Guidance for industry collection of race and ethnicity data in clinical trials

Guidance for Industry
U.S. Department of Health and Human Services
Food and Drug Administration
Center for Drug Evaluation and Research (CDER)
Center for Biologics Evaluation and Research (CBER)
Center for Devices and Radiologic Health (CDRH)
Office of the Commissioner (OC)
September 2005
Clinical Medical
Guidance for Industry
Additional copies are available from: Office of Training and Communications Division of Drug Information, HFD-240 Center for Drug Evaluation and Research (CDER) 5600 Fishers Lane, Rockville, MD 20857 http://www.fda.gov/cder/guidance/index.htm Office of Communication, Training, and Center for Biologics Evaluation and Research (CBER) 1401 Rockville Pike, Rockville, MD 20852-1488 Phone: 800-835-4709 or 301-827-1800 http://www.fda.gov/cber/guidelines.htm U.S. Department of Health and Human Services
Food and Drug Administration
Center for Drug Evaluation and Research (CDER)
Center for Biologics Evaluation and Research (CBER)
Center for Devices and Radiologic Health (CDRH)
Office of the Commissioner (OC)
September 2005
Clinical Medical
TABLE OF CONTENTS
I. INTRODUCTION.1
II. BACKGROUND .2
A. RELEVANCE OF POPULATION SUBGROUP STUDIES .3 B. FDA DECISION TO RECOMMEND USE OF THE OMB CATEGORIES.3 III. COLLECTING RACE AND ETHNICITY DATA IN CLINICAL TRIALS .4
IV. CLINICAL TRIALS CONDUCTED OUTSIDE OF THE UNITED STATES.5
PRESENTATION OF DEMOGRAPHIC TABULATIONS IN THE eCTD .6
APPENDIX 1 .8
HISTORY OF FEDERAL EFFORTS IN DATA COLLECTION ON RACE AND ETHNICITY AND
OTHER SUBPOPULATIONS .8
APPENDIX 2 .12
REVISED DIRECTIVE 15.12
REFERENCES .16
BIBLIOGRAPHY.17
Contains Nonbinding Recommendations
Guidance for Industry1
Collection of Race and Ethnicity Data in Clinical Trials
This guidance represents the Food and Drug Administration's (FDA's) current thinking on this topic. It does not create or confer any rights for or on any person and does not operate to bind FDA or the public. An alternative approach may be used if such approach satisfies the requirements of the applicable statutes and regulations.

I. INTRODUCTION

This guidance recommends using a standardized approach for collecting and reporting race and
ethnicity information in clinical trials conducted in the United States and abroad for certain FDA
regulated products. The recommended standardized approach was developed by the Office of
Management and Budget (OMB). The guidance lists the OMB categories for race and ethnicity
and describes FDA's reasons for recommending the use of these categories. In addition, this
guidance recommends a format for race and ethnicity data within study data that are submitted in
standardized data sets such as the Study Data Tabulation Model2 or in the electronic Common
Technical Document (eCTD).3
This document is intended to provide guidance on meeting the requirements set forth in the 1998
final rule on investigational new drug (IND) applications and new drug applications (NDAs)4
(Demographic Rule). The Demographic Rule requires IND holders to tabulate in their annual
report the number of subjects enrolled in clinical studies of drugs and biologic products by age,
race, and gender, and sponsors of NDAs to include summaries of effectiveness and safety data for
important demographic subgroups, including racial subgroups.5 This guidance is also intended to
help applicants in preparing biologics license applications (BLAs).
1 This guidance has been developed by the Agency-wide Race and Ethnicity Working Group from the Office of the Commissioner (OC), the Center for Biologics Evaluation and Research (CBER), the Center for Drug Evaluation and Research (CDER), and the Center for Devices and Radiological Health (CDRH) of the Food and Drug Administration (FDA). 2 See CDISC standardized Study Data Tabulation Model (SDTM), Analysis Data Model (ADaM), Operational Data Model (ODM) at http://www.cdisc.org. 3 See FDA's guidance for industry titled M4 Common Technical Document for the Registration of Pharmaceuticals for Human Use (eCTD guidance) for the submission file location of the table format presented in section V of this guidance. Available at http://www.fda.gov/cder/regulatory/ersr/ectd.htm. 4 63 FR 6854 (February 11, 1998) (codified at 21 CFR 312.33(a)(2) and 21 CFR 314.50(d)(5)). 5 21 CFR 312.33(a)(2). See also 21 CFR 314.50(d)(5)(v) and (vi)(a) regarding demographic data submission in NDAs. Contains Nonbinding Recommendations
Although the regulations governing medical devices do not include requirements for the
collection of demographic data comparable to those for INDs and NDAs, for those cases in which
race and ethnicity data are relevant to determining the safety and effectiveness of a device, FDA
encourages sponsors to collect the data in accordance with the OMB recommendations and the
information collection standards discussed in this guidance document. Sponsors are also
encouraged to discuss any race or ethnicity issues with the appropriate review division in the
Office of Device Evaluation, Center for Devices and Radiological Health, when developing their
study protocols.
This guidance does not address the level of participation of racial and ethnic groups in clinical
trials. For questions related to the level of participation or the size of a study sponsors should
consult with the review division prior to the start of a study.
FDA's guidance documents, including this guidance, do not establish legally enforceable
responsibilities. Instead, guidances describe the Agency's current thinking on a topic and should
be viewed only as recommendations, unless specific regulatory or statutory requirements are
cited. The use of the word should in Agency guidances means that something is suggested or
recommended, but not required.

