Unmasking healthcare disparities: the underreporting of gender, race, and ethnicity data in high-impact factor minimally invasive surgery journals

Diverse representation in clinical research is essential for equitable healthcare. Despite mandates from organizations like the NIH and ICMJE, race and gender remain underreported in surgical research, raising concerns about the generalizability of findings. This study examines demographic reporting trends in minimally invasive surgery (MIS) and advanced endoscopy publications before and after the onset of the COVID-19 pandemic. A systematic review of Surgical Endoscopy , Journal of Robotic Surgery , and Surgical Innovation was conducted, analyzing articles published between January 1, 2018, and December 31, 2023. 472 studies were included. For each study, study type, journal, date, geographic origin, and reported demographic data were recorded. Reporting rates across time periods (pre- vs. post-March 2020), region of origin, study design, and journal were analyzed via Chi-square, Fisher’s exact tests, and Cochran–Armitage trend tests. Of the 472 studies, 61.2% were randomized controlled trials, with geographic representation from Asia (37.7%), Europe (34.8%), and North America (22.3%). Only 21 North American studies (20 U.S., 1 Canada) reported race; no studies from Asia or Europe did so. Among U.S. studies, race reporting did not differ significantly pre- vs. post-COVID (22.2% vs. 21.8%; p = 0.25), nor did gender reporting ( p = 0.07). Regional differences in U.S. race reporting were significant ( p = 0.003), with the Midwest having the lowest rate. Post-2020, gender reporting was significantly higher in Asia (94.9%) compared to Europe (84.7%) and North America (80.9%) ( p = 0.005). Demographics remain underreported in MIS and advanced endoscopy research, particularly outside North America. Despite increased attention to health equity during the COVID-19 pandemic, reporting practices have not significantly improved. Broader adoption of standardized demographic reporting is needed to ensure evidence-based surgical care for all populations.