May 17, 2005Open Access

Recruitment of ethnic minority patients to a cardiac rehabilitation trial: The Birmingham Rehabilitation Uptake Maximisation (BRUM) study ISRCTN72884263

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Post-myocardial infarction, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery (n=1997). Intervention: South Asian ethnicity vs. White ethnicity. Primary outcome: Eligibility for the trial (RR 0.42, 95% CI 0.33-0.55, p=<0.001).

Key Result

South Asian patients were significantly less likely to be eligible for the cardiac rehabilitation trial compared to White patients (adjusted RR 0.42), primarily due to language barriers.

Study Design

Type

Observational (n=1,997)

Multicenter

Yes

PICO

Population

Post-myocardial infarction, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery (n=1,997)

Intervention / Comparator

South Asian ethnicity vs White ethnicity

Primary Outcome

Eligibility for the trial — RR 0.42 (0.33-0.55), p=<0.001

Main Result

Effect estimate: RR 0.42 (95% CI 0.33-0.55)

Absolute Event Rate: 48.1% vs 63.8%

p-value: p=<0.001

Limitations

Socio-economic status was a potential confounding factor, as minority ethnic groups had significantly higher deprivation indices.
A higher proportion of minority ethnic groups who declined to participate gave no reason for their decision, potentially masking differences in reasons for non-participation.
The study was unable to support the range of minority languages other than Punjabi, which directly impacted eligibility rates.

Abstract

BACKGROUND: Concerns have been raised about low participation rates of people from minority ethnic groups in clinical trials. However, the evidence is unclear as many studies do not report the ethnicity of participants and there is insufficient information about the reasons for ineligibility by ethnic group. Where there are data, there remains the key question as to whether ethnic minorities more likely to be ineligible (e.g. due to language) or decline to participate. We have addressed these questions in relation to the Birmingham Rehabilitation Uptake Maximisation (BRUM) study, a randomized controlled trial (RCT) comparing a home-based with a hospital-based cardiac rehabilitation programme in a multi-ethnic population in the UK. METHODS: Analysis of the ethnicity, age and sex of presenting and recruited subjects for a trial of cardiac rehabilitation in the West-Midlands, UK. PARTICIPANTS: 1997 patients presenting post-myocardial infarction, percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery. DATA COLLECTED: Exclusion rates, reasons for exclusion and reasons for declining to participate in the trial by ethnic group. RESULTS: Significantly more patients of South Asian ethnicity were excluded (52% of 'South Asian' v 36% 'White European' and 36% 'Other', p < 0.001). This difference in eligibility was primarily due to exclusion on the basis of language (i.e. the inability to speak English or Punjabi). Of those eligible, similar proportions were recruited from the different ethnic groups (white, South Asian and other). There was a marked difference in eligibility between people of Indian, Pakistani or Bangladeshi origin. CONCLUSION: Once eligible for this trial, people from different ethnic groups were recruited in similar proportions. The reason for ineligibility in the BRUM study was the inability to support the range of minority languages.

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