II.
BACKGROUND
FDA regulations require sponsors of NDAs to present a summary of safety and effectiveness data by demographic subgroups (age, gender, race), as well as an analysis of whether modifications of dose or dosage intervals are needed for specific subgroups (21 CFR 314.50 (d)(5)(v) and (vi)(a)).6 One consideration in such summaries is the identification of a subject’s race or ethnicity. In 1997, OMB issued its revised recommendations for the collection and use of race and ethnicity data by Federal agencies (Policy Directive 15).7 FDA is now recommending the use of the standardized OMB race and ethnicity categories for data collection in clinical trials for two reasons. First, the use of the recommended OMB categories will help ensure consistency in demographic subset analyses in applications submitted to FDA (21 CFR 314.50(d)(5)(v) and (vi)(a), 312.120, 314.106(b), and 601.2) and in data collected by other government agencies. Second, consistency in these categories may make the demographic subset analysis more useful in evaluating potential differences in the safety and efficacy of pharmaceutical products among 6 Under 21 CFR 314.101(d)(3), the Agency may refuse to file an NDA if it is incomplete because it does not contain information required by 21 CFR 314.50. Thus, if there is an inadequate evaluation for safety and/or effectiveness of the population intended to use the drug, including pertinent subsets, such as gender, age, and racial subsets the Agency may refuse to file the application. See FDA's guidance for industry titled New Drug Evaluation Guidance Document: Refusal to File, available on the Internet at http://www.fda.gov/cder/guidance/index.htm. 7 Statistical Policy Directive No. 15, Race and Ethnic Standards for Federal Statistics and Administrative Reporting, 1997 (reprinted in Appendix 2). See also the OMB guidance entitled Provisional Guidance on the Implementation of the 1997 Standards for Federal Data on Race and Ethnicity (2000), available at http://www.whitehouse.gov/omb/bulletins/b00-02.html. Contains Nonbinding Recommendations
population subgroups. To assess potential subgroup differences in a meaningful way, it is important to use uniform, standard methods of defining racial and ethnic subgroups. Relevance of Population Subgroup Studies
Differences in response to medical products have already been observed in racially and ethnically distinct subgroups of the U.S. population.8 These differences may be attributable to intrinsic factors (e.g., genetics, metabolism, elimination), extrinsic factors (e.g., diet, environmental exposure, sociocultural issues), or interactions between these factors. For example, in the United States, Whites9 are more likely than persons of Asian and African heritage to have abnormally low levels of an important enzyme (CYP2D6) that metabolizes drugs belonging to a variety of therapeutic areas, such as antidepressants, antipsychotics, and beta blockers (Xie 2001). Other studies have shown that Blacks respond poorly to several classes of antihypertensive agents (beta blockers and angiotensin converting enzyme (ACE) inhibitors) (Exner 2001 and Yancy 2001). Racial differences in skin structure and physiology that can affect response to dermatologic and topically applied products have been noted (Taylor 2002). Clinical trials have demonstrated lower responses to interferon-alpha used in the treatment of hepatitis C among Blacks when compared with other racial subgroups (McHutchison 2000 and Reddy 1999). FDA Decision to Recommend Use of the OMB Categories
The OMB stated that its race and ethnicity categories were not anthropologic or scientifically based designations, but instead were categories that described the sociocultural construct of our society. The Department of Health and Human Services (HHS) chose to adopt these standardized categories for its agencies that report statistics because the categories are relevant to assessing various health related data, including public health surveillance and research. FDA believes that the use of the current OMB categories and any future revisions will facilitate comparisons across clinical studies analyzed by FDA and data collected by other agencies. Collection of data using standard categories can enhance patient safety by helping FDA evaluate potential differences in drug response among subpopulations. Using standard categories may also facilitate analyses seeking to identify differences in response. Although FDA has long requested race and ethnicity data on subjects in certain clinical trials, the Agency has not previously made explicit recommendations on the categories to use when collecting and reporting the data. In 1998, the Agency issued the Demographic Rule, which reflected growing recognition within the Agency and the health community that (1) different subgroups of the population may respond differently to specific drug products, and (2) although an effort should be made to look for differences in effectiveness and adverse reactions among such subgroups, that effort is not being made consistently.10 In the Demographic Rule, FDA 8 In fact, in June of 2005, FDA approved BiDil, the first drug approved by the Agency to treat a disease in patients identified by race. The drug was approved for the treatment of heart failure in black patients. The company conducted two trials in the general population that failed to show a benefit, but suggested a benefit of BiDil in black patients. The company then studied the drug in 1,050 self-identified black patients and it was shown to be safe and effective. 9 The terms used in this guidance to describe the various racial and ethnic groups are those used by OMB. 10 63 FR 6854 at 6855, February 11, 1998. Contains Nonbinding Recommendations
discussed the importance of collecting data in clinical trials (and of presenting those data in
applications to the Agency) on population subgroups organized by gender, race, age, and other
relevant categories. The Agency recommended that sponsors ask subjects in certain clinical trials
to identify their racial group and, if desired, that sponsors use OMB categories when collecting
race and ethnicity data.11
During the past two decades, efforts have been under way in a number of Federal organizations to
collect race and ethnicity data in Federal programs in a standardized way. (See Appendix 1 for a
summary of those efforts). In 1997, HHS issued a document entitled Policy Statement on
Inclusion of Race and Ethnicity in DHHS Data Collection Activities.12 In this policy statement,
HHS adopted the revised OMB categories for including race and ethnicity in HHS funded and
sponsored data collection and reporting systems. The HHS policy states that the categories
described in revised OMB Directive 15 and its future revisions should be used when collecting
and reporting data in HHS data systems or reporting HHS funded statistics.13
The Agency recommends that sponsors use the categories outlined in this guidance when
collecting race and ethnicity data in clinical studies for FDA-regulated products conducted in
United States and abroad. More detailed race and ethnicity data can be collected when
appropriate to the study or locale, but we recommend that these more detailed race and ethnicity
data be related to the identified OMB categories of all clinical trial participants when submitting
such data to the Agency.

