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Yeager R, Keith RJ, Riggs DW, Fleischer D, Browning MHEM, Ossola A, Walker KL, Hart JL, Srivastava S, Rai SN, Smith T, Bhatnagar A. Intra-neighborhood associations between residential greenness and blood pressure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 946:173788. [PMID: 38901580 DOI: 10.1016/j.scitotenv.2024.173788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/08/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Previous investigations have reported that individuals living in greener neighborhoods have better cardiovascular health. It is unclear whether the effects reported at large geographic scales persist when examined at an intra-neighborhood level. The effects of greenness have not been thoroughly examined using high-resolution metrics of greenness exposure, and how they vary with spatial scales of assessment or participant characteristics. METHODS We conducted a cross-sectional assessment of associations between blood pressure and multiple high-resolution measures of residential area greenness in spatially concentrated HEAL Study cohort of the Green Heart Project. We employed generalized linear models, accounting for individual-level covariates, to examine associations between different high-resolution measures of greenness and blood pressure among 667 participants in a 4 sq. mile contiguous neighborhood area in Louisville, KY. RESULTS In adjusted models, we observed significant inverse associations between residential greenness, measured by leaf area index (LAI), and systolic blood pressure (SBP) within 150-250 m and 500 m of homes, but not for Normalized Difference Vegetation Index (NDVI) or grass cover. Weaker associations were also found with diastolic blood pressure (DBP). Significant positive associations were observed between LAI and SBP among participants who reported being female, White, without obesity, non-exercisers, non-smokers, younger age, of lower income, and who had high nearby roadway traffic. We found few significant associations between grass cover and SBP, but an inverse association in those with obesity, but positive associations for those without obesity. CONCLUSIONS We found that leaf surface area of trees around participants home is strongly associated with lower blood pressure, with little association with grass cover. These effects varied with participant characteristics and spatial scales. More research is needed to test causative links between greenspace types and cardiovascular health and to develop population-, typology-, and place-based evidence to inform greening interventions.
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Affiliation(s)
- Ray Yeager
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Center for Integrative Environmental Health Sciences, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
| | - Rachel J Keith
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
| | - Daniel W Riggs
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
| | - Daniel Fleischer
- Hyphae Design Laboratory, 942 Clay Street, Oakland, CA 94607, USA
| | - Matthew H E M Browning
- Department of Parks, Recreation, and Tourism Management, Clemson University, Sirrine 120B, Clemson, SC, USA
| | - Alessandro Ossola
- Department of Plant Sciences, University of California Davis. PES-1238, One Shields Avenue, Davis, CA 95616, USA
| | - Kandi L Walker
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Department of Communication, University of Louisville, 310 Strickler Hall West, Louisville, KY 40292, USA
| | - Joy L Hart
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Department of Communication, University of Louisville, 310 Strickler Hall West, Louisville, KY 40292, USA
| | - Sanjay Srivastava
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
| | - Shesh N Rai
- Department of Environmental and Public Health Sciences, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Ted Smith
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Center for Integrative Environmental Health Sciences, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Division of Environmental Medicine, Department of Medicine, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Superfund Research Center, University of Louisville. 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA; Center for Integrative Environmental Health Sciences, University of Louisville, 302 E Muhammad Ali Blvd, Louisville, KY 40202, USA
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Bomberg EM, Clark J, Rudser KD, Gross AC, Kelly AS, Fox CK. Effectiveness and predictors of weight loss response to phentermine plus lifestyle modifications among youth in a paediatric weight management clinical setting. Pediatr Obes 2024:e13143. [PMID: 38886982 DOI: 10.1111/ijpo.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Anti-obesity medications (AOMs) are promising lifestyle modification (LSM) adjuncts for obesity treatment, and phentermine is commonly prescribed in paediatric weight management clinics. Determining 'real-world' AOM effectiveness and characteristics predicting response is important. OBJECTIVES We sought to describe phentermine plus LSM effectiveness and identify baseline characteristics predicting response. METHODS This was a retrospective cohort study among youth seen in a US academic-based weight management clinic from 2012 to 2020. Baseline characteristics (e.g., body mass index (BMI), liver transaminases, eating-related behaviours) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, %BMI change, weight) were determined through electronic health records and intake surveys. RESULTS Among 91 youth prescribed phentermine plus LSM over 8 years (mean %BMIp95 150%), %BMIp95 was statistically significantly reduced at 1.5, 3, 6 and 12 months (peak reduction 10.9 percentage points at 6 months; p < 0.001). Considering multiple comparisons, the presence of baseline elevated alanine aminotransferase was associated with statistically significant smaller 1.5-month %BMIp95 reductions (p = 0.001) and higher food responsiveness with smaller 3- (p = 0.001) and 6-month (p < 0.001) reductions. CONCLUSIONS Phentermine plus LSM reduced %BMIp95 among youth in a weight management clinic, and baseline characteristics may help determine those more or less likely to respond. Prospective studies are needed to further characterize effectiveness and confirm response predictors.
