Dr. Nassr Nama and colleagues mark the 75th anniversary of Pediatrics with a reflective, humble, and self-critical assessment of trends in the use of race as a variable in articles published in Pediatrics over the past 75 years (10.1542/peds.2023-064819). Dr. Nama’s co-authors include the editor and deputy editor, an associate editor, an editorial board member, and 2 editorial fellows of Pediatrics.
This remarkable undertaking utilized a structured approach with both quantitative and qualitative aspects to assess trends in racial bias and the use of race as a variable over time.
The authors examined a stratified random sample of 50 research articles published per decade in Pediatrics (1948–2022), for a total of 375 articles.
The main outcome was:
- Was race a study variable? If so, was race considered a biological or social variable?
Additional outcomes included any statements reflecting:
- Explicit bias (bias of which we are consciously aware)
- Implicit bias (those attitudes and beliefs that occur outside our conscious thinking)
- Inappropriate terminology
- Methods of collection and analysis of race data
In summary, 147 articles (39%) included race as a variable; 85% of these provided race information only to describe study subjects, but this proportion increased significantly over time from 20% to 60% (p<0.01).
More concerning, 22% of (US) studies included statements that reflected explicit or implicit bias, with prevalent use of inappropriate terminology such as undefined “other” and “minorities” categories. The article includes much more information, and tables and figures summarize additional results.
The authors acknowledge that guidance on this topic has evolved over time, and that race-based medicine, in which race was assumed to be a biological rather than a social construct, was prevalent for decades. With recent recognition of race as a social construct, our understanding that health inequities that mirror racial categories represent structural and systematic racism has slowly followed.
But what can we do with this unsettling information? We can, and must, do better. While language does matter, it is not manuscripts describing scientific studies that need to change; the way studies are conducted must change. This means investigators will need to struggle to overcome their own implicit biases, because without self-reflection that is operationalized in study conduct, we are bound to repeat our mistakes regardless of good intention.
Meaningful inclusion of the voices and ideas of persons who are the subjects of interest for the research is essential. For example, community-based participatory research is an approach in which researchers and community members work as equals in the research process, identifying topics, concerns, and methods that align with the community’s needs. If this is beyond reach, inclusion of a Community Advisory Board composed of community members can also bring these voices to the research table. Recruitment that respects the preferences and practices of community members, inclusion of patient/participant centered outcomes, and analysis that centers on the population of interest (rather than assuming the referent race as White) are approaches that can aid us. The blunt and self-reflective article by Nama and colleagues is an excellent start for us all, including Pediatrics’ scientists, reviewers, and readers.
