ImportanceRacially minoritized and socioeconomically disadvantaged populations are currently underrepresented in clinical trials. Data-driven, quantitative analyses and strategies are required to help address this inequity.ObjectiveTo systematically analyze the geographical distribution of self-identified racial and socioeconomic demographics within commuting distance to cancer clinical trial centers and other hospitals in the US.Design, Setting, and ParticipantsThis longitudinal quantitative study used data from the US Census 2020 Decennial and American community survey (which collects data from all US residents), OpenStreetMap, National Cancer Institute–designated Cancer Centers list, Nature Index of Cancer Research Health Institutions, National Trial registry, and National Homeland Infrastructure Foundation-Level Data. Statistical analyses were performed on data collected between 2006 and 2020.Main Outcomes and MeasuresPopulation distributions of socioeconomic deprivation indices and self-identified race within 30-, 60-, and 120-minute 1-way driving commute times from US cancer trial sites. Map overlay of high deprivation index and high diversity areas with existing hospitals, existing major cancer trial centers, and commuting distance to the closest cancer trial center.ResultsThe 78 major US cancer trial centers that are involved in 94% of all US cancer trials and included in this study were found to be located in areas with socioeconomically more affluent populations with higher proportions of self-identified White individuals (+10.1% unpaired mean difference; 95% CI, +6.8% to +13.7%) compared with the national average. The top 10th percentile of all US hospitals has catchment populations with a range of absolute sum difference from 2.4% to 35% from one-third each of Asian/multiracial/other (Asian alone, American Indian or Alaska Native alone, Native Hawaiian or Other Pacific Islander alone, some other race alone, population of 2 or more races), Black or African American, and White populations. Currently available data are sufficient to identify diverse census tracks within preset commuting times (30, 60, or 120 minutes) from all hospitals in the US (N = 7623). Maps are presented for each US city above 500 000 inhabitants, which display all prospective hospitals and major cancer trial sites within commutable distance to racially diverse and socioeconomically disadvantaged populations.Conclusion and RelevanceThis study identified biases in the sociodemographics of populations living within commuting distance to US-based cancer trial sites and enables the determination of more equitably commutable prospective satellite hospital sites that could be mobilized for enhanced racial and socioeconomic representation in clinical trials. The maps generated in this work may inform the design of future clinical trials or investigations in enrollment and retention strategies for clinical trials; however, other recruitment barriers still need to be addressed to ensure racial and socioeconomic demographics within the geographical vicinity of a clinical site can translate to equitable trial participant representation.

中文翻译：

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按出行时间公平访问美国癌症临床试验中心的分析和优化

重要性 种族少数群体和社会经济弱势群体目前在临床试验中代表性不足。需要数据驱动的定量分析和策略来帮助解决这种不平等问题。目的系统地分析美国癌症临床试验中心和其他医院通勤距离内自我认同的种族和社会经济人口统计数据的地理分布。设计、设置和参与者这项纵向定量研究使用的数据来自 2020 年美国人口普查十年一次和美国社区调查（收集所有美国居民的数据）、OpenStreetMap、国家癌症研究所指定的癌症中心列表、癌症研究健康机构自然指数、国家试验登记处和国家国土基础设施基础级数据。对 2006 年至 2020 年期间收集的数据进行统计分析。 主要结果和措施美国癌症试验地点 30 分钟、60 分钟和 120 分钟单程驾驶通勤时间内社会经济剥夺指数和自我认同种族的人口分布。高贫困指数和高多样性区域与现有医院、现有主要癌症试验中心以及到最近癌症试验中心的通勤距离的地图重叠。结果参与了美国所有癌症试验的 94% 的 78 个主要癌症试验中心，并包括在这项研究中发现，与全国平均水平相比，这些地区的社会经济条件更加富裕，自我认同的白人比例较高（+10.1% 未配对平均差；95% CI，+6.8% 至 +13.7%）。美国所有医院前 10 个百分位的服务区人口的绝对总和差异范围为 2.4% 至 35%，其中亚洲人/多种族/其他人（仅亚洲人、仅美洲印第安人或阿拉斯加原住民、夏威夷原住民或其他原住民）各占三分之一单独的太平洋岛民、单独的其他种族、两个或多个种族的人口）、黑人或非裔美国人以及白人人口。目前可用的数据足以识别美国所有医院预设通勤时间（30、60 或 120 分钟）内的不同人口普查轨迹 (N = 7623)。提供了每个人口超过 50 万的美国城市的地图，其中显示了与种族多样化和社会经济弱势群体通勤距离内的所有未来医院和主要癌症试验地点。 结论和相关性本研究确定了居住在美国通勤距离内的人口的社会人口统计学偏差基于癌症试验地点，并能够确定更公平地通勤的前瞻性卫星医院地点，这些地点可用于增强临床试验中的种族和社会经济代表性。这项工作中生成的地图可以为未来临床试验的设计或临床试验的入组和保留策略的调查提供信息；然而，仍需解决其他招募障碍，以确保临床地点附近地理范围内的种族和社会经济人口统计数据可以转化为公平的试验参与者代表性。