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Affiliation(s)
- Eric M Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Justin Clark
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle D Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy C Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
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Kaczynski M, Vassilopoulos A, Vassilopoulos S, Sisti A, Benitez G, Tran QL, Mylona EK, Shehadeh F, Rogers R, Mylonakis E. Temporal trends and characteristics associated with racial, ethnic, and sex representation in COVID-19 clinical trials: A systematic review and meta-analysis. Contemp Clin Trials 2024; 143:107578. [PMID: 38789079 DOI: 10.1016/j.cct.2024.107578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 05/05/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Early in the pandemic, extensive attention was cast on limited inclusion of historically underrepresented patient populations in COVID-19 clinical trials. How diverse representation improved following these initial reports remains unclear. METHODS PubMed, Embase and the Cochrane Library were searched (through April 2024) for US-based COVID-19 trials. Utilizing random-effects, we compared expected proportions of trial participants from racial and ethnic groups and of female sex between trials enrolling primarily in 2020 versus primarily 2021-2022. Meta-regression was performed to assess associations between trial characteristics and group representation. RESULTS We retrieved 157 studies comprising 198,012 participants. White (2020: 63.1% [95% CI, 60.8%-67.3%]; 2021-2022: 73.8% [95% CI, 71.5%-76.0%]) and female representation (2020: 46.1% [95% CI, 44.7%-47.4%)]; 2021-2022: 51.1% [95% CI, 49.3%-52.8%) increased across enrollment periods. Industry-sponsored trials were associated with higher White (coefficient, 0.10 [95% CI, 0.03-0.18]) and Hispanic or Latinx representation (coefficient, 0.16 [95% CI, 0.08-0.25]) and lower Asian (coefficient, -0.03 [95% CI, -0.06- -0.003]) and female representation (coefficient, -0.03 [95% CI, -0.07- -0.002]). Outpatient trials were associated with higher White (coefficient, 0.20 [95% CI, 0.13-0.26]) and female representation (coefficient, 0.16 [95% CI, 0.13-0.18]), and lower Black representation (coefficient, -0.10 [95% CI, -0.10- -0.08]). CONCLUSIONS Despite improved female representation in COVID-19 trials over time, there was no clear increase in non-White representation. Trial characteristics such as primary sponsor, clinical setting, and intervention type correlate with representation of specific demographic groups and should be considered in future efforts to improve participant diversity.
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Affiliation(s)
- Matthew Kaczynski
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Athanasios Vassilopoulos
- Department of Internal Medicine, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Stephanos Vassilopoulos
- Department of Internal Medicine, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anthony Sisti
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Gregorio Benitez
- Infectious Diseases Division, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Quynh-Lam Tran
- Geisel School of Medicine at Dartmouth University, Hanover, NH, USA
| | - Evangelia K Mylona
- Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Fadi Shehadeh
- Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA; School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Ralph Rogers
- Infectious Diseases Division, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School at Brown University, Providence, RI, USA; Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.
