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©2023 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

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ABSTRACT 
The language used to describe study participants in the 

medical literature is of paramount importance. The objec-

tive is to use the terms that people use to describe them-

selves while also being sensitive and consistent, supporting 

diversity, and conveying respect. It is also important to 

medical editors that a style guide reflects their responsi-

bilities and need for clear guidance. To this end, the AMA 

Manual of Style committee reassessed our guidance on 

race and ethnicity soon after its release in February 2020 

because we realized that our guidance already needed to 

be updated. We started with some small steps, like deciding 

to capitalize all racial and ethnic categories including Black 

and White, and then ended up dismantling the entire sec-

tion in our quest to develop more robust, comprehensive, 

and thoughtful guidance. After almost a year of research, 

updates, external review, and further revision, we published 

our efforts to garner public feedback, which was successful 

and led to further revision and review. When we were con-

fident that our guidance met our objectives, we published 

our revision in August 2021. Our updates include definitions 

of commonly used terms associated with race and ethnic-

ity, concerns and controversies in health care and research, 

racial and ethnic collective term usage, alphabetization 

of racial and ethnic categories, and geographic origin and 

regionalization considerations, and we provide examples 

to help guide authors and editors. Our current guidance is 

more reflective and complete, and we plan to make further 

revisions as the language and culture evolve.

 

The 11th edition of the AMA Manual of Style was published 

in February 2020, but we made a major update to the sec-

tion on race and ethnicity a year and a half later because we 

realized that our guidance needed to be updated to reflect 

ongoing understanding and the need to report sociodemo-

graphic information more accurately, sensitively, and con-

sistently. Our goal was to provide recommendations and 

suggestions that encourage fairness, equity, consistency, 

and clarity in reporting of race and ethnicity in medical and 

science journals. “Terminology, usage, and word choice are 

critically important, especially when describing people and 

when discussing race and ethnicity. Inclusive language sup-

ports diversity and conveys respect. Language that imparts 

bias toward or against persons or groups based on charac-

teristics or demographics must be avoided.”1

PROCESS
As we have done with all AMA Manual of Style revisions, we 

looked at the current guidance on reporting race and eth-

nicity to determine what was missing and what we wanted 

to add or change. The AMA Manual of Style committee 

began reassessment in the spring of 2020 and talked about 

what the plan would be.

 After an 8-month process of research, updates, exter-

nal review, and more revision, we published our initial 

guidance in February 2021 as an editorial in JAMA1 with 

an invitation for wider public review and feedback, hoping 

to capture the expertise of people we did not seek out ini-

tially. This was a first for us and successful because we had 

dozens of individuals in academia, publishing, and gov-

ernment with expertise in reporting race and ethnicity and 

diversity, equity, and inclusion reach out with suggestions 

and advice. It was a lot to sift through, and we encountered 

several topics for which people outright contradicted one 

another, but the feedback was invaluable and helped us to 

build a stronger, more comprehensive section. We sought 

review once more, and then the final version was published 

in JAMA on August 17, 2021.2 A week later, the content was 

live and freely available in the online AMA Manual of Style.3

KEY PRINCIPLES IN THE UPDATED GUIDANCE
Our revised guidance followed 5 key principles. First, we 

acknowledge that race and ethnicity are social constructs. 

Race is a created concept, not a biological category defined 

by genetic traits or biological differences. Racial and ethnic 

Tracy Frey / JAMA Network, Chicago, IL

Updated Guidance on the Reporting of Race and Ethnicity in  
Medical and Science Journals

TOPICAL FEATURE

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AMWAJournal.org     37Updated Guidance on the Reporting of Race and Ethnicity in Medical Journals

categories are social constructs with limited utility in under-

standing medical research, practice, and policy. However, 

the terms may be useful as a lens through which to study 

and view racism and disparities and inequities in health, 

health care, and medical practice, education, and research. 

The indistinct construct of racial and ethnic categories has 

been increasingly acknowledged, and concerns about use of 

these terms in medical and health research, education, and 

practice have been progressively recognized.

