Asian-American Pacific Islander Representation in Outcomes Research: NSQIP Scoping Review.

Chao, Grace F; Emlaw, Jonel; Chiu, Alexander S; Yang, Jie; Thumma, Jyothi; Brackett, Alexandria; Pei, Kevin Y

BACKGROUND If Asian American and Pacific Islanders (AAPIs) are not recognized within patients in health services research, we miss an opportunity to ensure health equity in patient outcomes. However, it is unknown what the rates are of AAPI inclusion in surgical outcomes research. STUDY DESIGN Through a scoping review, we used Covidence to search MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, and CINAHL for studies published 2008-2018 using National Surgical Quality Improvement Program (NSQIP) data. NSQIP was chosen given its national scope, widespread use in research, and coding inclusive of AAPIs. We examine the proportion of studies representing AAPIs in the demographics, methods, results, or discussion. We then performed multivariable logistic regression to examine associations between study characteristics and AAPI inclusion. RESULTS In 1,264 studies included for review, 62% included race. Overall, only 22% (n=278) of studies included AAPIs. Of studies that included race, 35% represented AAPIs in some component of the study. We found no association between sample size or publication year and inclusion. Studies were significantly more likely to represent AAPIs when there was a higher AAPI population in the region of the first author institution (lowest vs highest tercile, P<.001). Studies with a disparities focus were more likely to include AAPIs (P=0.001). CONCLUSIONS Our study is the first to examine AAPI representation in surgical outcomes research. We found <75% of studies examine race despite availability within NSQIP. Little more than a third of studies including race reported on AAPIs as a separate group. To provide the best care, we must include AAPI patients in our research.