Racial and Ethnic Representation Reporting in Orthopaedic Research

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Abstract
Introduction: Orthopaedic research informs clinical practice, making it critical to collect data that reflect diverse patient demographics, including race and ethnicity. Despite the importance of these variables in addressing healthcare disparities, race and ethnicity are often underreported in orthopaedic studies. The aim of this study was to evaluate the frequency of race and ethnicity reporting in high-impact orthopaedic journals and identify trends based on study characteristics. Methods: Original research published between January 1, 2018, and December 31, 2020, in Clinical Orthopaedics and Related Research (CORR), Journal of Bone and Joint Surgery , and Journal of Orthopaedic Trauma (JOT) was compiled for analysis. Data on publication date, study type, level of evidence, country, and demographic variables were collected. Reporting rates were compared with the US Census 2020 diversity index and the Historical Index for Ethnic Fractionalization for global reporting, creating a performance ratio (PR) to quantify underreporting or overreporting based on geographic diversity. Results: Among 1452 studies, 89.2% reported sex and 86.5% reported age, but only 18.9% included race and 6.1% included ethnicity. Reporting was highest in Level II studies (29.3% race, 10.2% ethnicity) and cross-sectional studies (31.0% race, 11.2% ethnicity). United States–based studies reported race and ethnicity more frequently (28.0%), with the highest PR in Hawaii, New Hampshire, and Washington DC. Internationally, Japan, Thailand, and Finland had the highest PR. Reporting varied by journal, with CORR leading in race reporting (23.9%) and JOT in ethnicity (8.0%). Discussion: Race and ethnicity are markedly underreported in orthopaedic research. Addressing this disparity through standardized guidelines and enforcement mechanisms is essential to improve research quality and identify healthcare inequities. Additional exploration of these variables can better characterize diverse patient populations and inform clinical practice.

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