Race, ethnicity, and language are underreported in hip fracture CPGs

INTRODUCTION: Clinical Practice Guidelines (CPGs) are systematically developed recommendations based on peer-reviewed literature that guide patient care. Considering the impact of sociodemographic factors on patient outcomes, this study aims (1) to review the racial, ethnic, and linguistic representation of patients in literature utilized to inform the CPGs for hip fractures in older adults and (2) to assess the use of linguistically- and culturally-adapted Patient Reported Outcome Measures (PROM) in these studies. MATERIALS AND METHODS: Publications listed under the American Academy of Orthopaedic Surgeons (AAOS) CPGs for the Management of Hip Fractures in Older Adults were identified and extracted. Variables extracted included: title, author, publication year, inclusion/exclusion criteria, country/ies of study, language of study, patient language, race and ethnicity, patient language proficiency, outcome measures utilized, translation or cultural-adaptation of outcome measures, and clinical trial registration page. The extracted variables were reported descriptively. RESULTS: Of the 196 unique articles included, 12/196 (6.12%) reported race/ethnicity data and 9/196 (4.59%) reported patient language, of which 6/9 (66.7%) reported patient language proficiency. Of the studies that reported patient language or language proficiency, 8/9 (88.9%) specified this data in their inclusion or exclusion criteria. Of the 196 articles, 134/196 (67.4%) used one or more PROMs, and of these 7/134 studies (5.2%) reported the use of one or more translated PROMs. Of these, 4/7 studies (57.1%) reported the use of one or more culturally-adapted PROMs. CONCLUSIONS: This study found a paucity of reporting of patient language, race, and ethnicity in the studies utilized to inform the AAOS CPGs for hip fractures in elderly adults. Additionally, there is minimal usage of translated and/or culturally-adapted PROMs in these studies. As care outcomes are associated with sociodemographic factors, improved reporting of these factors in guideline-informing literature may enhance guideline applicability and health equity. LEVEL OF EVIDENCE: V.