Structural inequities in the availability of prostate cancer clinical trial opportunities

Prostate cancer is marked by vast disparities in clinical outcomes for minoritized and socioeconomically disadvantaged populations. We aimed to evaluate the geographic distribution of prostate cancer clinical trial opportunities relative to prostate cancer mortality and social determinants of health by performing an ecological analysis of linked county-level prostate cancer clinical trial data, epidemiologic data, and the Centers for Disease Control and Prevention Social Vulnerability Index. On analysis of 1575 counties in the United States with available data, increasing Social Vulnerability Index was associated with an increase in prostate cancer mortality (+17.88, 95% confidence interval [CI] = 14.16 to 21.61; P < .001), lower odds of having any trial (odds ratio [OR] = 0.14, 95% CI = 0.09 to 0.23; P < .001), and fewer population-adjusted trials (incidence rate ratio = 0.27, 95% CI = 0.19 to 0.40; P < .001). Identifying communities experiencing adverse social determinants of health for expansion of clinical trial opportunities and mitigation of barriers may be an impactful strategy toward improving equity in clinical trials and cancer care.