{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T05:34:29Z","timestamp":1737610469307,"version":"3.33.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Equity Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Throughout the COVID-19 pandemic, underserved populations, such as racial and ethnic minority communities, were disproportionately impacted by illness and death. Ensuring people from diverse backgrounds have the ability to participate in clinical trials is key to advancing health equity. We sought to analyze the spatial variability in locations of COVID-19 trials sites and to test associations with demographic correlates. All available and searchable COVID-19 studies listed on ClinicalTrials.gov until 04\/04\/2022 and conducted in the United States were extracted at the trial-level, and locations were geocoded using the Microsoft Bing API. Publicly available demographic data were available at the county level for national analysis and the census tract level for local analysis. Independent variables included eight racial and ethnic covariates, both sexes, and twelve age categories, all of which were population-normalized. The county-level, population-normalized count of study site locations, by type, was used as the outcome for national analysis, thereby enabling the determination of demographic associations with geospatial availability to enroll as a participant in a COVID-19 study. Z-scores of the Getis-Ord Gi statistic were used as the outcome for local analysis in order to account for areas close to those with clinical study sites. For both national (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and local analysis (<jats:italic>p<\/jats:italic>\u2009=\u20090.006 for Los Angeles, <jats:italic>p<\/jats:italic>\u2009=\u20090.030 for New York), areas with greater proportions of men had significantly fewer studies. Sites were more likely to be found in counties with higher proportions of Asian (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and American Indian or Alaska Native residents (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Areas with greater concentrations of Black or African American residents had significantly lower concentrations of observational (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and government-sponsored COVID-19 studies (<jats:italic>p<\/jats:italic>\u2009=\u20090.003) in national analysis and significantly fewer concentrations of study sites in both Los Angeles (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and New York (<jats:italic>p<\/jats:italic>\u2009=\u20090.007). Though there appear to be a large number of COVID-19 studies that commenced in the US, they are distributed unevenly, both nationally and locally.<\/jats:p>","DOI":"10.1186\/s12939-024-02360-8","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:50:52Z","timestamp":1737593452000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Demographic disparities in access to COVID-19 clinical trial sites across the United States: a geospatial analysis"],"prefix":"10.1186","volume":"24","author":[{"given":"Raphael","family":"Cuomo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiana","family":"McMann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhuoran","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena","family":"Lolic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richardae","family":"Araojo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Mackey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"2360_CR1","unstructured":"\u201cCOVID-19 Public Health Emergency of International Concern (PHEIC) Global Research and Innovation Forum.\u201d https:\/\/www.who.int\/publications\/m\/item\/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum. Accessed 24 May 2022."},{"key":"2360_CR2","unstructured":"Johns Hopkins Coronavirus Resource Center. \u201cCOVID-19 Map.