Few headlines have grabbed my attention like this one did today: “Doctors can’t research the health of black men, because they keep getting sent to prison.” The Vox article focused on a new Yale study that, in the words of writer Dara Lund, “suggests that some of the biggest medical studies of the last few decades may have seriously distorted data on African-American men.”
For the study, researcher Emily Wang, MD, MAS, and colleagues examined fourteen long-term trials that began enrolling participants between 1972-2000. They concluded that the high rates of incarceration among black men at this time (as of 2001, one in six black men had been incarcerated) “may have accounted for up to 65 percent of the loss to follow-up among black men in these studies.” Why is this important? As the researchers describe in the paper, which appears in Health Affairs:
The implications of having a disproportionate number of black men drop out of prospective cohort studies because of incarceration are significant, even though the differences between loss to follow-up are not always large or significantly different between black men, white men, black women, and white women. Conditions such as cardiovascular disease and sickle cell disease are more common in black men than in white men and have complex factors that influence morbidity and mortality. This makes it important for analysts to have access to a large number of cases so that they can adjust for possible confounders.
The likely high association between imprisonment and being lost to follow-up in these studies may yield underpowered and biased estimates for black men. Furthermore, participants who are incarcerated are more likely to be sick than are participants who have never been incarcerated. This difference increases the likelihood that disease rates and progression of disease in blacks and black-white disparities will be underestimated.
One possible solution, Wang and her co-authors note, is for incarcerated people to be allowed to continue their participation in a study. But Lind reports that “for now, there doesn’t appear to be much momentum behind [this].”
Previously: NPR explores the need for improving diversity in clinical trials, Study shows deaths from acute leukemia higher in minority patients, A conversation with Augustus White, a pioneer for underrepresented minorities and Surgeon’s memoir calls for an end to health disparities
Photo by Martin Fisch