Mp34-14 Association of Population-Level Social Determinants of Health With Urologic Cancer Clinical Trials Availability

You have accessJournal of UrologyDiversity, Equity & Inclusion: Health Equity & Outcomes II (MP34)1 May 2024MP34-14 ASSOCIATION OF POPULATION-LEVEL SOCIAL DETERMINANTS OF HEALTH WITH UROLOGIC CANCER CLINICAL TRIALS AVAILABILITY Rishi Sekar, Lindsey Herrel, and Kristian Stensland Rishi SekarRishi Sekar , Lindsey HerrelLindsey Herrel , and Kristian StenslandKristian Stensland View All Author Informationhttps://doi.org/10.1097/01.JU.0001008876.78012.90.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Disparities in clinical trial enrollment persist across vulnerable populations and remain a barrier to achieving equitable cancer care. Adverse social determinants of health (SDOH) and geographic availability of clinical trials likely interact to worsen these disparities. For these reasons, we evaluate the association between population-level SDOH and county-level urologic cancer clinical trial availability in the United States. METHODS: Using data linkage from ClinicalTrials.gov, Surveillance Epidemiology and End Results (SEER) Registry, and the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), we performed a cross-sectional analysis of county-level clinical trial data and population-level SDOH. We included Phase 2 and Phase 3 interventional clinical trials (2007 to 2022) for prostate (PCa), kidney (KCa), and bladder cancer (BCa). The total and cancer-specific number of available clinical trials over the study period were calculated for each county and population-adjusted for 100,000 residents. Counties were grouped into quintiles of SVI (i.e., least vulnerable to most vulnerable). Trial availability was compared across SVI quintiles. Multivariable logistic regression and negative binomial regression analyses were performed to evaluate the association between SVI quintile and trial availability. RESULTS: Only 40.8% of counties in the United States had 1 or more clinical trials. County trial availability by cancer type was 41.8% for PCa, 36.6% for BCa and 32.0% for KCa. The mean number of trials per 100,000 residents was 64.4, with the most vulnerable counties having fewer trials compared to the least vulnerable counties (42.7 vs. 132.0, p<0.05). Further, the most vulnerable counties had decreased odds of having any trial (OR 0.31, 95% CI 0.23 – 0.43) and fewer total trials (incidence rate ratio (IRR) 0.38, 95% CI 0.27 – 0.54) compared to the least vulnerable counties. These findings were consistent on sub-analysis of each cancer type. CONCLUSIONS: Significant geographical disparities in cancer clinical trial availability exist in the United States, with less than half of all counties having any trial for the most common urologic cancers. Further, the most socially vulnerable counties had drastically lower availability of trials, even after adjusting for relevant factors. These counties represent areas of scientifically underserved populations and highlights a potential mechanism to improve representation and trial enrollment in vulnerable populations with cancer. Source of Funding: Rishi Sekar received research support from the National Cancer Institute institutional training grant T32-CA-236621 and a Bladder Cancer Advocacy Network Young Investigator Award © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e576 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Rishi Sekar More articles by this author Lindsey Herrel More articles by this author Kristian Stensland More articles by this author Expand All Advertisement PDF downloadLoading ...