\u201d https:\/\/coronavirus.jhu.edu\/map.html. Accessed 24 May 2022."},{"key":"2360_CR3","doi-asserted-by":"publisher","unstructured":"Wherry, E. John, Elizabeth M. Jaffee, Nicholas Warren, Gypsyamber D\u2019Souza, Antoni Ribas, and on behalf of the AACR COVID-19 and Cancer Task Force. \u201cHow Did We Get a COVID-19 Vaccine in Less Than 1 Year?\u201d Clin Can Res. 2021;27(8):2136\u201338. https:\/\/doi.org\/10.1158\/1078-0432.CCR-21-0079.","DOI":"10.1158\/1078-0432.CCR-21-0079"},{"key":"2360_CR4","doi-asserted-by":"publisher","unstructured":"Borio, Luciana L., Rick A. Bright, and Ezekiel J. Emanuel. \u201cA National Strategy for COVID-19 Medical Countermeasures: Vaccines and Therapeutics.\u201d JAMA. 2022;327(3):215\u201316. https:\/\/doi.org\/10.1001\/jama.2021.24165.","DOI":"10.1001\/jama.2021.24165"},{"key":"2360_CR5","doi-asserted-by":"publisher","unstructured":"Ho, Rodney J. Y. \u201cWarp-Speed Covid-19 Vaccine Development: Beneficiaries of Maturation in Biopharmaceutical Technologies and Public-Private Partnerships.\u201d J Pharmaceutical Sci. 2021;110(2):615\u201318. https:\/\/doi.org\/10.1016\/j.xphs.2020.11.010.","DOI":"10.1016\/j.xphs.2020.11.010"},{"key":"2360_CR6","doi-asserted-by":"publisher","unstructured":"Kuter, Barbara J., Paul A. Offit, and Gregory A. Poland. \u201cThe Development of COVID-19 Vaccines in the United States: Why and How so Fast?\u201d Vaccine. 2021;39(18):2491\u201395. https:\/\/doi.org\/10.1016\/j.vaccine.2021.03.077.","DOI":"10.1016\/j.vaccine.2021.03.077"},{"key":"2360_CR7","doi-asserted-by":"publisher","unstructured":"Norton, Alice, Adrian Bucher, Emilia Antonio, Nicole Advani, Cathryn Johnston, Henrike Grund, Sheila Mburu, et al. \u201cA Living Mapping Review for COVID-19 Funded Research Projects: One Year Update.\u201d Wellcome Open Research. 2022;5(5):209. https:\/\/doi.org\/10.12688\/wellcomeopenres.16259.5.","DOI":"10.12688\/wellcomeopenres.16259.5"},{"key":"2360_CR8","doi-asserted-by":"publisher","unstructured":"Bumpus, Namandj\u00e9 N. \u201cFor Better Drugs, Diversify Clinical Trials.\u201d Science. 2021;371(6529):570\u201371. https:\/\/doi.org\/10.1126\/science.abe2565.","DOI":"10.1126\/science.abe2565"},{"key":"2360_CR9","doi-asserted-by":"publisher","unstructured":"Robinson, James C. \u201cFunding of Pharmaceutical Innovation During and After the COVID-19 Pandemic.\u201d JAMA. 2021;325(9):825\u201326. https:\/\/doi.org\/10.1001\/jama.2020.25384.","DOI":"10.1001\/jama.2020.25384"},{"issue":"6","key":"2360_CR10","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1111\/jcpt.13532","volume":"46","author":"M Lolic","year":"2021","unstructured":"Lolic M, Araojo R, Okeke M, Temple R. U.S. Racial and Ethnic Participation in Global Clinical Trials by Therapeutic Areas. J Clin Pharm Ther. 2021;46(6):1576\u201381. https:\/\/doi.org\/10.1111\/jcpt.13532.","journal-title":"J Clin Pharm Ther"},{"issue":"2","key":"2360_CR11","doi-asserted-by":"publisher","first-page":"e258","DOI":"10.1093\/pubmed\/fdaa196","volume":"43","author":"W Ekezie","year":"2021","unstructured":"Ekezie W, Czyznikowska BM, Rohit S, et al. The views of ethnic minority and vulnerable communities towards participation in COVID-19 vaccine trials. J Public Health. 2021;43(2):e258\u201360. https:\/\/doi.org\/10.1093\/pubmed\/fdaa196. PMID: 33124667.","journal-title":"J Public Health"},{"key":"2360_CR12","unstructured":"Racial Disparities in COVID-19 Impacts and Vaccinations for Children. KFF. Published September 16, 2021. https:\/\/www.kff.org\/racial-equity-and-health-policy\/issue-brief\/racial-disparities-in-covid-19-impacts-and-vaccinations-for-children\/. 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Aebersold, Stephan Bodis, Marcus Beck, et al. \u201cHyperthermia-Related Clinical Trials on Cancer Treatment within the ClinicalTrials.Gov Registry.\u201d Int J Hyperthermia. 