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Bomberg EM, Clark J, Rudser KD, Gross AC, Kelly AS, Fox CK. Clinical effectiveness and predictors of response to topiramate plus lifestyle modification in youth with obesity seen in a weight management clinical setting. Front Endocrinol (Lausanne) 2024; 15:1369270. [PMID: 38800488 PMCID: PMC11116594 DOI: 10.3389/fendo.2024.1369270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Obesity affects approximately 20% of U.S. youth. Anti-obesity medications (AOMs) are promising lifestyle modification adjuncts for obesity treatment, and topiramate is commonly prescribed in pediatric weight management clinics. It is important to determine "real-world" effectiveness of AOMs and, given shifts towards personalized approaches, characteristics potentially predicting better or worse response. We therefore sought to describe clinical effectiveness from topiramate plus lifestyle modification, and to determine if baseline phenotypic characteristics are associated with better or worse response. Methods We performed a retrospective cohort study (2012-2020) among youth (<18 years old) followed in a U.S. academic-based weight management clinic. Baseline characteristics (i.e., body mass index (BMI), liver function tests, eating-related behaviors) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, percent %BMI change, weight) were determined through review of electronic health records and clinic intake survey data. Results Among 282 youth prescribed topiramate plus lifestyle modifications (mean baseline age 12.7 years, %BMIp95 144%), %BMIp95 and percent BMI change were statistically significantly reduced at each time point (1.5-, 3-, 6-, and 12-month %BMIp95 reductions: -2.2, -3.9, -6.6, and -9.3 percentage points, respectively; percent BMI reduction: -1.2%, -1.9%, -3.2%, and -3.4%, respectively; all p<0.01). Considering multiple comparisons, no baseline characteristics statistically significantly predicted response at any time point. Conclusions We found that topiramate plus lifestyle modification reduced %BMIp95 and BMI among youth in a weight management clinical setting, and that no baseline characteristics evaluated were associated with response. These results should be considered preliminary given the observational nature of this study, and prospective studies are needed to further characterize clinical effectiveness and identify and confirm potential predictors of response.
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Affiliation(s)
- Eric M. Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Justin Clark
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kyle D. Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Amy C. Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Claudia K. Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
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Steventon L, Nicum S, Man K, Chaichana U, Wei L, Chambers P. A systematic review of ethnic minority participation in randomised controlled trials of systemic therapies for gynecological cancers. Gynecol Oncol 2024; 184:178-189. [PMID: 38330832 DOI: 10.1016/j.ygyno.2024.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Randomised controlled trials (RCTs) must include ethnic minority patients to produce generalisable findings and ensure health equity as cancer incidence rises globally. This systematic review examines participation of ethnic minorities in RCTs of licensed systemic anti-cancer therapies (SACT) for gynecological cancers, defining the research population and distribution of research sites to identify disparities in participation on the global scale. METHODS A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Phase II and III RCTs of licensed therapies for gynecological cancers published 01/11/2012-01/11/2022 that reported patient race/ethnicity were included. Extracted data included race/ethnicity and research site location. RCT populations were aggregated and participation of groups compared. Global distribution of research sites was described. RESULTS 26 RCTs met inclusion criteria of 351 publications included in full-text screening, representing 17,041 patients. 79.8% were "Caucasian", 9.1% "East Asian", 3.7% "Black/African American" and 6.1% "Other, Unknown, Not Reported". "Caucasian" patients participated at higher rates than all other groups. Of 5,478 research sites, 80.1% were located in North America, 13.0% in Europe, 3.4% in East Asia, 1.3% in the Middle East, 1.3% in South America and 0.8% in Australasia. CONCLUSIONS Ethnic minorities formed smaller proportions of RCT cohorts compared to the general population. The majority of sites were located in North America and Europe, with few in other regions, limiting enrollment of South Asian, South-East Asian and African patients in particular. Efforts to recruit more ethnic minority patients should be made in North America and Europe. More sites in underserved regions would promote equitable access to RCTs and ensure findings are generalisable to diverse groups. This review assessed the global population enrolled in contemporary RCTs for novel therapies now routinely given for gynecological cancers, adding novel understanding of the global distribution of research sites.
