Comparison of Reporting Race and Ethnicity in Medical Journals Before and After Implementation of Reporting Guidance, 2019-2022

Annette Flanagin,1 Miriam Y. Cintron,1 Stacy L. Christiansen,1 Tracy Frey,1 Timothy Gray,1 Iris Y. Lo,1 Roger J. Lewis1,2.3,4


Previous research found limited progress in reporting race and socioeconomic status in research published in medical journals from 2015 to 2019.1 This study compared race and ethnicity reporting in 3 JAMA Network medical journals before and after implementation of Updated Guidance on Reporting Race and Ethnicity in Medical and Science Journals in August 2021.2


All major research articles published in JAMA, JAMA Internal Medicine, and JAMA Pediatrics in the first 3 months of 2019 and 2022 and the 3 months immediately before guidance implementation (May-July 2021) were included. Articles were reviewed independently by 2 reviewers for the following: study included human participants; race and ethnicity, age, sex and gender, and measures of socioeconomic status reported; where race and ethnicity was reported (abstract, methods, results, tables); number and order of racial and ethnic categories reported; if the category “other” was included and if that was defined; and if the article indicated how race and ethnicity were determined. Comparisons between years were calculated with χ² for 2-sided P values, odds ratios (ORs), and Wald test 95% CIs using R version 4.2.0.


Of 258 research articles published during the study periods, 249 (96.5%) included human participants and were included in this analysis. In 2019, 49 of 86 articles (57.0%) reported race and ethnicity of study participants compared with 42 of 77 (54.5%) in 2021 and 58 of 86 (67.4%) in 2022 (Table 4). Compared with articles reporting race and ethnicity, higher proportions of articles reported participants’ age and sex or gender and a lower proportion reported socioeconomic status measures in all years. There were no significant differences in article location of reporting race and ethnicity or the proportion of articles that reported racial and ethnic categories. Of articles that included “other” as a collective racial and ethnic category, the proportion that defined specific categories included in “other” was 26.7% in 2019, 70.4% in 2021, and 84.8% in 2022, with a significant difference observed before guidance implementation in 2021 vs 2019 (OR, 6.53; 95% CI, 2.05-20.76; P < .001). A significant difference after reporting guidance implementation was observed for articles listing categories in alphabetical order (92.6% in 2022 vs 16.7% in 2021 [OR 73.75; 95% CI, 20.15-269.99; P < .001]) and articles indicating how race and ethnicity were determined (74.1% in 2022 vs 50.0% in 2021 [OR, 2.87; 95% CI, 1.23-6.66; P = .01]).


In this analysis, higher proportions of articles reported how race and ethnicity were determined and listed categories in alphabetical order in 2022 following the implementation of reporting guidance. Some improvement was noted before 2021 and may have been associated with internal guidance shared in October 2020 and publication of an early draft of the guidance in February 2021.3 Overall, race and ethnicity were still underreported compared with age, sex, and gender.


1. Alegria M, Sud S, Steinberg BE, Gai N, Siddiqui A. Reporting of participant race, sex, and socioeconomic status in randomized clinical trials in general medical journals, 2015 vs 2019. JAMA Netw Open. 2021;4(5):e2111516. doi:10.1001/jamanetworkopen.2021.11516

2. Flanagin A, Frey T, Christiansen SL; AMA Manual of Style Committee. Updated guidance on the reporting of race and ethnicity in medical and science journals. JAMA. 2021;326(7):621-627. doi:10.1001/jama.2021.13304

3. Flanagin A, Frey T, Christiansen SL, Bauchner H. The reporting of race and ethnicity in medical and science journals: comments invited. JAMA. 2021;325(11):1049-1052. doi:10.1001/jama.2021.2104

1JAMA Network, Chicago, IL, USA, annette.flanagin@jamanetwork.org; 2Berry Consultants LLC, Austin, TX, USA; 3Harbor-UCLA Medical Center, Torrance, CA, USA; 4David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

Conflict of Interest Disclosures

Stacy L. Christiansen is chair and Annette Flanagin and Tracy Frey are members of the AMA Manual of Style committee. Annette Flanagin is executive director of the Peer Review Congress but was not involved in the review or decision for this abstract.