III.
COLLECTING RACE AND ETHNICITY DATA IN CLINICAL TRIALS

The recommendations in this section reflect the Agency's interest in more consistent data
collection. For studies conducted in the United States, the Agency recommends that a two-
question format be used, and that trial participants self-report their racial and ethnic ancestral
origins. Based on the current OMB Directive, the Agency provides the following
recommendations for the collection of the data:
1. We recommend using the two-question format for requesting race and ethnicity information,
with the ethnicity question preceding the question about race. 11 In the preamble to the final rule, FDA stated that it did not believe it was necessary to define specific racial categories in the rule itself because drug sponsors have been successful in identifying the relevant racial categories to examine safety and efficacy profiles of drugs (63 FR 6854 at 6859). However, FDA now believes that using uniform categories will enhance the consistency and comparability of data across studies submitted in marketing applications and other government reported statistics. 12 Memorandum issued by HHS Sec. Donna Shalala on October 24, 1997 reaffirming HHS’ commitment to the inclusion of data on minority groups in research, services and related activities. Effective as of November 1,1997. Available at http://aspe.hhs.gov/datacncl/inclusn.htm. 13 OMB directed these activities to begin by January 1, 2003, in all Federal programs, including HHS. Although in the past FDA sought and received a variance from OMB exempting the Agency from reporting data using the Directive 15 categories, FDA now recommends the use of the categories to enhance data consistency. To view the policy memorandum see: http://www.hhs.gov/oirm/infocollect/nclusion.html Contains Nonbinding Recommendations
2. We recommend that study participants self-report race and ethnicity information whenever feasible, and that individuals be permitted to designate a multiracial identity. When the collection of self-reported designations is not feasible (e.g., because of the subject’s inability to respond), we recommend that the information be requested from a first-degree relative or other knowledgeable source. 3. For ethnicity, we recommend the following minimum choices be offered: • Hispanic or Latino • Not Hispanic or Latino 4. When race and ethnicity information is collected separately, we recommend the following • American Indian or Alaska Native • Asian • Black or African American • Native Hawaiian or Other Pacific Islander • White 5. In certain situations, as recommended in OMB Directive 15, more detailed race and ethnicity information may be desired (e.g., White can reflect origins in Europe, the Middle East, or North Africa; Asian can reflect origins from areas ranging from India to Japan). If more detailed characterizations of race or ethnicity are collected to enhance data consistency, we recommend these characterizations be traceable to the five minimum designations for race and two designations for ethnicity (five and two) listed in numbers 3 and 4. When more detailed characterizations are desired, the use of Race and Ethnicity vocabulary tables located within Health Level Seven’s15 Reference Information Model Structural Vocabulary Tables is recommended. These tables provide the OMB characterizations traceable to more detailed characterizations and concept ID code sets to help ensure that traceability is consistent. Where gaps exist in the representation of race or ethnicity categories, sponsors are encouraged to discuss the race or ethnicity issue with the appropriate review division. CLINICAL TRIALS CONDUCTED OUTSIDE OF THE UNITED STATES
To assist in assessing the relevance of foreign study population data to U.S. populations, we recommend that sponsors use the OMB standardized categories when collecting data from study participants in clinical trials conducted outside of the United States. However, FDA recognizes that the recommended categories for race and ethnicity were developed in the United States and that these categories may not adequately describe racial and ethnic groups in foreign countries. Therefore, for studies conducted outside the United States, we recommend using more detailed categories to provide sponsors the flexibility to adequately characterize race and ethnicity. If 14 To identify ancestral origins for each of the named categories see OMB Directive 15 (Appendix 2). 15 Health Level Seven (HL7), an American National Standards Institute (ANSI) accredited organization, has been designated by the Department as a Standards Development Organization for the development of interoperability standards for health care and health related information, and is available at http://hl7.org. Contains Nonbinding Recommendations
sponsors choose to use more detailed characterizations of race and ethnicity, it is important for analytical purposes that the data can be traced back to the recommended categories described below. When more detailed characterizations are desired, the use of the Race and Ethnicity vocabulary tables located within Health Level Seven’s Reference Information Model Structural Vocabulary Tables is recommended16. These tables provide the five and two OMB characterizations traceable to more detailed characterizations and concept ID code sets and their use will help ensure that traceability is consistent. Where gaps exist in the representation of race or ethnicity categories, sponsors are encouraged to discuss the issue with the appropriate review division. 1. For ethnicity, we recommend the following categories or the use of categories that are mappable to the two categories listed below: • Hispanic or Latino • Not Hispanic or Latino 2. When race is collected separately in clinical studies conducted in foreign countries, we recommend that the categories be modified to reflect the following, as appropriate: • American Indian or Alaska Native • Asian • Black • Native Hawaiian or Other Pacific Islander • White Note that the ethnic and racial categories for studies inside and outside the United States are the same, except for one racial designation: the racial designation is African American in the United States, whereas it is Black for studies conducted in foreign countries.
V. PRESENTATION OF DEMOGRAPHIC TABULATIONS IN THE eCTD

