{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:26:07Z","timestamp":1789043167278,"version":"build-2803163510"},"reference-count":59,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T00:00:00Z","timestamp":1726272000000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Flatiron Health, Inc"},{"name":"Roche Group"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Although racially and ethnically minoritized populations are less likely to participate in cancer trials, it is unknown whether social determinants of health (SDOH) explain these inequities. Here we identify SDOH factors that contribute to racial and ethnic inequities in clinical trial participation among patients with 22 common cancers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective cohort study used electronic health record data (2011-2023) linked to neighborhood (US Census tract) data from multiple sources. Patients were followed from diagnosis to clinical study drug receipt (proxy for trial participation), death, or last recorded activity. Associations were assessed using Cox proportional hazards models adjusted for clinical factors (year of diagnosis, age, sex, performance status, disease stage, cancer type). To elucidate which area-level SDOH underlie racial and ethnic inequities, mediation analysis was performed using nonlinear multiple additive regression tree models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>This study included 250\u200a105 patients (64.7% non-Latinx White, 8.9% non-Latinx Black, 5.2% Latinx). Black and Latinx patients were more likely to live in economically or socially marginalized areas (eg, disproportionately minoritized [measure of segregation], limited English proficiency, low vehicle ownership) than White patients. Black (3.7%; hazard ratio\u2009=\u20090.55, 95% confidence interval [CI]\u2009=\u20090.52 to 0.60) and Latinx patients (4.4%; hazard ratio\u2009=\u20090.63, 95% CI\u2009=\u20090.58 to 0.69) were less likely to participate in trials than White patients (6.3%). Fewer patients in economically or socially marginalized neighborhoods participated in trials. Mediators explained 62.2% (95% CI\u2009=\u200949.5% to 74.8%) of participation inequities between Black and White patients; area-level SDOH\u2014including segregation (29.9%, 95% CI\u2009=\u200921.2% to 38.6%) and vehicle ownership (11.6%, 95% CI\u2009=\u20097.0% to 16.1%)\u2014were the most important mediators. Similarly, Latinx-White participation inequities were mediated (65.1%, 95% CI\u2009=\u200949.8% to 80.3%) by area-level SDOH, such as segregation (39.8%, 95% CI\u2009=\u200928.3% to 51.3%), limited English proficiency (11.6%, 95% CI\u2009=\u20092.8% to 20.4%), and vehicle ownership (9.6%, 95% CI\u2009=\u20095.8% to 13.5%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>To improve racial and ethnic diversity in cancer trials, efforts to address barriers related to adverse neighborhood SDOH factors are necessary.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jncics\/pkae085","type":"journal-article","created":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T08:38:00Z","timestamp":1726303080000},"source":"Crossref","is-referenced-by-count":10,"title":["Mediators of racial and ethnic inequities in clinical trial participation among patients with cancer, 2011-2023"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2312-4140","authenticated-orcid":false,"given":"Jenny S","family":"Guadamuz","sequence":"first","affiliation":[{"name":"Flatiron Health , New York, NY,","place":["USA"]},{"name":"Division of Health Policy and Management, School of Public Health, University of California, Berkeley , Berkeley, CA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5184-2935","authenticated-orcid":false,"given":"Xiaoliang","family":"Wang","sequence":"additional","affiliation":[{"name":"Flatiron Health , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1222-885X","authenticated-orcid":false,"given":"Ivy","family":"Altomare","sequence":"additional","affiliation":[{"name":"Flatiron Health , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1336-8106","authenticated-orcid":false,"given":"Wendy","family":"Camelo Castillo","sequence":"additional","affiliation":[{"name":"Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy , Baltimore, MD,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somnath","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Flatiron Health , New York, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8267-5356","authenticated-orcid":false,"given":"Ronac","family":"Mamtani","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania , Philadelphia, PA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7744-3518","authenticated-orcid":false,"given":"Gregory S","family":"Calip","sequence":"additional","affiliation":[{"name":"Flatiron Health , New York, NY,","place":["USA"]},{"name":"Now with AbbVie , North Chicago, IL,","place":["USA"]},{"name":"Program on Medicines and Public Health, Alfred E. 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