Sekar Rishi R, Maganty Avinash, Stensland Kristian D, Herrel Lindsey A
Department of Urology, University of Michigan, Ann Arbor, MI.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
JCO Oncol Pract. 2025 Feb;21(2):235-244. doi: 10.1200/OP.24.00206. Epub 2024 Aug 29.
Community factors and structural barriers may contribute to disparities and underrepresentation in cancer clinical trials. We evaluate the influence of community-level social determinants of health, as measured by the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), on disparities in cancer clinical trial discussion and participation.
We performed a cross-sectional analysis of the 2021 Health Information National Trends Survey-SEER, a representative survey of cancer survivors sampled from three SEER registries. The primary outcomes included patient-reported clinical trial discussion and participation. The primary exposure was county-level SVI, linked to each survey respondent by ZIP code of residence and categorized into quintiles. Survey-weighted bivariate comparisons and multivariable logistic regression were performed to evaluate the association between SVI and clinical trial discussion and participation, adjusting for age, sex, race and ethnicity, education, income, and cancer stage.
We identified 1,220 respondents residing in 153 counties with a median SVI of 0.41 (IQR, 0.27-0.62), representing a population of over 400,000 cancer survivors on weighted analysis. Of the cohort, 15.1% reported clinical trial discussion and 7.7% reported clinical trial participation. Patients who are most socially vulnerable (fifth quintile of SVI) had significantly lower odds of clinical trial discussion (odds ratio [OR], 0.36 [95% CI, 0.15 to 0.87]; = .02) and clinical trial participation (OR, 0.15 [95% CI, 0.03 to 0.75]; = .02) compared with patients who are least socially vulnerable (first quintile of SVI).
These findings suggest interventions to identify socially vulnerable communities for expansion of clinical trial opportunities and infrastructure may be an impactful strategy toward improving diversity and representation in cancer clinical trials.
社区因素和结构障碍可能导致癌症临床试验中的差异和代表性不足。我们评估了以疾病控制和预防中心社会脆弱性指数（SVI）衡量的社区层面健康社会决定因素对癌症临床试验讨论和参与差异的影响。
我们对2021年健康信息国家趋势调查-监测、流行病学与最终结果（SEER）进行了横断面分析，这是一项从三个SEER登记处抽取的癌症幸存者代表性调查。主要结局包括患者报告的临床试验讨论和参与情况。主要暴露因素是县级SVI，通过居住邮政编码与每位调查受访者相关联，并分为五个五分位数。进行了调查加权双变量比较和多变量逻辑回归，以评估SVI与临床试验讨论和参与之间的关联，并对年龄、性别、种族和民族、教育程度、收入和癌症分期进行了调整。
我们确定了1220名居住在153个县的受访者，SVI中位数为0.41（四分位间距，0.27 - 0.62），加权分析显示代表超过40万癌症幸存者群体。在该队列中，15.1%报告了临床试验讨论，7.7%报告了临床试验参与。与社会脆弱性最低的患者（SVI第一五分位数）相比，社会脆弱性最高的患者（SVI第五五分位数）进行临床试验讨论的几率显著更低（优势比[OR]，0.36[95%置信区间，0.15至0.87]；P = 0.02），参与临床试验的几率也显著更低（OR，0.15[95%置信区间，0.03至0.75]；P = 0.02）。
这些发现表明，采取干预措施识别社会脆弱社区以扩大临床试验机会和基础设施，可能是提高癌症临床试验多样性和代表性的一项有效策略。
