Racial and Ethnic Minorities Are Underrepresented Among Studies Informing North American Spine Society Appropriate Use Criteria for Degenerative Spine Conditions

Study DesignComparative study.ObjectivesTo compare the racial and ethnic representation of study participants in primary literature used to develop North American Spine Society (NASS) appropriate use criteria (AUCs) relative to their prevalence in the United States (US) population.MethodsPrimary literature used for the development of NASS AUCs for cervical fusion and degenerative spondylolisthesis were analyzed. Demographic characteristics of study participants were extracted and compared to their prevalence in the US population via participation-to-prevalence ratios (PPRs). A PPR of 0.8-1.2 indicated equivalent representation while a PPR <0.8 and >1.2 was considered underrepresentation and overrepresentation, respectively.ResultsThere were 215 793 study participants available for demographic analysis. Most studies reported sex (38/42, 90%), but fewer studies reported race (11/42, 26%) and ethnicity (8/42, 21%). Male (PPR = 1.01, 95% CI: 0.92-1.11) and female (PPR = 0.98, 95% CI: 0.89-1.07) study participants had equivalent representation in NASS AUCs relative to their prevalence in the US population. White (PPR = 1.38, 95% CI: 1.35-1.41) and Native Hawaiian/Pacific Islander (PPR = 1.86, 95% CI: 0.42.-3.30) study participants were overrepresented, while American Indian/Alaskan Natives (PPR = 1.08, 95% CI: 0.35-1.81) were found to have equivalent representation. There was underrepresentation of Black (PPR = 0.78, 95% CI: 0.55-0.99), Hispanic (PPR = 0.25, 95% CI: 0.24-0.26) and Asian (PPR = 0.32, 95% CI: 0.01-0.63) study participants.ConclusionsThere is limited representation of racial and ethnic minorities in NASS AUCs for degenerative spine conditions, which may limit the translatability of these clinical guidelines to underrepresented groups. Future work is needed to improve racial and ethnic minority representation in clinical spine surgery research.