2015;31(6):609\u201314. https:\/\/doi.org\/10.3109\/02656736.2015.1040471.","DOI":"10.3109\/02656736.2015.1040471"},{"key":"2360_CR16","doi-asserted-by":"publisher","unstructured":"Cho, Stephanie M., Stylianos Serghiou, John PA. Ioannidis, Terry P. Klassen, and Despina G. Contopoulos-Ioannidis. \u201cLarge Pediatric Randomized Clinical Trials in ClinicalTrials.Gov.\u201d Pediatrics. 2021;148(3):e2020049771. https:\/\/doi.org\/10.1542\/peds.2020-049771.","DOI":"10.1542\/peds.2020-049771"},{"issue":"10","key":"2360_CR17","doi-asserted-by":"publisher","first-page":"e544","DOI":"10.1016\/j.amjmed.2020.04.008","volume":"133","author":"MN Fouad","year":"2020","unstructured":"Fouad MN, Ruffin J, Vickers SM. COVID-19 Is Disproportionately High in African Americans. This Will Come as No Surprise\u2026. Am J Med. 2020;133(10):e544\u20135. https:\/\/doi.org\/10.1016\/j.amjmed.2020.04.008.","journal-title":"Am J Med"},{"key":"2360_CR18","doi-asserted-by":"publisher","unstructured":"Chokkara, Sukarn, Anna Volerman, Siddhi Ramesh, and Neda Laiteerapong. \u201cExamining the Inclusivity of US Trials of COVID-19 Treatment.\u201d J General Inter Med. 2021;36(5):1443\u201345. https:\/\/doi.org\/10.1007\/s11606-020-06566-8.","DOI":"10.1007\/s11606-020-06566-8"},{"issue":"1","key":"2360_CR19","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/INF.0000000000003331","volume":"41","author":"S Morin","year":"2022","unstructured":"Morin S, Lallemant M, Garcia-Prats A, Lewis L, Watkins M, Giaquinto C, Valentin M, Penazzato M, Reeder JC. Pediatric COVID-19 Therapeutics. Pediatr Infect Dis J. 2022;41(1):e1-5. https:\/\/doi.org\/10.1097\/INF.0000000000003331.","journal-title":"Pediatr Infect Dis J"},{"key":"2360_CR20","doi-asserted-by":"publisher","unstructured":"Flores, Laura E., Walter R. Frontera, Michele P. Andrasik, Carlos del Rio, Antonio Mondr\u00edguez-Gonz\u00e1lez, Stephanie A. Price, Elizabeth M. Krantz, Steven A. Pergam, and Julie K. Silver. \u201cAssessment of the Inclusion of Racial\/Ethnic Minority, Female, and Older Individuals in Vaccine Clinical Trials.\u201d JAMA Network Open. 2021;4(2):e2037640. https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.37640.","DOI":"10.1001\/jamanetworkopen.2020.37640"}],"container-title":["International Journal for Equity in Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-024-02360-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12939-024-02360-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-024-02360-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:50:58Z","timestamp":1737593458000},"score":1,"resource":{"primary":{"URL":"https:\/\/equityhealthj.biomedcentral.com\/articles\/10.1186\/s12939-024-02360-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,23]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2360"],"URL":"https:\/\/doi.org\/10.1186\/s12939-024-02360-8","relation":{},"ISSN":["1475-9276"],"issn-type":[{"value":"1475-9276","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,23]]},"assertion":[{"value":"6 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 December 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors have approved the manuscript and given their consent for submission and publication. All figures were created by the author and no external identifiable features are included.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"TM, QX, ZL, and TKM are employees of the startup company S-3 Research LLC. S-3 Research is a startup funded and currently supported by the National Institutes of Health \u2013 National Institute on Drug Abuse through a Small Business Innovation and Research contract for social media research and technology commercialization. Authors reports no other conflict of interest associated with this manuscript and have not been asked by any organization to be named on or to submit this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"26"}}