State of the evidence: a survey of global disparities in clinical trials
State of the evidence: a survey of global disparities in clinical trials
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证据状况：临床试验全球差异的调查
DOI：
10.1101/2020.10.08.20209353
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Marshall I
中科院分区：
文献类型：
--
作者：
Marshall I
理想情况下，造成全球最大疾病负担的健康状况应该引起更多的研究关注。我们进行了一项全面的全球研究，调查了针对不同健康状况发表的随机对照试验 (RCT) 的数量，以及如何将其与它们造成的全球疾病负担进行比较。方法我们使用机器学习每天监控 PubMed，并查找和分析 RCT 报告。我们评估了全球疾病负担研究中调查发病率和死亡率主要原因的随机对照试验。使用回归模型，我们将不同健康状况下的实际随机对照试验数量与根据其全球疾病负担（伤残调整生命年（DALY））预测的数量进行了比较。我们调查了对于社会经济发展水平较低的国家，随机对照试验的数量是否存在差异。结果我们估计，从 1990 年到 2020 年 7 月，发表了 463 000 篇描述随机对照试验的文章（95% 预测区间为 439 000 至 485 000）。随机对照试验招募的参与者中位数为 72 名（IQR 32-195）。 82% 的随机对照试验是由社会经济发展排名前五分之一的国家的研究人员进行的。随着特定健康状况的 DALY 增加 10%，同年的 RCT 数量增加 5% (3.2%–6.9%)，但相关性较弱（调整后的 R2=0.13）。对社会经济发展水平较低的国家影响尤为严重的疾病，包括呼吸道感染和结核病（低于预测的 7000 项随机对照试验）和肠道感染（低于预测的 9700 项随机对照试验），其疾病负担的研究似乎相对不足。伤残调整生命年 (DALY) 每向社会经济发展水平较低和中等的国家转移 10%，随机对照试验 (RCT) 就会减少 4% (3.7%–4.9%)。随着时间的推移，这些差异并没有发生实质性变化。 结论 研究重点没有得到很好的优化，以减轻全球疾病负担。大多数随机对照试验是由高度发达国家制定的，平均而言，这些国家的健康需求受到青睐。
IntroductionIdeally, health conditions causing the greatest global disease burden should attract increased research attention. We conducted a comprehensive global study investigating the number of randomised controlled trials (RCTs) published on different health conditions, and how this compares with the global disease burden that they impose.MethodsWe use machine learning to monitor PubMed daily, and find and analyse RCT reports. We assessed RCTs investigating the leading causes of morbidity and mortality from the Global Burden of Disease study. Using regression models, we compared numbers of actual RCTs in different health conditions to numbers predicted from their global disease burden (disability-adjusted life years (DALYs)). We investigated whether RCT numbers differed for conditions disproportionately affecting countries with lower socioeconomic development.ResultsWe estimate 463 000 articles describing RCTs (95% prediction interval 439 000 to 485 000) were published from 1990 to July 2020. RCTs recruited a median of 72 participants (IQR 32–195). 82% of RCTs were conducted by researchers in the top fifth of countries by socio-economic development. As DALYs increased for a particular health condition by 10%, the number of RCTs in the same year increased by 5% (3.2%–6.9%), but the association was weak (adjusted R2=0.13). Conditions disproportionately affecting countries with lower socioeconomic development, including respiratory infections and tuberculosis (7000 RCTs below predicted) and enteric infections (9700 RCTs below predicted), appear relatively under-researched for their disease burden. Each 10% shift in DALYs towards countries with low and middle socioeconomic development was associated with a 4% reduction in RCTs (3.7%–4.9%). These disparities have not changed substantially over time.ConclusionResearch priorities are not well optimised to reduce the global burden of disease. Most RCTs are produced by highly developed countries, and the health needs of these countries have been, on average, favoured.
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影响因子：
158.5
作者：
Gross, CP;Anderson, GF;Rowe, NR
通讯作者：
Rowe, NR
DOI：
10.1093/jamia/ocaa163
发表时间：
2020-12-09
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Marshall IJ;Nye B;Kuiper J;Noel-Storr A;Marshall R;Maclean R;Soboczenski F;Nenkova A;Thomas J;Wallace BC
通讯作者：
Wallace BC
影响因子：
120.7
作者：
Moses, Hamilton, III;Matheson, David H. M.;Dorsey, E. Ray
通讯作者：
Dorsey, E. Ray
DOI：
10.1016/s0140-6736(17)32130-x
发表时间：
2017-09-16
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2016 DALYs and HALE Collaborators
通讯作者：
GBD 2016 DALYs and HALE Collaborators
DOI：
10.1016/s0140-6736(18)32335-3
发表时间：
2018-11-10
期刊：
Lancet (London, England)
影响因子：
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作者：
GBD 2017 DALYs and HALE Collaborators
通讯作者：
GBD 2017 DALYs and HALE Collaborators