Inclusion and reporting by age, sex, and ethnicity in clinical studies of high-risk medical devices approved in the European Union
Bibliographic record
Abstract
INTRODUCTION: Adequate inclusion and representation of patients in clinical studies is critical for the generalizability of research findings. The aim of this analysis was to determine inclusion and reporting by age, sex, and ethnicity in clinical studies of high-risk medical devices (orthopaedic, diabetes, and cardiovascular) approved in the European Union. METHODS: This is an analysis of data from three co-ordinated systematic reviews of clinical evidence for high-risk medical devices. This analysis includes 641 studies, reporting on more than 1.9 million patients treated with high-risk orthopaedic, diabetes, and cardiovascular medical devices. The main outcomes were the proportions of studies providing data on the age, sex, and ethnicity of participants, and the performance of stratified analyses based on these factors. RESULTS: The majority (>90%) of studies in all three device categories (orthopaedics, diabetes, and cardiovascular) provided data on the age and sex of participants, but only a minority (<10%) provided information on ethnicity. Female patients comprised over half of the patients in the included orthopaedic and diabetes device studies, but <40% of patients in the included cardiovascular device studies (P < 0.001). A minority of studies performed analyses stratified by age (14.6%) or sex (10.4%), although those were more frequently reported in randomized studies. CONCLUSIONS: Almost all studies in this analysis provided demographic data on age and sex, but only a small minority had analysed whether these factors had any impact on device performance. Very few studies provided information on the ethnicity of study participants. Cardiovascular device studies enrolled a lower proportion of female patients in comparison to orthopaedic and diabetes device studies. STUDY REGISTRATION: Cardiovascular device systematic review: PROSPERO (CRD42022308593). Diabetes device systematic review: PROSPERO (CRD42022366871). Orthopaedic device systematic review: open science framework (https://osf.io/6gmyx).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.340 | 0.533 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.006 | 0.010 |
| Bibliometrics | 0.016 | 0.024 |
| Science and technology studies | 0.002 | 0.004 |
| Scholarly communication | 0.007 | 0.006 |
| Open science | 0.004 | 0.005 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".