Abstract
IMPORTANCE: The updated race and ethnicity reporting guidelines published in the AMA Manual of Style: A Guide for Authors and Editors highlight the importance of using specific racial and ethnic categories rather than generalized terms, promoting inclusive language, supporting diversity and respect, and examining sociodemographic factors that shape the relationship between race and ethnicity and health outcomes. OBJECTIVE: To evaluate adherence to the AMA Manual of Style's updated race and ethnicity reporting guidelines in the 3 highest-impact ophthalmology journals. EVIDENCE REVIEW: A systematic review of articles published in American Journal of Ophthalmology, JAMA Ophthalmology, and Ophthalmology from August 1, 2023, through August 31, 2024. Articles with a study population were included. Articles were excluded if they lacked a study population, used artificial intelligence, determined race and ethnicity by facial features, or reported ancestry instead of race or ethnicity. FINDINGS: This review yielded 931 research articles, with 525 meeting inclusion criteria. Of these, 491 articles (93.5%) reported age, 472 (89.9%) sex and/or gender, 285 (54.3%) race and/or ethnicity, and 96 (18.3%) socioeconomic measures. Of the 285 articles reporting race and/or ethnicity, 159 (55.8%) reported "race," 155 (54.4%) "ethnicity," and 106 (37.2%) "race/ethnicity" as 1 category. Race was misclassified as ethnicity or vice versa in 54 articles (19.0%); 3 (5.6%) used primary datasets, 13 (24.1%) used secondary, and 38 (70.4%) did not specify. A total of 276 articles (96.8%) reported specific race and/or ethnicity categories; 19 articles (6.9%) collected race and ethnicity data without reporting categories. Race and ethnicity categories were used as nouns in 44 articles (15.4%). "Minority/minorities" was used in 39 articles (13.7%), and the use of a modifier was mixed, with a modifier consistently used in 22 (56.4%), inconsistently in 4 (10.3%), and not at all in 13 (33.3%). Of the 26 articles (9.1%) using "multiracial" or "multiethnic," 5 (19.2%) reported the included categories. "African American" and "Black" were used interchangeably in 23 articles (8.1%), and 36 (12.6%) used "Caucasian" for White race. CONCLUSIONS AND RELEVANCE: In this systematic review of research articles in the 3 highest-impact ophthalmology journals from August 2023 through August 2024, race and ethnicity reporting was substantially nonadherent with updated JAMA recommendations. These findings suggest that improvements in demographic reporting are needed.