For INDs, NDAs, BLAs and relevant device submissions we recommend the submission of
tabulated demographic data based on the Demographic Rule for all clinical studies using the
characterizations of race and ethnicity described in this guidance.
For submitting an electronic application not in FDA's typical application format (i.e., when using
the ICH document for submitting a marketing application to FDA and regulatory agencies in
Japan and Europe, the eCTD) presentation of demographic data is described in ICH M4E eCTD
Guidance (section 2.7.4.1.3 and table 2.7.4.2), which suggests a tabular display of demographic
characteristics (e.g., age, gender, race) by treatment group (e.g., active drug, placebo). The
document suggests specific kinds of demographic information to be collected as a part of a
clinical trial, but does not provide rigid specifications on how the data should be presented,
noting, for example, that “if relative exposure of demographic groups in the controlled trials
differ from the overall exposure, it may be useful to provide separate tables.” Choices of how
16 These tables are located at http://hl7.org. To locate the tables from HL7’s home page click on HL7 Standards under Resources, then RIMS, HL7 Reference Model Structured Vocabulary Tables in HTML, 2.1 HL7 Vocabulary Domain Values and select either the Race or Ethnicity table from the list. Contains Nonbinding Recommendations
best to summarize demographic data depend on the nature of the data to be conveyed. For some trials, it may be useful to show the distribution of one demographic characteristic within a second demographic (e.g., the age distribution of men and women enrolled in a set of controlled trials). With regard to the description of race and ethnicity, the categories that are suggested previously in this document (sections III and IV) are preferable to those suggested in ICH M4E eCTD guidance. Contains Nonbinding Recommendations
APPENDIX 1
HISTORY OF FEDERAL EFFORTS IN DATA COLLECTION ON RACE AND
ETHNICITY AND OTHER SUBPOPULATIONS

For more than 20 years, a number of U.S. Government initiatives have tried to address questions
related to whether to and how to collect race and ethnicity data. Major initiatives are reviewed
briefly here.
Office of Management and Budget (OMB) Initiatives

