Socioeconomic disparities in clinical trials on Alzheimer's disease: a systematic review

摘要

Background and purpose There is now a wide consensus at recognizing social and economic circumstances as main determinants of an individual's health status. Nevertheless, characteristics relating to socioeconomic status ( SES ) are poorly described in research reports. The aim of the present review was to verify whether the SES of participants is adequately reported in interventional studies targeting Alzheimer's disease ( AD ), and to explore the impact of SES proxy measures on the efficacy of the considered medications. Methods A systematic review of available randomized controlled trials ( RCT s) on the currently marketed drugs for AD (i.e. cholinesterase inhibitors and memantine) was conducted by performing a structured search on PubMed and the Cochrane databases. The following indicators of SES were considered in the retained studies: (i) educational level, (ii) lifetime job category, (iii) income and (iv) wealth. The study quality was assessed using the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Results A total of 48 articles were finally selected. Overall, only eight RCT s reported data concerning the four considered SES indicators. Indeed, only information pertaining to the educational level of participants was provided. Only one RCT ( n = 60) performed ad hoc , secondary analyses accounting for the SES of participating subjects. Conclusions The research and clinical relevance of SES has mistakenly been overlooked by the vast majority of RCT s on AD . A greater effort should be made to collect and report data on those SES indicators that may significantly affect the clinical manifestations and trajectories of patients with cognitive disturbances.