 Second, we knew there would be historical sensitivities 

and controversies related to the language used to describe 

race and ethnicity and associated nomenclature in medical 

and health research, education, and practice, including the 

intersectionality of ancestry and heritage, social determi-

nants of health, and other socioeconomic, structural, insti-

tutional, cultural, and demographic factors.

 Third, race and racism do not exist in isolation, and 

therefore, racial and ethnic descriptors should not be 

reported alone. Other sociodemographic factors and con-

text should be included as much as feasible, if reporting race 

assists in the study of disparities and inequities in health, 

health care, and medical practice, education, and research. 

Language and terminology must be accurate, clear, and pre-

cise, and must reflect fairness, equity, and consistency in 

use and reporting of race and ethnicity.

 Fourth, it should be abundantly clear, particularly in 

research, what the origin of the categories is. Who classified 

individuals, what categories were available, and how these 

determinations were made should be clearly described (eg, 

self-report or selection, investigator observed, database, 

electronic health record, survey instrument). Reporting of 

race and ethnicity should not be considered in isolation and 

should be accompanied by other sociodemographic factors, 

social determinants, and the intersectionality of race and 

ethnicity with these other factors.

 Finally, and most important, the guidance we have put 

forth in the manual is not final. The dialogue continues, and 

we will collect feedback and experience with implementing 

our guidance, which will allow us to make further updates 

to it. Continual review of the terms and language used in the 

reporting of race and ethnicity is critically important as soci-

etal norms continue to evolve.

GUIDANCE COMPONENTS
The revised guidance includes definitions of commonly 

used terms associated with race and ethnicity and acknowl-

edges that these terms and definitions have changed, that 

some are out of date or should not be used, and that the 

nomenclature will continue to evolve.

 We address concerns, sensitivities, and controversies 

in health care and research and provide guidance on the 

reporting of race and ethnicity in research articles, with the 

understanding that editors are working with the data that 

researchers collected. We also provide guidance for capi-

talization; adjectival, punctuation, and abbreviation usage; 

and what order to present categories, as well as examples of 

collective or umbrella terms for racial and ethnic groups.

 Examples are included to help guide authors and edi-

tors, and we will continue to collect feedback and more 

examples to help. In addition, a quiz has been developed 

on race and ethnicity at the AMA Manual of Style website3 

to help editors identify potential issues in reporting and 

explain the rationale for the correct quiz answer, of which in 

some cases there is more than one.

SUMMARY OF APPROPRIATE TERMS WHEN 
REPORTING RACE AND ETHNICITY
The following is a summary of the preferred terms to use 

when reporting race and ethnicity in medical and science 

journals. Complete guidance is available at the online AMA 

Manual of Style,3 and a summary table of appropriate terms 

is available in the Instructions for Authors for JAMA and the 

JAMA Network journals.4

1. All racial and ethnic categories, including Black and 

White, should have initial capitalization, except when 

capitalization could be perceived as inflammatory or 

inappropriate (eg, “white supremacy”). Race and eth-

nicity categories should be listed in alphabetical order, 

not in order of proportion, and “other” and “unknown” 

should be listed last. The categories included in “other” 

groups should be defined and reported. Authors should 

be as specific as possible when reporting on racial and 

ethnic categories (even if these categories contain small 

numbers). If the numbers in some categories are small 

enough to potentially identify study participants, the spe-

cific numbers and percentages do not need to be reported 

provided that this is documented. For cases in which the 

group “other” is used but not defined, the author should 

be queried for further explanation.

2. Race and ethnicity terms should be used as adjectives, 

not nouns. They can be modifiers (eg, Asian patient, Black 

individual, White populations) or predicate adjectives (eg, 

patients who are Asian, Black, or White).

3. Most combinations of proper adjectives derived from 

geographic entities are not hyphenated when used as 

noun or adjective formations, so do not hyphenate these 

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AMWAJournal.org     38Updated Guidance on the Reporting of Race and Ethnicity in Medical Journals

terms and similar combinations as nouns or compound 

modifiers (eg, African American patient).

4.  Generally, abbreviations of categories for race and 

ethnic-ity should be avoided unless necessary because of 

space constraints (eg, in tables and figures). If used, any 

abbre-viations should be clearly explained parenthetically 

in the text or in the table/figure footnotes or legends.

