Exclusion of Non-English Speakers in Published Emergency Medicine Research - A Comparison of 2004 and 2014

BACKGROUND: Non-English speakers (NES) as a proportion of the United States population have steadily increased in recent years. There remains substantial risk of excluding NES from research. OBJECTIVE: To assess whether the percentage of emergency medicine (EM) studies that exclude Non-English speakers from participation has changed with time. METHODS: In a structured fashion, the lead investigator analyzed all original research articles in Academic Emergency Medicine and Annals of Emergency Medicine retrospectively for 2004 and prospectively for 2014. An independent investigator conducted a blind review of a sample of articles to assess for interobserver agreement. Demographic data were analyzed using descriptive statistics. Chi-square, t-tests, and linear regression models were utilized; alpha set at 0.05. Cohen’s kappa calculated to assess interrater reliability. RESULTS: We included a total of 236 original research articles. Overall, 11% excluded NES from research (10% AEM, 12% Annals). Cohen’s kappa (nonweighted) was 0.73. Comparing all articles in 2004 vs. 2014, research excluded NES 6% vs. 16% of the time respectively (P=0.02). This was not statistically significant when comparing year to year for AEM (7.3% vs. 14.5%; P=0.12) and Annals (6.7% vs. 19%; P=0.06) separately. Factors affecting NES exclusion included type of study design (P<0.001), geographic area (P=0.009) and hospital type (P=0.035). Interestingly, 42% of articles failed to mention language as an exclusion or inclusion criteria. CONCLUSION: We found that the percentage of articles excluding NES from EM research increased between 2004 and 20014. Further, many investigators do not report whether NES are excluded/included in their studies.