In May 1977, OMB issued “Statistical Policy Directive No. 15, Race and Ethnic Standards for
Federal Statistics and Administrative Reporting.” The standards were developed in response to
the need to enforce civil rights laws in education. These classifications were not to be interpreted
as being scientific or anthropological in nature, or to be viewed as determinants of eligibility for
participation in any Federal program. They were developed in response to needs expressed by
both the Executive Branch and the Congress to provide for the collection and use of compatible,
nonduplicated, exchangeable race and ethnicity data by Federal agencies. This Directive
specified four categories for race:
• American Indian or Alaskan Native • Asian or Pacific Islander • Black • White • Hispanic • Not of Hispanic origin The OMB Directive specified two questionnaire formats for data collection: (1) a format combining race and ethnicity, and (2) a preferred format with two separate questions for race and ethnicity. Since 1993, efforts have been under way to standardize the collection of race and ethnicity data to foster comparability across data collection and reporting systems. In 1997, OMB published Directive 15, “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity” (see Appendix 2). These revisions specified the minimum racial and ethnic diversity categories to be used when race and ethnicity are included in data collection and reporting for Federal programs. The Directive does not require that race and ethnicity be included in data collection and reporting; rather, it specifies what formats and categories to use when collecting this kind of data. The revised OMB standards made the following changes: Contains Nonbinding Recommendations
• Introduced the option of reporting more than one race for multiracial persons • Divided the Asian or Pacific Islander category into two — one labeled Asian, the other Native Hawaiian or Other Pacific Islander • Changed Hispanic to Hispanic or Latino • Changed Black to Black or African-American • Strongly encouraged the use of self-identification • Maintained the two-question format for race and Hispanic ethnicity when self- identification is used (the Hispanic origin question should precede the race question) The revised categories were described in an OMB guidance entitled Implementation of the 1997
Standards for Federal Data on Race and Ethnicity (2000) as sociopolitical and intended for use
in the collection of health data, among other types of statistics.
Department of Health and Human Services Initiatives
In 1999, the Department of Health and Human Services (HHS) issued a report, Improving the
Collection and Use of Racial and Ethnic Data in HHS. The report describes HHS policy on
collecting and reporting data on race and ethnicity for HHS programs. The report asks for the
inclusion of race and ethnicity categories in HHS funded and sponsored data collection and
reporting systems in all HHS programs, including in both health and human services. This policy
clearly states that the minimum standard categories in OMB Directive 15 and revisions should be
used when collecting and reporting data in HHS data systems or reporting HHS funded statistics.
The policy was developed to (1) help monitor HHS programs, (2) determine whether Federal
funds are being used in a nondiscriminatory manner, and (3) promote the availability of standard
race and ethnicity data across various agencies to facilitate HHS responses to major health and
human services issues.
National Institutes of Health Initiatives

In 1993, the National Institutes of Health (NIH) Revitalization Act directed NIH to establish
guidelines for including women and minorities in NIH-sponsored clinical research. NIH was
directed to ensure that women and minorities were included as subjects, unless their exclusion
was justified due to circumstances specified by NIH guidelines. Furthermore, clinical trials were
to be designed and carried out in a manner that would elicit information about individuals of both
genders and diverse racial and ethnic groups to examine differential effects on such groups. NIH
guidelines stipulate that when proposing a Phase 3 clinical trial, evidence must be reviewed to
establish whether or not there are potentially clinically important gender- and minority-based
differences in the anticipated effects of the intervention. If previous studies support the existence
of significant differences, the primary questions and design of the study must specifically
accommodate this. For example, if men and women are thought to respond differently to an
intervention, then the Phase 3 clinical trial must be designed to answer two separate primary
questions, one for men, and the other for women. When prior studies support no significant
differences for either gender or minorities with a given intervention, then gender and minority
status will not be required as subject selection criteria, although the inclusion and analysis of both
genders and minorities is strongly encouraged. When prior studies neither support nor negate
significant differences, then the design of the Phase 3 clinical trial will be required to support
Contains Nonbinding Recommendations
sufficient representation of both genders and minorities to allow for valid analysis of the
intervention effects across all groups. However, the trial will not be required to provide high
statistical power for these comparisons.
Food and Drug Administration Initiatives

