study
Missing racial categories - can not be applied to reader’s population

Internal Validity

Too-small sample sizes of minoritised ethnic populations can impact reliability as it leads to higher variability which may lead to bias
Evidence generated from small sample sizes is especially prone to error (false negatives/positives)

Examples of Underrepresentation in research:

Loree et al., 2019: Review of trials which led to FDA cancer drug approvals found Black population significantly underrepresented (22% of expected proportion). Race was only reported in 63% of trials
Murphy et al., 2016: Review of 209 US studies regarding mood and anxiety disorders. At least 38% no African Americans, 42% no race reported, 4% appropriate representation
Ding et al., 2021: Review of pivotal trials for dermatology drugs. Despite the varying population demographics of different countries and continents, where a study was conducted seemed to have minimal influence on the central tendency to predominantly enroll White participants.

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