{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:21:18Z","timestamp":1791246078191,"version":"4.1.0"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi260881-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Geographic disparities in cancer clinical trial access are well described in the US, but patterns in bladder cancer remain poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260881-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate bladder cancer trial availability across US counties and its associations with epidemiologic and socioeconomic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260881-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cross-sectional study of completed, open, or active bladder cancer clinical trials from June 1, 2019, to June 1, 2025, on ClinicalTrials.gov used data on county-level incidence, mortality, and Social Vulnerability Index (SVI) obtained from the Centers for Disease Control and Prevention, the National Cancer Institute, and the Agency for Toxic Substances and Disease Registry and included interventional bladder cancer clinical trials of adults at 1 or more US sites. Data were analyzed from July 1, 2025, to October 20, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260881-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Epidemiologic and socioeconomic characteristics of bladder cancer clinical trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260881-8\">\n                    <jats:title>Main Outcome and Measures<\/jats:title>\n                    <jats:p>Trial availability was defined as 1 or more bladder cancer trial sites per county. Trial volume (number of unique trials per county) was modeled using a multivariable zero-inflated negative binomial regression and reported as incidence rate ratios. Associations between trial characteristics and location in highest vs lowest bladder cancer mortality quintile counties were assessed using a generalized linear mixed-effects logistic regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260881-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study identified 436 bladder cancer trials across 713 US counties. Of 3145 counties, 713 (22.7%) had 1 or more trial sites, and 2432 (77.3%) had none. Most trials were sponsored by pharmaceutical companies (211 [48.4%]) or academic institutions (170 [39%]). Most trials were drug focused (350 [80.2%]) and early phase (phase 1 or phase 2; 314 [72%]). Higher bladder cancer incidence was associated with higher trial rates (incidence rate ratio [IRR], 1.03; 95% CI, 1.003-1.06). A higher bladder cancer mortality rate was associated with lower trial rates (IRR, 0.80; 95% CI, 0.73-0.88). Compared with counties with a high SVI, trial rates were higher in counties with a lower-middle (IRR, 1.57; 95% CI, 1.18-2.08), middle-high (IRR, 1.60; 95% CI, 1.22-2.11), and low SVI (IRR, 2.53; 95% CI, 1.89-3.38). Of 7091 trial sites, 225 (3.2%) were located in counties in the highest quintile for bladder cancer mortality. Pharmaceutical company\u2013sponsored trials were less likely than academic trials to be in counties with the highest mortality rate (odds ratio, 0.11; 95% CI, 0.04-0.29;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), as were trials enrolling fewer than 100 participants compared with more than 100 participants (odds ratio, 0.20; 95% CI, 0.09-0.46;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260881-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cross-sectional study of 436 bladder cancer clinical trials across US counties, most counties lacked trials, with geographic availability concentrated in counties with a high bladder cancer incidence and low social vulnerability. Expanding trial sites to counties with a high mortality rate or a high SVI may improve the geographic availability of bladder cancer clinical trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.32012","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:03:48Z","timestamp":1788451428000},"page":"e2632012","source":"Crossref","is-referenced-by-count":1,"title":["Regional Variation in Bladder Cancer Clinical Trial Availability in the US"],"prefix":"10.1001","volume":"9","author":[{"given":"Koral U.","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Jaime-Casas","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchi","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vitor","family":"Abreu de Goes","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela V.","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Mercier","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Dickter","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily M.","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaya","family":"Goud","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akasha","family":"Dukkipati","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jadon","family":"Fann","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyra","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Swarat","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Zugman","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazli","family":"Dizman","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Moradi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Barragan-Carrillo","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Tripathi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles B.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Chehrazi-Raffle","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumanta K.","family":"Pal","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"issue":"19","key":"zoi260881r2","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1056\/NEJMoa2408154","article-title":"Perioperative durvalumab with neoadjuvant chemotherapy in operable bladder cancer.","volume":"391","author":"Powles","year":"2024","journal-title":"N Engl J Med"},{"issue":"13","key":"zoi260881r3","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1056\/NEJMoa2511674","article-title":"Perioperative enfortumab vedotin and pembrolizumab in bladder 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Surveillance, Epidemiology, and End Results Program. National Institute of Health. National Cancer Institute. 2025. Accessed September 30, 2025. https:\/\/seer.cancer.gov\/statfacts\/html\/urinb.html"},{"key":"zoi260881r8","unstructured":"US National Library of Medicine: ClinicalTrials.gov. National Library of Medicine. Accessed December 1, 2025. https:\/\/clinicaltrials.gov\/"},{"key":"zoi260881r9","unstructured":"United States zip codes. Search by ZIP, address, city, or county. United States Postal Service, U.S. Census Bureau. Accessed December 30, 2025. https:\/\/www.unitedstateszipcodes.org\/"},{"key":"zoi260881r10","unstructured":"Agency for Toxic Substances and Disease Registry. Centers for Disease Control and Prevention Agency. Accessed December 30, 2025. https:\/\/atsdr.cdc.gov\/"},{"key":"zoi260881r11","unstructured":"State cancer profiles. National Institute of Health. 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