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Home » New Report Addresses Trial Scarcity, Mapping Trial Distribution, County Demographics
New Report Addresses Trial Scarcity, Mapping Trial Distribution, County Demographics
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July 15, 2024
In an effort to improve access to clinical research in the US and ease enrollment challenges, the Milken Institute has published a new report focusing on distance as a barrier to trial participation, digging deep into demographics and distribution of trials across US counties, as well as offering an interactive map tool filterable by therapeutic area.
These new resources can be used by sponsors to inform trial placement and support, by sites to better understand their surrounding communities, and by physicians to learn more about trial opportunities in their regions.
Tapping into federal census and disease prevalence data and phase 2 and 3 trial information from the Clinical Trials Transformation Initiative’s Aggregate Analysis of ClinicalTrials.gov (AACT) database, the report and accompanying digital map offer insights on 1,189 counties’ demographics and trial proximities.
The report also examines “remote counties,” counties with no trials within 60 miles, as well as “high-prevalence remote counties,” counties that have a much greater disease prevalence than the national average but are more than 60 miles away from relevant trials. These counties in particular could be advantageous targets for efforts to broaden access, as they could yield exceptional payoffs in terms of recruitment.
“Remote counties are problematic as they represent locations where it is difficult to participate in phase 2 and 3 clinical trials due to large travel distances. Though travel distance is not the only relevant barrier to participation in clinical trials, it is one of the easiest to identify and has potential remedies,” the report reads. “Having clear documentation of where remote counties are, and for which types of diseases, allows for better targeting of advancements, such as decentralized clinical trials and the use of digital health technologies.”
For example, there are many remote counties in the US with high numbers of cancer patients, but they are mainly found in the northern US, including Idaho, Montana and North and South Dakota, as well as in Great Plains states like Kansas and Nebraska. Conversely, along the whole west coast, there are no high-prevalence remote counties for cancer, and this is nearly the same for the regions east of the Mississippi minus a few counties along the Canadian border.
The central and southern US are host to most of the remote counties with high prevalence of Alzheimer’s disease and related dementias, with large concentrations in Arkansas, Kansas, Louisiana, Oklahoma and Texas. Like oncology, the west and east coasts are largely devoid of these counties.
The report confirms challenges faced by rural communities when it comes to taking part in trials, finding that phase 2 and 3 trials are largely confined to major metropolitan areas and their surrounding suburbs. Counties in the nation’s interior, too, are less likely to have trials available within a reasonable distance compared to counties on the coast, the institute found.
The report and map are meant to serve as practical tools for opening doors to greater participation, especially in specific therapeutic areas, Andrew Friedson, report coauthor and director of health economics at the Milken Institute, said.
“This report provides detailed, actionable intelligence on where to deploy trial resources such that they will make large improvements in terms of patient access,” Friedson said. “We highlight where trials are not and where high-prevalence populations are. Put those together and you have your highest return locations if you are trying to knock down distance as a barrier to access.”
Access the report and interactive map here.
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