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Affiliation(s)
- Luke Steventon
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom; University College London Hospitals NHS Foundation Trust, Medical Oncology Department, 250 Euston Road, London NW1 2PG, United Kingdom
| | - Shibani Nicum
- University College London Hospitals NHS Foundation Trust, Medical Oncology Department, 250 Euston Road, London NW1 2PG, United Kingdom; UCL Cancer Institute, Department of Oncology, 72 Huntley Street, London WC1 6DD, United Kingdom
| | - Kenneth Man
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom
| | - Ubonphan Chaichana
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom
| | - Li Wei
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom
| | - Pinkie Chambers
- UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9EU, United Kingdom; University College London Hospitals NHS Foundation Trust, Medical Oncology Department, 250 Euston Road, London NW1 2PG, United Kingdom.
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Wagner E, Luykx JJ, Strube W, Hasan A. Challenges, unmet needs and future directions - a critical evaluation of the clinical trial landscape in schizophrenia research. Expert Rev Clin Pharmacol 2024; 17:11-18. [PMID: 38087450 DOI: 10.1080/17512433.2023.2293996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Developing novel antipsychotic mechanisms of action and repurposing established compounds for the treatment of schizophrenia is of utmost importance to improve relevant symptom domains and to improve the risk/benefit ratio of antipsychotic compounds. Novel trial design concepts, pathophysiology-based targeted treatment approaches, or even the return to old values may improve schizophrenia outcomes in the future. AREAS COVERED In this review of the clinical trial landscape in schizophrenia, we present an overview of the challenges and gaps in current clinical trials and elaborate on potential solutions to improve the outcomes of people with schizophrenia. EXPERT OPINION The classic parallel group design may limit substantial advantages in drug approval or repurposing. Collaborative approaches between regulatory authorities, industry, academia, and funding agencies are needed to overcome barriers in clinical schizophrenia research to allow for meaningful outcome improvements for the patients.
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Affiliation(s)
- Elias Wagner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Evidence-based psychiatry and psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Jurjen J Luykx
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Bipolar Outpatient Clinic, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Wolfgang Strube
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- DZPG (German Center for Mental Health), partner site München/Augsburg, Augsburg, Germany
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Adu-Brimpong J, Pugh J, Darko DA, Shieh L. Examining Diversity in Digital Therapeutics Clinical Trials: Descriptive Analysis. J Med Internet Res 2023; 25:e37447. [PMID: 37531157 PMCID: PMC10433021 DOI: 10.2196/37447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/31/2023] [Accepted: 05/31/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Digital therapeutics (DTx) are an emerging class of software-based medical therapies helping to improve care access and delivery. As we leverage these digital health therapies broadly in clinical care, it is important to consider sociodemographic representation underlying clinical trials data to ensure broad application to all groups. OBJECTIVE We review current sociodemographic representation in DTx clinical trials using data from the Digital Therapeutics Alliance Product Library database. METHODS We conducted a descriptive analysis of DTx products. We analyzed 15 manuscripts associated with 13 DTx products. Sociodemographic information was retrieved and compared with the US population's demographic distribution. RESULTS The median study size and age of participants were 252 and 43.3 years, respectively. Of the 15 studies applicable to this study, 10 (67%) reported that females made up 65% or greater of the study cohort. A total of 14 studies reported race data with Black or African American and Asian American individuals underrepresented in 9 and 11 studies, respectively. In 7 studies that reported ethnicity, Hispanics were underrepresented in all 7 studies. Furthermore, 8 studies reported education levels, with 5 studies reporting populations in which 70% or greater had at least some college education. Only 3 studies reported health insurance information, each reporting a study cohort in which 100% of members were privately insured. CONCLUSIONS Our findings indicate opportunities for improved sociodemographic representation in DTx clinical trials, especially for underserved populations typically underrepresented in clinical trials. This review is a step in examining sociodemographic representation in DTx clinical trials to help inform the path forward for DTx development and testing.