5. Authors use many collective terms when describing racial 

and ethnic minority groups. Many of these terms carry neg-

ative connotations, may be inaccurate or stigmatizing, and 

may be “too inclusive,” to the point that they erase differ-

ences among specific groups.5-8 These terms include mixed 

race; minority and minorities used as nouns; people of color; 

brown; and Black, Indigenous, and people of color (BIPOC), 

Black, Asian, and minority ethnic (BAME), and Black and 

minority ethnic (BME). These terms should be avoided 

unless they were specifically used in data collection, and in 

those cases, the term should be defined, if possible.

a.  The terms multiracial and multiethnic are preferred 

over mixed race in reports of studies if the specific 

categories these terms comprise are defined or if the 

terms were predefined in a study or database to 

which participants self-selected. 

b.  We recommend using the collective terms racial and 

ethnic minority groups and racial and ethnic minority 

individuals, in which minority is used as a modifier 

and not as a stand-alone term. Terms such as under-

served populations (eg, when referring to health 

disparities among groups) or underrepresented pop-
ulation (eg, when referring to a disproportionately 

low number of individuals in a workforce or educa-

tional program) may also be used as collective terms 

provided the categories of individuals included are 

defined at first mention. The term minoritized may be 

acceptable as an adjective provided that the noun(s) 

that it modifies is included (eg, “racial and ethnic 

minoritized group”). Groups that have been histori-

cally marginalized may also be suitable at times if the 

rationale for this description is provided. However, 

preference is for the specific racial or ethnic catego-

ries included or intended to be addressed instead of 

using a collective term.

c.  The terms Hispanic, Latino or Latina, Latinx, and 

Latine are preferred to the term Spanish speaking. 

Avoid reflexively changing Latino and Latina to

Latinx or Latine or vice versa and follow author pref-

erence. Authors of research reports, in turn, should 

use the terms that were prespecified in their study 

(eg, via participant self-report or selection, investi-

gator observed, database, electronic health record, 

survey instrument).

d. Description of people as being of a regional descent 

(eg, of African, Asian, European, or Middle Eastern 

or North African descent) is acceptable if those terms 

were used in data collection. However, it is prefera-

ble to identify a specific country or region of origin 

when known and relevant to the study. It is generally 

preferable to describe individuals of Asian ancestry 

according to their specific country or regional area 

of origin (eg, Cambodian, Chinese, Indian, Japanese, 

Korean, Sri Lankan, East Asian, Southeast Asian). 

Similarly, study participants from the Middle Eastern 

and North African region should be described using 

their nation of origin (eg, Egyptian, Iranian, Iraqi, 

Israeli, Lebanese) when possible. For individuals of 

various ancestries living in the United States, do not 

reflexively add “American.” However, there are times 

it is appropriate. For example, individuals of Middle 

Eastern and North African descent who identify with 

Arab ancestry and reside in the United States may be 

referred to as Arab American. Similar construction 

would be applicable for other groups such as Asian 

American, Indian American, etc. 

e. In reference to persons indigenous to North America, 

American Indian or Alaska Native is generally pre-

ferred over Native American. However, the term 

Indigenous is also acceptable. There also are other 

specific designations for people from other loca-

tions, such as Native Hawaiian and Pacific Islander, 

Indigenous people, Indigenous peoples of Canada, 

and Aboriginal people. If appropriate, specify the 

nation or peoples (eg, Inuit, Iroquois, Mayan, Navajo, 

Nez Perce, Samoan).

f. Avoid collective reference to racial and ethnic 

minority groups as “non-White.” If comparing racial 

and ethnic groups, indicate the specific groups being 

compared. Researchers should avoid study designs 

and statistical comparisons of White groups with 

“non-White” groups and should specify racial and 

ethnic groups included and conduct analyses com-

paring the specific groups. If such a comparison is 

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AMWAJournal.org     39Updated Guidance on the Reporting of Race and Ethnicity in Medical Journals

justified, authors should explain the rationale and 

specify what categories are included in the “non-

White” group.

g. There are similar concerns about dichotomized com-

parisons of only 2 racial or ethnic groups (eg, Black 

vs White patients). If such a comparison is justified, 

authors should explain the rationale for this focused 

comparison limited to only 2 groups.

