A new study has found that COVID-19 research often does not include the populations most vulnerable to the disease. The study, led by UChicago Medicine researchers, was published on January 27 in the Journal of General Internal Medicine.
This study is part of a growing body of academic research showing that long-standing systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19. The study also suggests that patients from racial and ethnic minorities, pregnant women, and children are underrepresented in ongoing COVID-19 treatment trials.
Since the pandemic began, Black and Hispanic communities have been disproportionately affected by COVID-19, with some studies suggesting that they are 30 percent to 50 percent more likely to test positive for COVID-19 than their white counterparts. The authors of the paper attribute this to several factors, including systemic health disparities, working frontline jobs and living in multigenerational households.
The researchers performed a cross-sectional analysis of all US COVID-19 treatment trials registered on ClinicalTrials.gov under the terms “coronavirus” and “COVID.” The UC Med team also used available census data from centers that provide Medicare and Medicaid Services to conduct analysis regarding COVID positivity rates with regard to geographical location.
Results showed that about half of U.S. COVID-19 treatment trials underrepresented people with conditions deemed medically complex, such as pregnant women and children. Research data was also collected in hospitals that predominantly served white populations: an aggregate estimate suggests that only 17 percent of the hospital patient populations were Black and 14 percent Hispanic.
"Smaller community hospitals may have larger communities of color but may not be equipped to set up these sorts of trials for infectious diseases," commented Sukarn Chokkara, a second-year medical student at the University of Chicago Pritzker School of Medicine and lead author of the paper in an interview with UChicago Medicine’s publication, At The Forefront. "Given how little is known about COVID-19, being overly cautious with these populations means we have little evidence as to how to actually take care of them when they do contract [the virus].”
Pregnant women and children, who are often treated as unrepresentative of the broader population, are routinely excluded from clinical trials because these groups are viewed as potentially complicating the work of researchers in understanding and evaluating new treatments. These exclusions, however, lead to harmful consequences including treatments that will likely be less effective on vulnerable populations. The paper argues that lack of data will translate to little evidence about COVID-19 treatment for these populations, increasing their risk of experiencing potentially severe adverse drug reactions.
"Greater effort is needed to develop and study treatments in vulnerable populations, and this is going to take a long-term commitment to prioritize health equity," Chokkara commented.