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Affiliation(s)
- Joel Adu-Brimpong
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Jennifer Pugh
- Division of Dermatology, Washington University School of Medicine, St Louis, MO, United States
| | - David Agyen Darko
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lisa Shieh
- School of Medicine, Stanford University, Stanford, CA, United States
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Cao JA, Patel SB, Wong CW, Garcia D, Munoz J, Cone C, Zamora D, Reagan M, Nguyen TV, Pearce W, Fish RH, Brown DM, Chaudhary V, Wykoff CC, Fan KC. Demographic and Socioeconomic Factors in Prospective Retina-Focused Clinical Trial Screening and Enrollment. J Pers Med 2023; 13:880. [PMID: 37373869 DOI: 10.3390/jpm13060880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Historically marginalized populations are disproportionately affected by many diseases that commonly affect the retina, yet they have been traditionally underrepresented in prospective clinical trials. This study explores whether this disparity affects the clinical trial enrollment process in the retina field and aims to inform future trial recruitment and enrollment. Age, gender, race, ethnicity, preferred language, insurance status, social security number (SSN) status, and median household income (estimated using street address and zip code) for patients referred to at least one prospective, retina-focused clinical trial at a large, urban, retina-based practice were retrospectively extracted using electronic medical records. Data were collected for the 12-month period from 1 January 2022, through 31 December 2022. Recruitment status was categorized as Enrolled, Declined, Communication (defined as patients who were not contacted, were contacted with no response, were waiting for a follow-up, or were scheduled for screening following a clinical trial referral.), and Did Not Qualify (DNQ). Univariable and multivariable analyses were used to determine significant relationships between the Enrolled and Declined groups. Among the 1477 patients, the mean age was 68.5 years old, 647 (43.9%) were male, 900 (61.7%) were White, 139 (9.5%) were Black, and 275 (18.7%) were Hispanic. The distribution of recruitment status was: 635 (43.0%) Enrolled, 232 (15.7%) Declined, 290 (19.6%) Communication, and 320 (21.7%) DNQ. In comparing socioeconomic factors between the Enrolled and Declined groups, significant odds ratios were observed for age (p < 0.02, odds ratio (OR) = 0.98, 95% confidence interval (CI) [0.97, 1.00]), and between patients who preferred English versus Spanish (p = 0.004, OR = 0.35, 95% CI [0.17, 0.72]. Significant differences between the Enrolled and Declined groups were also observed for age (p < 0.05), ethnicity (p = 0.01), preferred language (p < 0.05), insurance status (p = 0.001), and SSN status (p < 0.001). These factors may contribute to patient participation in retina-focused clinical trials. An awareness of these demographic and socioeconomic disparities may be valuable to consider when attempting to make clinical trial enrollment an equitable process for all patients, and strategies may be useful to help address these challenges.
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Affiliation(s)
| | - Sagar B Patel
- Retina Consultants of Texas, Houston, TX 77401, USA
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX 77030, USA
| | - Calvin W Wong
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - David Garcia
- Retina Consultants of Texas, Houston, TX 77401, USA
| | - Jose Munoz
- Retina Consultants of Texas, Houston, TX 77401, USA
| | | | | | - Mary Reagan
- Retina Consultants of Texas, Houston, TX 77401, USA
| | - Tieu V Nguyen
- Retina Consultants of Texas, Houston, TX 77401, USA
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX 77030, USA
| | - Will Pearce
- Retina Consultants of Texas, Houston, TX 77401, USA
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX 77030, USA
| | - Richard H Fish
- Retina Consultants of Texas, Houston, TX 77401, USA
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX 77030, USA
| | - David M Brown
- Retina Consultants of Texas, Houston, TX 77401, USA
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX 77030, USA
| | - Varun Chaudhary
- Department of Surgery, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Charles C Wykoff
- Retina Consultants of Texas, Houston, TX 77401, USA
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX 77030, USA
| | - Kenneth C Fan
- Retina Consultants of Texas, Houston, TX 77401, USA
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX 77030, USA
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