UPDATE TO JAMA NETWORK JOURNALS’ 
INSTRUCTIONS FOR AUTHORS
In addition to updating the style manual, we also updated 

the Instructions for Authors for JAMA and the JAMA 

Network journals4 with regard to the collection and report-

ing of demographic data on race and ethnicity. We specify 

that the Methods section should include an explanation of 

who identified participant race and ethnicity, the source 

of the classifications used, and the reasons why race and 

ethnicity were collected for a study. We clarify that specific 

racial and ethnic categories are preferred over collective 

terms, when possible, and that authors should report the 

specific categories used in their studies and define catego-

ries included in groups labeled as “other.” The Results sec-

tion should report the race and ethnicity categories of the 

study population and categories should be listed in alpha-

betical order in the text and tables.

FUTURE GUIDANCE
Our next step is to update the sections on sex and gender, 

sexual orientation, age, socioeconomic status, ability, and 

persons with diseases, disorders, or disabilities. As with 

race and ethnicity, we recognize that our guidance in these 

sections may be dated, inadequate, and sometimes confus-

ing, and we are working to change that. Our revision for sex 

and gender and sexual orientation is in process, and we will 

soon have our draft updated guidance reviewed by inter-

nal and external experts on diversity, equity, and inclusion 

to ensure we recommend using clear, concise, consistent, 

appropriate, and inclusive language.

 Some of our interim guidance appears in the Instructions 

for Authors for JAMA and the JAMA Network journals4:

The term sex should be used when reporting bio-

logical factors and gender should be used when 

reporting gender identity or psychosocial/cultural 

factors. The methods used to obtain information on 

sex, gender, or both (eg, self-reported, investigator 

observed or classified, or laboratory test) should be 

explained in the Methods section. The distribution of 

study participants or samples should be reported in 

the Results section, including for studies of humans, 

tissues, cells, or animals. All participants should be 

represented, not just the category that represents the 

majority of the sample. Studies that address preg-

nancy should follow these recommendations, and if 

the gender identity of participants was not assessed, 

use the terms “pregnant participants,” “pregnant 

individuals,” “pregnant patients,” etc, as appropriate.

CONCLUSIONS
Our race and ethnicity guidance is freely available on the 

JAMA website,1 at the online AMA Manual of Style,3 and 

is linked from the JAMA and JAMA Network journals’ 

Instructions for Authors.4 This guidance is not intended to 

be final but is presented with the understanding that moni-

toring will continue, and further updates will be provided as 

needed. Continual review of the terms and language used in 

the reporting of race and ethnicity is critically important as 

societal norms continue to evolve.

Author declaration and disclosures: The author notes no  
commercial associations that may pose a conflict of interest in 
relation to this article. 

Author contact: tracy.frey@jamanetwork.org

References
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of race and ethnicity in medical and science journals: comments 
invited. JAMA. 2021;325(11):1049-1052. 

2.   Flanagin A, Frey T, Christiansen SL; AMA Manual of Style 
Committee. Updated guidance on the reporting of race and ethnicity 
in medical and science journals. JAMA. 2021;326(7):621-627. 

3.   AMA Manual of Style. Accessed August 26, 2022. https://academic.
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4.   JAMA instructions for authors: reporting demographic information 
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https://jamanetwork.com/journals/jama/pages/instructions-for-
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5.   Racial and ethnic identity. APA Style. Accessed August 26, 2022. 
https://apastyle.apa.org/style-grammar-guidelines/bias-free-
language/racial-ethnic-minorities

6.   Kim TE. The perils of “people of color.” The New Yorker. Published 
July 29, 2020. Accessed August 26, 2022. https://www.newyorker.
com/news/annals-of-activism/the-perils-of-people-of-color

7.   Lamuye A. I am no “person of colour”, I am a black African woman. 
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person-colour-bme-black-woman-women-different-experiences-
race-racism-a7868586.html

8.   Falcon A. Latinos and the “of color” problem. AL DÍA. Published 
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