Beginning in the 1980s, FDA grew concerned about possible differences in drug safety and
efficacy among different population subgroups. Because the origins of subpopulation issues stem
from the identification of differences in response in women and geriatric populations, references
to those initiatives are included below. In 1983, the Agency initiated development of guidance
on the study of drugs to be used in geriatric patients. FDA's Guideline for the Study of Drugs
Likely to be Used in the Elderly was issued in 1989.
The first regulation specifying the analysis of population subsets appeared in 1985 in 21 CFR
314.50, which called for evidence to support the “dosage and administration section of the
labeling, including support for the dosage and dose interval recommended,” and modifications for
specific subgroups (e.g., pediatrics, geriatrics, patients with renal failure) (21 CFR
314.50(d)(5)(v)).
In 1988, the Agency issued guidance describing elements of a new drug application's analysis of
clinical study data. Guideline for the Format and Content of the Clinical and Statistical Sections
of New Drug Applications emphasized the importance of conducting subset analyses on data from
clinical studies submitted in new drug applications (NDAs). This guidance specified race and
ethnicity as types of population subsets for which separate analyses of data from clinical studies
should be conducted for assessments of product safety and effectiveness.
In July 1993, FDA published a guidance on the study of drugs in both genders entitled Guideline
for the Study and Evaluation of Gender Differences in the Clinical Evaluation of Drugs. The
guidance specifically called for analyzing trials by gender and for evaluating pharmacokinetics in
women. In the Federal Register notice announcing the guidance, FDA also abandoned the policy
explained in a 1977 guidance, excluding women of childbearing potential from participation in
the earliest phases of clinical trials.
In 1993, FDA also published New Drug Evaluation Guidance Document: Refusal to File, on the
Agency's use of the refusal-to-file (RTF) option if certain analyses were not performed. The
guidance states that the Agency can exercise its RTF authority under 21 CFR 314.101(d)(3) if
there is “inadequate evaluation for safety and/or effectiveness of the population intended to use
the drug, including pertinent subsets, such as gender, age, and racial subsets.”
In the Food and Drug Administration Modernization Act of 1997 (the Modernization Act),
Congress directed FDA to examine issues related to the inclusion of racial and ethnic groups in
clinical trials of new drugs. Section 115(b) of the Modernization Act required the Secretary, “in
consultation with the Director of the National Institutes of Health and with representatives of the
drug manufacturing industry, [to] review and develop guidance, as appropriate, on the inclusion
of women and minorities in clinical trials. . . .” (codified at 21 U.S.C. 355(b)(1)). In response,
FDA established the Women and Minorities Working Group to review and implement this
Contains Nonbinding Recommendations
section of the Modernization Act. In a report issued on July 20, 1998, the Working Group
concluded that the Agency would implement procedures to enhance its ability to gather and
evaluate demographic data, and then decide whether additional guidance should be developed in
the future.
In 1998, the Agency published the Demographic Rule, which amended the language in 21 CFR
312.33(a)(2) and 314.50(d)(5), requiring sponsors to (1) tabulate the numbers of participants in
clinical trials by age group, gender, and race in investigational new drug application (IND)
annual reports, (2) characterize the data in NDAs according to these same subgroups, and (3)
when appropriate, present safety data from other subgroups of the population of patients, such as
for patients with hepatic or renal failure or patients with different levels of severity of the
disease.
In 1999, a guidance for industry entitled Population Pharmacokinetics made recommendations
on the use of population pharmacokinetics in the drug development process to help identify
differences in drug safety and efficacy among population subgroups, including race and
ethnicity. This guidance recommended that industry conduct clinical studies in subjects
representative of the population to be treated with the drug.
In 2002, the Best Pharmaceuticals for Children Act (Public Law 107-109, January 4, 2002)
directed FDA to monitor the racial and ethnic designations of children participating in clinical
studies for pharmaceutical products.
ICH E5 - Guidance on Ethnic Factors in the Acceptability of Foreign Clinical Data

In 1999, as part of an international effort by Japan, the European Union, and the United States to
harmonize technical requirements for pharmaceutical drug development and regulation (the
International Conference on Harmonization (ICH)), the FDA published a guidance entitled E5
Guidance on Ethnic Factors in the Acceptability of Foreign Clinical Data (63 FR 31790, June
10, 1999), to permit the clinical data collected in one region to be used in the registration or
approval of a drug or biological product in another region, while allowing for the influence of
ethnic factors. The E5 guidance defines ethnic factors that affect response in terms of both
intrinsic and extrinsic issues. Because differences in ethnic factors have the potential to affect
responses in some subpopulations, the E5 guidance provides a general framework for evaluating
medicines with regard to their sensitivity to ethnic factors.
Contains Nonbinding Recommendations
APPENDIX 2
REVISED DIRECTIVE 15
OMB Standards for Maintaining, Collecting, and Presenting
Federal Data on Race and Ethnicity

This classification provides a minimum standard for maintaining, collecting, and presenting data
on race and ethnicity for all Federal reporting purposes. The categories in this classification are
social-political constructs and should not be interpreted as being scientific or anthropological in
nature. They are not to be used as determinants of eligibility for participation in any Federal
program. The standards have been developed to provide a common language for uniformity and
comparability in the collection and use of data on race and ethnicity by Federal agencies.
The standards have five categories for data on race: American Indian or Alaska Native, Asian,
Black or African American, Native Hawaiian or Other Pacific Islander, and White. There are two
categories for data on ethnicity: Hispanic or Latino, and Not Hispanic or Latino.
1.
Categories and Definitions

The minimum categories for data on race and ethnicity for Federal statistics, program
administrative reporting, and civil rights compliance reporting are defined as follows:
American Indian or Alaska Native. A person having origins in any of the original peoples of
North and South America (including Central America), and who maintains tribal affiliation or
community attachment.
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or
the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American. A person having origins in any of the black racial groups of
Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black or African
American.”
Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin, regardless of race. The term, “Spanish origin,” can be used in
addition to “Hispanic or Latino.”
Native Hawaiian or Other Pacific Islander. A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White. A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.
Contains Nonbinding Recommendations
Respondents shall be offered the option of selecting one or more racial designations.
Recommended forms for the instruction accompanying the multiple response question are “Mark
one or more” and “Select one or more.”

