Is health research undertaken where the burden of disease is greatest? Observational study of geographical inequalities in recruitment to research in England 2013-2018
Is health research undertaken where the burden of disease is greatest? Observational study of geographical inequalities in recruitment to research in England 2013-2018
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DOI：
10.1186/s12916-020-01555-4
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发表时间：
2020-05-18
期刊：
影响因子：
9.3
通讯作者：
Abel, Kathryn
中科院分区：
文献类型：
--
作者：
Bower, Peter;Grigoroglou, Christos;Abel, Kathryn
研究是高质量护理的基础，但人们对是否在受高疾病流行率影响最严重的人群中进行健康研究表示担忧。研究活动的地理分布很重要，原因有很多。招聘是开展研究的一个主要障碍，在流行率高的地区进行招聘可能会更有效率。风险因素和结果存在区域差异，因此在健康人群中进行的研究可能无法推广。许多应用卫生研究评估干预措施，其影响可能因环境（包括地理）而异。最后，公平性要求所有人都应该能够获得由政府资助的研究，这样参与研究的利益才能得到公平的分配。我们探讨了健康研究的患者招募是否与英格兰的疾病流行率一致。方法我们使用英格兰的质量和结果框架（总的长期条件，心理健康和糖尿病）测量疾病患病率。我们使用NIHR临床研究网络的数据来衡量研究活动。我们提供了招募率的地理差异的描述性数据。我们探讨了招募率和疾病患病率之间的关系。我们计算了需要重新分配的患者招募比例，以使招募与患病率保持一致。我们评估了招募率和疾病患病率之间的关联是否随条件和时间而变化。结果招募率存在明显的地域差异。当按疾病流行率对地区进行排名时，招募与流行率不一致，在长期和精神健康状况总体流行率较高的地区，招募比例低得不成比例。在15个地方网络一级，分析表明，目前约有12%的招募活动需要重新分配，以适应疾病流行情况。总体而言，对齐显示随着时间的推移变化不大，但随着时间的推移，在个别条件下的趋势有变化。结论招募的地理差异并不能反映研究人群的适宜性。应制定指标，以评估研究与需求之间的匹配程度，并允许评估资助者、研究人员和患者之间的干预措施，以鼓励研究活动与负担之间更密切的协调。
Background Research is fundamental to high-quality care, but concerns have been raised about whether health research is conducted in the populations most affected by high disease prevalence. Geographical distribution of research activity is important for many reasons. Recruitment is a major barrier to research delivery, and undertaking recruitment in areas of high prevalence could be more efficient. Regional variability exists in risk factors and outcomes, so research done in healthier populations may not generalise. Much applied health research evaluates interventions, and their impact may vary by context (including geography). Finally, fairness dictates that publically funded research should be accessible to all, so that benefits of participating can be fairly distributed. We explored whether recruitment of patients to health research is aligned with disease prevalence in England. Methods We measured disease prevalence using the Quality and Outcomes Framework in England (total long-term conditions, mental health and diabetes). We measured research activity using data from the NIHR Clinical Research Network. We presented descriptive data on geographical variation in recruitment rates. We explored associations between the recruitment rate and disease prevalence rate. We calculated the share of patient recruitment that would need to be redistributed to align recruitment with prevalence. We assessed whether associations between recruitment rate and disease prevalence varied between conditions, and over time. Results There was significant geographical variation in recruitment rates. When areas were ranked by disease prevalence, recruitment was not aligned with prevalence, with disproportionately low recruitment in areas with higher prevalence of total long-term and mental health conditions. At the level of 15 local networks, analyses suggested that around 12% of current recruitment activity would need to be redistributed to align with disease prevalence. Overall, alignment showed little change over time, but there was variation in the trends over time in individual conditions. Conclusions Geographical variations in recruitment do not reflect the suitability of the population for research. Indicators should be developed to assess the fit between research and need, and to allow assessment of interventions among funders, researchers and patients to encourage closer alignment between research activity and burden.