An assessment of randomized controlled trials (RCTs) for non-communicable diseases (NCDs): more and higher quality research is required in less developed countries

Abstract

Research is crucial to implement evidence-based health interventions for control of non-communicable diseases (NCDs). This study aims to assess main features of randomized controlled trials (RCTs) for control of NCDs, and to identify gaps in clinical research on NCDs between high-income and less developed countries. The study included 1177 RCTs in 82 Cochrane Systematic reviews (CSRs) and evaluated interventions for adults with hypertension, diabetes, stroke, or heart diseases. Multivariate logistic regression analyses were conducted to explore factors associated with risk of bias in included RCTs. We found that 78.2% of RCTs of interventions for major NCDs recruited patients in high-income countries. The number of RCTs included in the CSRs was increasing over time, and the increasing speed was more noticeable for RCTs conducted in middle-income countries. RCTs conducted in less developed countries tended to be more recently published, less likely to be published in English, with smaller sample sizes, and at a higher risk of bias. In conclusion, there is still a lack of research evidence for control of NCDs in less developed countries. To brace for rising NCDs and avoid waste of scarce research resources, not only more but also higher quality clinical trials are required in low-and-middle-income countries.

An assessment of factors associated with quality of randomized controlled trials for smoking cessation

“…In addition, the quality of RCTs conducted in multiple nations belonging to different income groups was higher than those conducted in either high-income countries or in LMICs. However, the current study found no significant difference in quality between RCTs in LMICs and those in high-income countries, in contrast to findings from a previous study [ 7 ]. It should be acknowledged that the number of RCTs from LMICs in this study is very small (n=30), and reported quality may not necessarily reflect the true quality of trials [ 53 ].…”

“…Although the flow of research evidence is currently mainly from developed to less developed countries, it has been recently emphasized that high quality research in LMICs may also benefit developed countries [ 61 ]. According to findings from the current study and a previous study [ 7 ], collaboration between researchers in developed and less developed countries will be more likely to generate higher quality evidence. International and national research funding bodies need to encourage and support more studies of smoking cessation and tobacco control that are collaboratively conducted by researchers in developed and less developed countries.…”

“…Previous studies found that most research on tobacco control were conducted in high-income countries [ 5 , 6 ], and the quality of RCTs on non-communicable diseases in less developed countries tended to be lower than those in developed countries [ 7 ]. Evidence on the overall quality of RCTs on smoking cessation and associated factors remains scarce.…”

Differences and Similarities in Diabetes Research between China and the USA

“…Studies on NCDs from LMICs is limited [4,5,6] and of poorer quality than those conducted in developed countries [7]. For example, a bibliometric analysis of diabetes research in India showed that research was focused more on epidemiology and less on prevention strategies or therapeutic interventions [8].…”

What Global Oncology Needs: Mutual Learning and More Funding

“…3,4 It is interesting to note that although trials conducted in LMICs are, on average, of lower quality than trials conducted in HICs, trials conducted in both LMICs and HICs tend to be of an even higher quality than trials done only in HICs. 5 Thus, future collaborations should focus more on teaching how to fish rather than providing fish (ie, help LMICs build capacities for clinical research and trials to innovate and implement ideas of local importance rather than to simply encourage LMICs to copy what HICs do). 6 History is replete with examples of HICs collaborating with LMICs to co-develop low-cost and effective interventions adapted to the needs of LMICs.…”