Conceptualization, operationalization, and utilization of race and ethnicity in major medical journals 1995-2018: a systematic review

Background Systemic racial and ethnic inequities continue to be perpetuated through scientific methodology and communication norms despite efforts by medical institutions. Purpose To characterize methodological practices regarding race and ethnicity in U.S. research published in leading medical journals. Data source Articles published in Annals of Internal Medicine, BMJ, JAMA, The Lancet, and NEJM from 1995-2018 were sampled via PubMed. Study Selection All original, human subjects research conducted in the U.S. Data Extraction Information on definition, measurement, coding, use in analyses, and justifications was collected. Data Synthesis The proportion of U.S. medical research studies including race and/or ethnicity data increased between 1995 and 2018. No studies defined race or ethnicity. and most did not state how race and/or ethnicity was measured. Common coding schemes included: “Black, other, White,” “Hispanic, Non-Hispanic,” and “Black, Hispanic, other, White.” Race and/or ethnicity was most often used as a control variable, descriptive covariate, or matching criteria. Under 30% of studies included justification for their methodological choices regarding race and/or ethnicity. Conclusions Despite regular efforts by medical journals to implement new policies around race and ethnicity in medical research, pertinent methodological information was systematically absent from the majority of reviewed literature. This stymies critical disciplinary reflection and progress towards equitable practice.