Social vulnerability and clinical trial enrollment: The next frontier of health equity
Abstract
1508 Background: Clinical trials are the basis for novel therapies but may not be representative of disadvantaged groups, particularly low-income individuals. This study assesses how social vulnerability impacts enrollment and explores the interaction between race and social vulnerability among patients with the top five leading causes of cancer death. Methods: The national Vizient Clinical Database was queried for outpatients with lung, breast, prostate, colorectal or pancreas cancer from 2022-2023. This includes data from 98% of academic medical centers and more than 110 cancer hospitals. The exposures of interest were Medicaid insurance and social vulnerability as measured by the Vizient Vulnerability Index (VVI), a novel marker of social drivers of health at the census tract level. Participation in a clinical trial was the primary outcome. A multivariable analysis was performed evaluating the association of social vulnerability quartiles with clinical trial participation. Interaction tests were performed for race and VVI. Results: 2,660,566 patients were identified. Of these, 36,456 (1.4%) enrolled in a clinical trial: 28.6% with breast cancer, 26.3% prostate, 22.8% lung, 12.8% colorectal and 9.5% pancreas. Trial participants were more likely to be young, White, privately insured, have metastatic disease, and live in a less vulnerable census tract.5.3% of trial participants were insured by Medicaid (12.2% of Black participants, 8.5% of Asian participants, and 3.5% of…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 2,660,566 participants or records.
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