2.
Data Formats

The standards provide two formats that may be used for data on race and ethnicity. Self-
reporting or self-identification using two separate questions is the preferred method for collecting
data on race and ethnicity. In situations where self-reporting is not practicable or feasible, the
combined format may be used.
In no case shall the provisions of the standards be construed to limit the collection of data to the
categories described above. The collection of greater detail is encouraged; however, any
collection that uses more detail shall be organized in such a way that the additional categories can
be aggregated into these minimum categories for data on race and ethnicity.
With respect to tabulation, the procedures used by Federal agencies shall result in the production
of as much detailed information on race and ethnicity as possible. However, Federal agencies
shall not present data on detailed categories if doing so would compromise data quality or
confidentiality standards.

a. Two-question format
To provide flexibility and ensure data quality, separate questions shall be used wherever feasible
for reporting race and ethnicity. When race and ethnicity are collected separately, ethnicity shall
be collected first. If race and ethnicity are collected separately, the minimum designations are:
Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
When data on race and ethnicity are collected separately, provision shall be made to report the
number of respondents in each racial category who are Hispanic or Latino. When aggregate data
are presented, data producers shall provide the number of respondents who marked (or selected)
only one category, separately for each of the five racial categories. In addition to these numbers,
data producers are strongly encouraged to provide the detailed distributions, including all
possible combinations of multiple responses to the race question. If data on multiple responses
are collapsed, at a minimum the total number of respondents reporting “more than one race” shall
be made available.
Contains Nonbinding Recommendations

b. Combined format
The combined format may be used, if necessary, for observer-collected data on race and
ethnicity. Both race (including multiple responses) and ethnicity shall be collected when
appropriate and feasible, although the selection of one category in the combined format is
acceptable. If a combined format is used, there are six minimum categories:
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
When aggregate data are presented, data producers shall provide the number of respondents who
marked (or selected) only one category, separately for each of the six categories. In addition to
these numbers, data producers are strongly encouraged to provide the detailed distributions,
including all possible combinations of multiple responses. In cases where data on multiple
responses are collapsed, the total number of respondents reporting “Hispanic or Latino and one or
more races” and the total number of respondents reporting “more than one race” (regardless of
ethnicity) shall be provided.

3.
Use of the Standards for Record Keeping and Reporting

The minimum standard categories shall be used for reporting as follows:

a. Statistical reporting
These standards shall be used at a minimum for all federally sponsored statistical data collections
that include data on race and/or ethnicity, except when the collection involves a sample of such
size that the data on the smaller categories would be unreliable, or when the collection effort
focuses on a specific racial or ethnic group. Any other variation will have to be specifically
authorized by the OMB through the information collection clearance process. In those cases
where the data collection is not subject to the information collection clearance process, a direct
request for a variance shall be made to OMB.

b. General program administrative and grant reporting
These standards shall be used for all Federal administrative reporting or record keeping
requirements that include data on race and ethnicity. Agencies that cannot follow these standards
must request a variance from OMB. Variances will be considered if the agency can demonstrate
that it is not reasonable for the primary reporter to determine racial or ethnic background in terms
of the specified categories, that determination of racial or ethnic background is not critical to the
administration of the program in question, or that the specific program is directed to only one or a
limited number of racial or ethnic groups.
Contains Nonbinding Recommendations

c. Civil rights and other compliance reporting
These standards shall be used by all Federal agencies in either the separate or combined format
for civil rights and other compliance reporting from the public and private sectors and all levels
of government. Any variation requiring less detailed data or data which cannot be aggregated
into the basic categories must be specifically approved by OMB for executive agencies. More
detailed reporting which can be aggregated to the basic categories may be used at the agencies'
discretion.

4.
Presentation of Data on Race and Ethnicity

Displays of statistical, administrative, and compliance data on race and ethnicity shall use the
categories listed above. The term “nonwhite” is not acceptable for use in the presentation of
Federal Government data. It shall not be used in any publication or in the text of any report. In
cases where the standard categories are considered inappropriate for presentation of data on
particular programs or for particular regional areas, the sponsoring agency may use:
a. The designations “Black or African American and Other Races” or “All Other Races” as
collective descriptions of minority races when the most summary distinction between the majority and minority races is appropriate;
b. The designations “White,” “Black or African American,” and “All Other Races” when the
distinction among the majority race, the principal minority race, and other races is appropriate; or
c. The designation of a particular minority race or races, and the inclusion of “Whites” with “All
Other Races” when such a collective description is appropriate. In displaying detailed information that represents a combination of race and ethnicity, the description of the data being displayed shall clearly indicate that both bases of classification are being used.
When the primary focus of a report is on two or more specific identifiable groups in the
population, one or more of which is racial or ethnic, it is acceptable to display data for each of the
particular groups separately and to describe data relating to the remainder of the population by an
appropriate collective description.

