What can we really do to give meaning and momentum to equality, diversity and inclusion in EM research?

A copy of the slides for my talk on how we can meaningfully improve diversity and inclusion in emergency care research, at the Royal College of Emergency Medicine Research Engagement Day in May 2024.

1. GIVING MEANING & MOMENTUM TO
ED&I IN EMERGENCY CARE RESEARCH
Prof Rick Body

3. 0%
10%
20%
30%
40%
93% 95% 97% 99%
What if you're
Black?
Pulse oximetry is less likely to recognise
hypoxia in Black patients when compared
with White patients
Chance
of occult
hypoxia
SpO2 observed
Valbuena et al, BMJ 2022;
378:e069775

4. We should undertake a multi-professional audit of
devices used in our field, examining potential
racial biases. We can record rashes at Skin Deep:
Optical devices
We must consider equity in all research proposals
Social, economic and health equity impacts must
be considered.
AI algorithms
Royal Colleges should produce guidance on equity and ethical
challenges of applying polygenic risk scores in our
populations.
Polygenic Risk Scores

5. https://www.nber.org/system/files/working
_papers/w30575/w30575.pdf
Black people are
significantly under-
represented in
clinical trials
They are also significantly less likely
to be prescribed new treatments than
White people

6. THE INCLUDE
ETHNICITY
FRAMEWORK
Ensure your eligibility crtiteria and
recruitment pathway do not limit
participation in ways you do not intend
Ensure your trial materials are developed
with inclusion in mind.
Ensure trial staff are culturally
competent.
Build trusting partnerships with community
organisations that work with ethnic
minority groups
Dawson et al. Trials 2022; 23: 672

7. How about
language?
Interpretation: verbal
Translation: written
01
Ensure adequate qualifications: DPSI level602
Budget for translation: 10-15p per word
03

8. WHAT ABOUT
POVERTY?

9. DEPRIVATION IS
ASSOCIATED
WITH…
MORE ED ATTENDANCES
LONGER WAITING TIMES
LESS FREQUENT HOSPITAL ADMISSION
MORE RE-ATTENDANCES & DEATHS
Turner et al, J Health Econ 2022; 102668

10. 100%
COVID-19 & Deprivation
Deprivation was associated
with a higher mortality rate
from COVID-19
COVID
vaccine
uptake
Dolby et al
J Epidemiol Community Health 2022;76:646-652
75%
50%
25%
0%
McGowan et al
Lancet 2022; 7(11): E966-75

11. Increasing
Geographical
Representation
Work with local communities
Understand the barriers
Build trust
Reimburse time
Address travel challenges

12. WOMEN

13. ONE IN THREE
From 325 cardiovascular trials,
women accounted for
Participants
Tobb et al, Am Heart J 2022; 13: 100109

14. In a study, 11 out of 300 drugs showed >40%
difference in pharmacokinetic measures between
men and women
DRUG
METABOLISM
Occur almost twice as often in women compared to
men
ADVERSE DRUG
REACTIONS
Zucker et al, Biol Sex Differ. 2020; 11: 32

15. How can we
do better?
Recognise specific challenges: e.g., carer
responsibilities disproportionately affect women.
01
Regulatory issues: systematic exclusion of women
of childbearing age
02
Recognise the role of under-diagnosis.03

16. ANSWER: ZERO
In a systematic review of 148 clinical trials in
the NIHR journals library, how many recorded
the number of transgender participants?

17. The normal range for common
blood tests (e.g., haemoglobin,
troponin, NT-proBNP) is higher
for men than women.
Q: Which normal range
should be used for
transgender people?

18. The normal range for common
blood tests (e.g., haemoglobin,
troponin, NT-proBNP) is higher
for men than women.
Q: Which normal range
should be used for
transgender people?
A: For trans men, use the
cisgender male range
For trans women, use the
cisgender female range

19. UNDER-RESEARCH
& HEALTH
INEQUALITY
Cass report commissioned systematic
review on gender affirming hormones
Moderate-quality evidence suggests mental
health may be improved during treatment,
but robust study is still required.
Cass recommendation: The option to
provide hormones from age 16 is
available, but the review recommends
extreme caution
All four studies evaluating suicidality
showed reductions (three statistically
significant)
No trans representation in the review team

20. PAEDIATRICS

22. PATIENT & PUBLIC
INVOLVEMENT

24. INCLUSIVE
RESEARCH
MEANS PAYING
ATTENTION TO:
Asking the right questions
Designing your research
Analysing and understanding your
findings
Gathering ‘phase 4’ data

25. Embrace
Mixed
Methods
QUANTITATIVE QUALITATIVE

26. IN SUMMARY
Research that is not inclusive drives health inequality.
01
Ensure cultural competency and representativeness in your
study team.
02
Use established frameworks to reduce inequality.
Consider the value of mixed methods to enhance understanding.
03