Improving Racial and Ethnic Representation in Pediatric Trials

March 24, 2022
Armand Butera

Armand Butera is the assistant editor for HCPLive. He attended Fairleigh Dickinson University and graduated with a degree in communications with a concentration in journalism. Prior to graduating, Armand worked as the editor-in-chief of his college newspaper and a radio host for WFDU. He went on to work as a copywriter, freelancer, and human resources assistant before joining HCPLive. In his spare time, he enjoys reading, writing, traveling with his companion and spinning vinyl records. Email him at

Dr. Rees spoke of how addressing issues of representation could improve upon disparities in health care not only in the pediatric space but across all fields.

Representation of different racial and ethnic groups in clinical trials has been an ongoing concern across all clinical fields, and pediatrics is no exception.

A recent study from Emory University School of Medicine found that the number of pediatric clinical trials that reported participant race and ethnicity had increased from 2011 to 2020. However, participant race and ethnicity were still underreported.

Lead study author Chris A. Rees, MD, MPH, Division of Pediatric Emergency Medicine at Emory University and Emergency Department Attending Physician at Children's Healthcare of Atlanta, spoke of how addressing issues of representation could improve upon disparities in health care not only in the pediatric space but across all medical fields.

“Overall, as a field, it’s time that we start moving more towards solutions,” said Rees. “In our mind, this was an actionable way to include representation.”

Rees and colleagues examined a 10-year period between 2011 and 2020 through the lens of a diversity index, which is a methodological approach that was developed in 1949. The team reviewed a variety of different factors across the 612 clinical trials included in the study such as trial size, stakeholder input (which showed lower odds of enrolling a diverse population), and more.

Overall, while the methods used for diversifying clinic trials have been lacking in recent years, Rees noted a trend towards more proactive measures.

“We've done things wrong for some time in terms of enrollment of children based on their race and ethnicity and in terms of treatment of patients based on their race and ethnicity,” Rees said. “So, I do think over the last few years, there has been the sort of awakening. We also saw that a lot of journals actually require the inclusion of rationale for including children of different races and ethnicities and require the reporting of race and ethnicity.”

Despite being a pediatric emergency medicine doctor, Rees felt that it was crucial to enroll diverse populations across all trials regardless of age.

“Some of the references we have showed that as low as 27% of adult trials, report participant race and ethnicity,” Rees said. “I truly think that it doesn't matter what the patient's age is, we should be thinking about being equitable and enrolling diverse populations.”