PO.PS01.04 · 人群科学
美国各县子宫癌临床试验地理可及性中的种族差异
Racial disparities in geographic access to uterine cancer clinical trials across U.S. counties
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
目的：子宫癌死亡率正在上升，且对种族及社会经济上边缘化的人群造成不成比例的影响。临床试验可改善新疗法的可及性及结局，然而试验入组中的种族差异依然存在。由于试验的地理分布决定了入组机会，我们考察了种族与县级介入性子宫癌试验可获得性之间的关联，以及这一关系是否因社区脆弱性而异。
方法：我们从ClinicalTrials.gov汇总分析数据库（2008-2021年）中识别美国的子宫癌介入性试验，并将试验点邮政编码汇总至县级，同一县内的多个试验点计为一项试验。县级试验可获得性与CDC社会脆弱性指数（SVI；范围0-1，分数越高脆弱性越大）及SEER中的子宫癌病例（2008-2021年）相关联。多变量logistic回归估计种族/族裔（美洲印第安人/阿拉斯加原住民、亚裔、黑人、西班牙裔、夏威夷原住民/太平洋岛民及白人）与县级试验可获得性之间的关联，并对临床特征及县规模进行校正。评估了SVI[高（≥第90百分位数）vs. 低（<第90百分位数）]的效应修饰作用。
结果：我们纳入151,610例于2008年至2021年间确诊的子宫癌病例（确诊时平均[SD]年龄61.7[11.7]岁）。在这些病例确诊当年及居住县内，有225项独特的介入性子宫癌临床试验处于开放状态；78%的患者居住在至少有一项开放介入性试验的县内。与白人女性相比，亚裔、黑人及夏威夷原住民/太平洋岛民女性获得试验的几率更高，而美洲印第安人/阿拉斯加原住民及西班牙裔女性的几率更低。我们观察到SVI的效应修饰作用（交互作用p<0.001）：在高脆弱性地区，黑人女性相较于白人女性获得试验的几率更高（OR=1.31，95% CI=1.08-1.60）。
结论：我们的发现凸显了子宫癌临床试验地理可及性中的种族差异——这是入组的一项基本前提。在社会脆弱性较高地区的居民中，黑人女性的试验可获得性高于白人女性，这与既往显示黑人患者入组率较低的研究形成对比。这表明，即便在试验可及之处，超越地理临近性的结构性障碍仍在限制公平参与。
查看英文原文 English abstract
Purpose: Uterine cancer mortality is rising, disproportionately affecting racially and socioeconomically marginalized populations. Clinical trials improve access to novel therapies and outcomes, yet racial disparities in trial enrollment persist. Because the geographic distribution of trials shapes opportunities for enrollment, we examined associations between race and county-level availability of interventional uterine cancer trials, and whether this relationship varies by neighborhood vulnerability.
Methods: We identified US-based uterine cancer interventional trials from the Aggregate Analysis of ClinicalTrials.gov database (2008-2021) and aggregated site ZIP codes to counties, counting multiple sites per county as one trial. County-level trial availability was linked to the CDC Social Vulnerability Index (SVI; range 0-1, higher scores = greater vulnerability) and uterine cancer cases in SEER (2008-2021). Multivariable logistic regression estimated associations between race/ethnicity (American Indian/Alaska Native, Asian, Black, Hispanic, Native Hawaiian/Pacific Islander, and White) and county-level trial availability, adjusting for clinical characteristics and county size. Effect modification by SVI [high (≥90th percentile) vs. low (<90th percentile) was assessed.
Results : We included 151,610 uterine cancer cases (mean [SD] age at diagnosis, 61.7 [11.7] years) diagnosed between 2008 and 2021. Two-hundred and twenty-five unique interventional uterine cancer clinical trials were open in the year of diagnosis and county of residence for these cases; 78% lived in a county with at least one open interventional trial. Compared to White women, Asian, Black, and Native Hawaiian/Pacific Islander women had higher odds of trial availability, whereas American Indian/Alaska Native and Hispanic women had lower odds. We observed effect modification by SVI (p-interaction <0.001): in areas of high vulnerability, Black compared to White women had higher odds of trial availability (OR=1.31, 95% CI=1.08-1.60).
Conclusions : Our findings highlight racial disparities in geographic access to uterine cancer clinical trials - an essential prerequisite for enrollment. Among residents of more socially vulnerable areas, trial availability was higher for Black than White women, contrasting with prior research showing lower enrollment among Black patients. This suggests structural barriers beyond proximity continue to limit equitable participation, even where trials are accessible.
利益披露 Disclosure
C. E. Meade, None..
J. A. Sinnott, None..
S. A. Kanal, None..
L. M. Chambers, None..
A. S. Felix, None.