Diversity, Equity, and Inclusion: A Decade of Progress?

Digital Health for Asthma Management: Electronic Medication Monitoring for Adherence as a Case Example

Digital health is an umbrella term for components of health care using computer platforms, software, connectivity, and sensors to augment the recording, documentation, and communication of clinical information. The functions of digital health may be viewed in three domains: (1) the repository for patient information, (2) monitoring devices, and (3) communication tools. Monitoring devices have provided robust information as diagnostic and prognostic tools in office and hospital settings. In this review, as a case study, we will discuss the research and our direct clinical experience of electronic medication monitoring technology and the potential benefits to patient care, and the opportunities and perils encountered in using this approach for patients with moderate to severe asthma, including issues related to patient uptake and concerns for bias, impacts on the provider-patient relationship, and discussions regarding monitoring of rescue medication use in exacerbations. Additionally, although there is evidence for improvements in various aspects of patient care afforded by electronic medication monitoring, these devices have not yet seen widespread uptake in clinical settings, and we will discuss the steps needed to address these barriers and keep these important devices available for patient use in the future.

Enrollment of underserved racial and ethnic populations in pediatric asthma clinical trials

Background

The existing data on enrollment trends of historically underserved racial and ethnic children in clinical trials are limited.

Objective

We sought to evaluate documentation and representation of race and ethnicity in pediatric asthma clinical trials in the United States.

Methods

This is a cross-sectional study of United States-based interventional trials studying pediatric asthma that were completed between 2008 and 2022 and registered on ClinicalTrials.gov. Enrollment disparities were assessed by using the measure enrollment prevalence difference (EPD) (defined as the median difference between the proportion of participants enrolled and asthma prevalence in the US population by race and ethnicity).

Results

Of the 67 trials reviewed, 53 (79.2%) and 36 (53.7%) reported on race and ethnicity at ClinicalTrials.gov, respectively. Most participants were White (39.1%), Black (37.1%), or non-Hispanic (66.1%). Black, Hispanic, multiracial, and White children were enrolled in the expected proportions based on their contribution to asthma burden. However, American Indian or Alaska Native (AI/AN) (EPD = -1 [95% CI = -1 to -1]) and Asian children (EPD = -3 [95% CI = -3 to -3]) were underrepresented relative to disease burden in these respective groups. Fewer Black children were enrolled in drug or device trials (β = -0.80 [95% CI = -1.60 to -0.01]) than in other trials. Fewer Hispanic children were enrolled in early-phase than late-phase trials (β = -2.42 [95% CI = -3.66 to -1.19]).

Conclusions

Enrollment in pediatric asthma trials conducted in the United States was commensurate with the demographics of children affected by asthma for most racial and ethnic groups, but American Indian or Alaska Native and Asian children were underrepresented. Concerted efforts are needed to promote inclusion of these underserved groups in future trials.

Addressing Health Equity in Food Allergy

Social determinants of health can lead to poor health outcomes for food-allergic patients, including limited access to allergen-free foods and specialty care. Housing and transportation limitations can worsen social factors including food insecurity, poor early food introduction, increased reactivity to foods, lower tertiary/allergy care utilization, and increased emergency department utilization. A key component of addressing health equity involves valuing all people with sustained, focused efforts to address social determinants of health. In this clinical commentary, we discuss the current state of heath equity for food-allergic patients, highlighting the disparities in emergency care, food allergy prevention, and food insecurity. Solutions to improve health equity through clinical practice are proposed. Currently available funding opportunities through the National Institutes of Health for health equity initiatives are outlined. Gaps in health equity for food-allergic patients include the lack of documented successful implementation of effective solutions to food insecurity, poor early food introduction uptake, poor access to specialist care, and unequal distribution of educational resources. The availability of research funding and legislative policies supporting access to food and education bolster the impetus to move toward health equity for 20 million people in the United States with food allergy.

Pancreatic Cancer Health Disparity: Pharmacologic Anthropology

Pancreatic cancer (PCa) remains a formidable global health challenge, with high mortality rates and limited treatment options. While advancements in pharmacology have led to improved outcomes for various cancers, PCa continues to exhibit significant health disparities, disproportionately affecting certain populations. This paper explores the intersection of pharmacology and anthropology in understanding the health disparities associated with PCa. By considering the socio-cultural, economic, and behavioral factors that influence the development, diagnosis, treatment, and outcomes of PCa, pharmacologic anthropology provides a comprehensive framework to address these disparities and improve patient care.

Practicing equitable principles in cancer clinical research: Has the EU got it right?

Clinical trials are a fundamental part of cancer research as they establish the efficacy and safety of new cancer treatments for everyone. The lack of sociodemographic diversity among cancer clinical trial participants leaves a vacuum in scientific knowledge, which can distort credible evidence from being accessible and represents a major barrier to advancing cancer care for the entire patient population. It can also cause avoidable harm to the public, undermine patients trust and result in wasteful allocation of healthcare resources. It is therefore imperative that there is representation of all population groups who may use these new cancer treatments in clinical trial settings. Europeans are disproportionately affected by cancer with cancer mortality rates being substantially affected by inequities in socioeconomic education status. General and political recognition of cancer injustices in the EU have further increased given the contemptuously unequal impacts of the legal and policy responses to it. While innovative advances in cancer research have bridged much of these critical gaps particularly in the last few decades more work needs to be done to circumvent implications of cancer health disparities. To reduce cancer health disparities, systemic and individual-level barriers to cancer clinical trial participation must be addressed through effective and ethically rigorous EU health laws and policies.