Geographic Distribution and Racial Disparities of CAR-T cell Therapy Centers in the United States

Chimeric antigen receptor T-cell (CAR-T) therapy has transformed outcomes in hematologic malignancies; however, access remains geographically and demographically limited. Uneven distribution of treatment centers may exacerbate disparities, particularly among racial and ethnic minority populations. To characterize the geographic distribution of CAR-T centers across the U.S. and assess access for the overall population, as well as for Hispanics (Hs) and African Americans (AA). We conducted a cross-sectional analysis of all active CAR-T centers in the U.S. using official manufacturer websites for seven FDA-approved products. Each center was geocoded to its ZIP code and linked to county-level demographic data from the 2020 U.S. Census. Access was measured as centers per million residents (CPM) overall and within Hispanic (CPM-Hs) and AA (CPM-AA) populations. Disparities were quantified using a disparity index (DI), defined as the proportion of centers in a state divided by the proportion of the population group residing there (DI <1 = underrepresentation). A total of 176 centers were identified across 111 counties in 48 states/territories (Figure 1). Product availability varied: tisa-cel was offered at 118 centers, axi-cel and brexu-cel at 160 each, ide-cel and liso-cel at 159 each, cilta-cel at 125, and obe-cel at 53. Forty-eight centers across 24 states/territories offered all seven products. The highest amounts were in California (n=17), New York (n=12), Florida and Pennsylvania (n=10 each), and Ohio and Texas (n=9 each), accounting for 38% of all centers and 40% of the U.S. population. Nevertheless, CPM was <1 in most large states (Table 1). The highest overall access was observed in Rhode Island (1.82 CPM), Vermont (1.55), D.C. (1.45), Hawaii (1.37), and North Dakota (1.28). In contrast, Alabama, Oklahoma, Washington, Connecticut, Puerto Rico, Texas, and Iowa had ≤0.31 CPM, while Alaska, Montana, Maine, and Wyoming had no centers. Analysis by race and ethnicity revealed additional disparities. Hispanic populations showed low CPM-Hs and DI-Hs < 1 in 16 states, primarily those with high Hispanic density, including Texas (DI-Hs 0.29), California (0.40), and Florida (0.65). Similarly, AA were underrepresented in 22 states, particularly in AA-dense regions such as Georgia (DI-AA 0.28), Texas (0.59) and Florida (0.73), reflecting persistent disparities in CAR-T access across minority-dense regions (Figure 2). Although CAR-T centers are distributed nationwide, per-capita access remains limited, particularly in large, minority-dense states. Regions with substantial Hispanic and AA populations demonstrate underrepresentation in CAR-T therapy access relative to their population size, highlighting the need to expand treatment infrastructure to reduce racial and geographic disparities in CAR-T availability.