The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis
Introduction Black, Asian and minority ethnic (BAME) people are disproportionately affected by COVID-19. Respiratory protective equipment (RPE) has conventionally been developed for a predominantly white male population that does not represent the healthcare workforce. The literature was reviewed to...
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BMJ Publishing Group
2021-11-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/6/11/e005537.full |
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| author | Ying Cheong Jagrati Chopra Nkemjika Abiakam Hansung Kim Cheryl Metcalf Peter Worsley |
| author_facet | Ying Cheong Jagrati Chopra Nkemjika Abiakam Hansung Kim Cheryl Metcalf Peter Worsley |
| author_sort | Ying Cheong |
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| description | Introduction Black, Asian and minority ethnic (BAME) people are disproportionately affected by COVID-19. Respiratory protective equipment (RPE) has conventionally been developed for a predominantly white male population that does not represent the healthcare workforce. The literature was reviewed to determine the protection offered to female and BAME users.Methods Five databases were searched. Eligible studies related to respirator fit in the context of anthropometrics, gender and ethnicity. Meta-analysis was performed for gender-based anthropometric differences. A priori protocol registration was not performed.Results 32 studies were included and anthropometric data was extracted from 15 studies. Meta-analysis revealed 14 anthropometric measurements were significantly smaller for females. Mean differences ranged from 0.37 mm to 22.05 mm. Gender-based anthropometric differences did not always translate to lower fit factor scores, with 12 studies reporting worse performance and fit for females and 10 reporting no gender effect. No studies provided disaggregate anthropometric data by ethnic group. Pass rates (PR) were low or moderate in 12 BAME or mixed-ethnicity cohorts. 14 studies reported associations between facial dimensions (FD) and respirator fit. Three comparative studies showed lower PR among selective BAME people. 18 studies reported RPE performance differed with model and design. Most studies did not prespecify inclusion/exclusion criteria. Small sample size and lack of justification or power calculations was a concern. Significant heterogeneity in study designs limited comparisons, particularly relating to respirator selection or availability and defining study outcomes relating to RPE performance.Conclusion The literature reports on largely Caucasian or single ethnic populations, and BAME people remain under-represented, limiting comparisons between ethnic groups. Facial anthropometrics vary between gender and likely between ethnicity, which may contribute to lower PR among females and ethnic minorities, particularly Asians. There is a need for studies including a broader spectrum of ethnicities and for consideration of female and BAME users during RPE development. |
| format | Article |
| id | doaj-art-aef0e1f835d94dae80e1f7f1a200d101 |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2021-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-aef0e1f835d94dae80e1f7f1a200d1012025-08-20T02:18:58ZengBMJ Publishing GroupBMJ Global Health2059-79082021-11-0161110.1136/bmjgh-2021-005537The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysisYing Cheong0Jagrati Chopra1Nkemjika Abiakam2Hansung Kim3Cheryl Metcalf4Peter Worsley5Scool of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UKScool of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UKSchool of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UKSchool of Electronics and Computer Science, University of Southampton, Southampton, UKSchool of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UKSchool of Health Sciences, University of Southampton, Southampton, UKIntroduction Black, Asian and minority ethnic (BAME) people are disproportionately affected by COVID-19. Respiratory protective equipment (RPE) has conventionally been developed for a predominantly white male population that does not represent the healthcare workforce. The literature was reviewed to determine the protection offered to female and BAME users.Methods Five databases were searched. Eligible studies related to respirator fit in the context of anthropometrics, gender and ethnicity. Meta-analysis was performed for gender-based anthropometric differences. A priori protocol registration was not performed.Results 32 studies were included and anthropometric data was extracted from 15 studies. Meta-analysis revealed 14 anthropometric measurements were significantly smaller for females. Mean differences ranged from 0.37 mm to 22.05 mm. Gender-based anthropometric differences did not always translate to lower fit factor scores, with 12 studies reporting worse performance and fit for females and 10 reporting no gender effect. No studies provided disaggregate anthropometric data by ethnic group. Pass rates (PR) were low or moderate in 12 BAME or mixed-ethnicity cohorts. 14 studies reported associations between facial dimensions (FD) and respirator fit. Three comparative studies showed lower PR among selective BAME people. 18 studies reported RPE performance differed with model and design. Most studies did not prespecify inclusion/exclusion criteria. Small sample size and lack of justification or power calculations was a concern. Significant heterogeneity in study designs limited comparisons, particularly relating to respirator selection or availability and defining study outcomes relating to RPE performance.Conclusion The literature reports on largely Caucasian or single ethnic populations, and BAME people remain under-represented, limiting comparisons between ethnic groups. Facial anthropometrics vary between gender and likely between ethnicity, which may contribute to lower PR among females and ethnic minorities, particularly Asians. There is a need for studies including a broader spectrum of ethnicities and for consideration of female and BAME users during RPE development.https://gh.bmj.com/content/6/11/e005537.full |
| spellingShingle | Ying Cheong Jagrati Chopra Nkemjika Abiakam Hansung Kim Cheryl Metcalf Peter Worsley The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis BMJ Global Health |
| title | The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis |
| title_full | The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis |
| title_fullStr | The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis |
| title_full_unstemmed | The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis |
| title_short | The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis |
| title_sort | influence of gender and ethnicity on facemasks and respiratory protective equipment fit a systematic review and meta analysis |
| url | https://gh.bmj.com/content/6/11/e005537.full |
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