5.
Effective Date
The provisions of these standards are effective immediately for all new and revised record keeping or reporting requirements that include racial and/or ethnic information. All existing record keeping or reporting requirements shall be made consistent with these standards at the time they are submitted for extension, or not later than January 1, 2003. Contains Nonbinding Recommendations
REFERENCES

Exner, D., D. Dries, M. Donamski, and J. Cohn, 2001, “Lesser Response to Angiotensin- Converting-Enzyme Inhibitor Therapy in Black as Compared with White Patients With Left Ventricular Dysfunction,” N Engl J Med, 344: 1351-1357. Freedman, L.S., R.M. Simon, M.A. Foulkes, L.M. Freedman, N.L. Gordon, et al., 1995, “Inclusion of Women and Minorities in Clinical Trials and the NIH Revitalization Act — the Perspective of NIH Clinical Trialists,” Control Clin Trials, 16(5):277-285, 310-312. McHutchison, J., T. Poynard, S. Pianko, S. Gordon, A. Reid, et al., 2000, “The Impact of Interferon Alpha Plus Ribavirin on Response to Therapy in Black Patients with Chronic Hepatitis C. The International Hepatitis Interventional Therapy Group,” Gastroenterology, 119: 1317-23. Reddy, K. R., J. Hoofnagle, M. Tong, W. Lee, P. Pockros, et al., 1999, “Racial Differences in Responses to Therapy with Interferon in Chronic Hepatitis C. Consensus Interferon Study Group,” Hepatology, 30: 787-93. Taylor, S., 2002, “Skin of Color: Biology, Structure, Function, and Implications for Dermatologic Disease,” Journal of American Academy of Dermatology, 46:S41-62. Xie, H., R. Kim, A. Wood, and C. Stein, 2001, “Molecular Basis of Ethnic Differences in Drug Disposition and Response,” Annu Rev Pharmacol Toxicol, 41:815-50. Yancy, C., M. Fowler, W. Colucci, E. Gilbert, M. Bristow, et al., 2001, “Race and the Response to Adrenergic Blockade with Carvedilol in Patients with Chronic Heart Failure,” N Engl J Med, 344: 1358-1365. Contains Nonbinding Recommendations
BIBLIOGRAPHY

DHHS Policy and Reports
Department of Health and Human Services (DHHS), 1997, Policy For Improving Race and Ethnicity Data, October 24, 1997, http://www.hhs.gov/oirm/infocollect/nclusion.html. DHHS, 1999, Improving the Collection and Use of Racial and Ethnic Data in HHS, joint report of the HHS Data Council Working Group on Racial and Ethnic Data and the Data Work Group of the HHS Initiative to Eliminate Racial and Ethnic Disparities in Health, December 1999, http://aspe.hhs.gov/datacncl/racerpt/index.htm. FDA Regulations
Food and Drug Administration (FDA), 1998, “Investigational New Drug Applications and New Drug Applications,” Final Rule, Federal Register (63 FR 6854, February 11, 1998). FDA, Content and Format for Human Prescription Drugs; Addition of “Geriatric Use” Subsection in the Labeling, Final Rule, Federal Register (62 FR 45313, August 27, 1997). FDA Guidance for Industry
Clinical Studies Section of Labeling for Prescription Drugs and Biologics (Draft)17 Content and Format for Geriatric Labeling Content and Format of the Adverse Reactions Section of Labeling for Human Prescription Drugs and Biologics (Draft) General Considerations for Pediatric Pharmacokinetic Studies for Drugs and Biological Products (Draft) General Considerations for the Clinical Evaluation of Drugs Format and Content of the Clinical and Statistical Sections of an Application Study and Evaluation of Gender Differences in the Clinical Evaluation of Drugs Study of Drugs Likely to be Used in the Elderly In Vivo Drug Metabolism/Drug Interaction Studies — Study Design, Data Analysis, and Recommendations for Dosing and Labeling Pharmacokinetics in Patients with Impaired Hepatic Function: Study Design, Data Analysis, and Impact on Dosing and Labeling Pharmacokinetics in Patients with Impaired Renal Function: Study Design, Data Analysis and Impact on Dosing and Labeling 17 Draft guidances are included for completeness only. As draft documents, they are not intended to be implemented until published in final form. Contains Nonbinding Recommendations
ICH Guidances
ICH, E4 Dose Response Information to Support Drug Registration ICH, E5 Ethnic Factors in the Acceptability Of Foreign Data ICH, E7 Studies in Support of Special Populations: Geriatrics ICH, E11 Clinical Investigation of Medicinal Products in the Pediatric Population ICH, M4 Common Technical Document for the Registration of Pharmaceuticals for Human Use Other Sources
Office of Management and Budget, 1994, Standards for the Classification of Federal Data on Race and Ethnicity, http://www.whitehouse.gov/omb/fedreg/notice_15.html. General Accounting Office, FDA Needs to Ensure More Study of Gender Differences in Prescription Drug Testing, GAO/HFD-93-17. NIH Revitalization Act of 1993, (PL 103-43). NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research- Updated August 1, 2000. Available at http://grants.nih.gov/grants/funding/women_min/women_min.htm. Food and Drug Administration Modernization Act of 1997 (Public Law 105-115). Best Pharmaceuticals Act for Children of 2002 (Public Law 107-109).

Source: http://www.hmc.mil.ar/webResources/Documentos/Guidance_industry.pdf