Underreporting and underrepresentation of racial and ethnic minorities limit trial generalizability. This issue is documented in stroke but less clear among other acute neurology trials. We assessed race and ethnicity reporting in U.S. acute neurology trials, hypothesizing inconsistent reporting/underrepresentation of disproportionately affected groups. Systematic review of MEDLINE/Embase (07/1990-12/2025) identifying adult U.S. phase II–IV acute neurology trials reporting race and/or ethnicity. Two reviewers screened/extracted data using Covidence®. Of 379 full-text articles, 27 (7%) otherwise eligible trials were excluded for lacking race and/or ethnicity data (n=6798): 15 covered acute ischemic stroke (AIS), 5 subarachnoid hemorrhage (SAH), 1 intracerebral hemorrhage (ICH), 2 traumatic brain injury, 3 seizures/status epilepticus (SE), and 1 encephalitis. The final cohort included 24 trials (n=10,811; 1999-2025): AIS (12), ICH/intraventricular hemorrhage (IVH) (6), SAH (4), and seizures/SE (2). Race included White in 23 (96%), Black/African American in 18 (75%), Asian in 10 (42%), American Indian/Alaska Native in 3 (13%), and Native Hawaiian/Other Pacific Islander in 1 (4%). Ethnicity was reported in 15, with 10 (67%) using it interchangeably with race. White individuals comprised >50% of patients in 19 (79%) trials. Six (26%) used non-standard/outdated categories. Only 17.4% reported who classified race and ethnicity (75% being self/family-reported). ICH/IVH trials largely matched epidemiology (5/6), with Black representation up to 56.2% and Asian 15–18%. AIS varied: 4 lacked Black patients; 6 reported 7–13%; 2 reported 17 and 29%; and 5 lacked Hispanic patients (otherwise 2–24%). SAH trials reported Black and Hispanic patients 7–28% and 6–32%, respectively, with ethnicity absent in 2/4. SE trials reported Black patients between 21–26%. Race and ethnicity reporting in acute neurology trials remains inconsistent and frequently misaligned with incidence patterns. Given higher disease burden among Black and Hispanic individuals, improved reporting and recruitment are needed for equitable representation.
Comparan et al. (Wed,) studied this question.