Jacobson Mireille, Molina-Henry Doris, Chang Tom Y, Jimenez-Maggiora Gustavo A, Pramanik Rajiv, Shah Samir B, Aisen Paul S
USC Schaeffer Institute, University of Southern California, Los Angeles.
Leonard Davis School of Gerontology, University of Southern California, Los Angeles.
JAMA Health Forum. 2025 Aug 1;6(8):e252273. doi: 10.1001/jamahealthforum.2025.2273.
Persons from marginalized racial and ethnic groups and of low socioeconomic status are at high risk of dementia but are underrepresented in clinical trials. Financial incentives may improve representation.
To evaluate the effect of financial incentives on enrollment of county health system patients into a memory concerns registry.
DESIGN, SETTING, AND PARTICIPANTS: Between March 1, 2024, and April 24, 2024, patients 50 years and older without a dementia diagnosis within a single integrated county health system that includes a hospital and 9 outpatient health centers were invited to enroll in the Alzheimer Prevention Trials (APT) Webstudy, an online observational study aimed at accelerating enrollment into Alzheimer disease clinical trials.
Patients were randomized 1:1:1 to an invitation message (arm 1), a message with a small ($25) enrollment incentive (arm 2), or a message with an enrollment incentive of entry into a $2500 lottery with 1 in 100 odds of award (arm 3).
The primary outcome was enrollment, defined as APT Webstudy registration and completion of at least 1 of 2 remote cognitive assessments. Outcomes were measured through April 30, 2024.
Of 44 844 patients invited to the APT Webstudy, the mean (SD) age was 64.7 (10.1) years, 25 447 (56.8%) were women, 25 044 (55.8%) had Medicaid insurance, 11 347 (25.3%) were Hispanic/Latino, 9526 (21.2%) were non-Hispanic Asian, 6044 (13.5%) were non-Hispanic Black, and 12 109 (27%) were non-Hispanic White. A total of 401 participants (0.9%) enrolled in the APT Webstudy. Relative to the message-only arm, participants randomized to the small incentive arm were more likely to enroll (adjusted odds ratio [OR], 1.39; 95% CI, 1.09-1.76; P = .008) in the APT Webstudy while those in the prize incentive arm were not more likely to enroll (adjusted OR, 1.08; 95% CI, 0.84-1.39; P > .99). Enrollment in the prize incentive arm was lower relative to the small incentive arm (adjusted OR, 0.78; 95% CI, 0.61-0.98; P = .04). Secondary heterogeneity analyses indicated that patients of White race (adjusted OR, 1.61; 95% CI, 1.15-2.25; P = .006) and male sex (adjusted OR, 2.40; 95% CI, 1.55-3.75; P < .001) were most responsive to the small $25 incentive relative to the message-only arm.
In this randomized clinical trial, relative to message invitations, invitations with guaranteed, small financial incentives but not lottery incentives increased enrollment of economically but not necessarily racially or ethnically diverse participants to a study that aimed to increase enrollment in clinical studies.
ClinicalTrials.gov Identifier: NCT06033066.
来自边缘化种族和族裔群体且社会经济地位较低的人群患痴呆症的风险较高，但在临床试验中的代表性不足。经济激励措施可能会提高其参与度。
评估经济激励措施对县卫生系统患者纳入记忆问题登记册的影响。
设计、地点和参与者：在2024年3月1日至2024年4月24日期间，邀请了一个包含一家医院和9个门诊健康中心的单一综合县卫生系统中50岁及以上且无痴呆症诊断的患者参加阿尔茨海默病预防试验（APT）网络研究，这是一项旨在加快阿尔茨海默病临床试验入组速度的在线观察性研究。
患者按1:1:1随机分为三组，分别收到一条邀请信息（第1组）、一条附带小额（25美元）入组激励的信息（第2组）或一条附带参与2500美元抽奖且中奖几率为1/100的入组激励信息（第3组）。
主要结局是入组，定义为APT网络研究注册并完成两项远程认知评估中的至少一项。结局数据截至2024年4月30日进行测量。
在被邀请参加APT网络研究的44844名患者中，平均（标准差）年龄为64.7（10.1）岁，25447名（56.8%）为女性，25044名（55.8%）有医疗补助保险，11347名（25.3%）为西班牙裔/拉丁裔，9526名（21.2%）为非西班牙裔亚洲人，6044名（13.5%）为非西班牙裔黑人，12109名（27%）为非西班牙裔白人。共有401名参与者（0.9%）参加了APT网络研究。与仅收到信息的组相比，被随机分配到小额激励组的参与者参加APT网络研究的可能性更大（调整后的优势比[OR]为1.39；95%置信区间为1.09 - 1.76；P = 0.008），而抽奖激励组的参与者参加的可能性并未增加（调整后的OR为1.08；95%置信区间为0.84 - 1.39；P > 0.99）。抽奖激励组的入组率相对于小额激励组较低（调整后的OR为0.78；95%置信区间为0.61 - 0.98；P = 0.04）。次要异质性分析表明，与仅收到信息的组相比，白人种族（调整后的OR为1.61；95%置信区间为1.15 - 2.25；P = 0.006）和男性（调整后的OR为2.40；95%置信区间为1.55 - 3.75；P < 0.001）对25美元的小额激励反应最为明显。
在这项随机临床试验中，与信息邀请相比，附带保证的小额经济激励而非抽奖激励的邀请增加了经济上但不一定在种族或族裔上具有多样性的参与者对一项旨在增加临床研究入组人数的研究的参与度。
ClinicalTrials.gov标识符：NCT06033066。
