Association of community-level social vulnerability with county-level clinical trial access among ovarian cancer patients

Clinical trials are essential to therapeutic advancement, yet access to trials in ovarian cancer may not be equitably distributed. This study evaluated associations between community-level social vulnerability and county-level availability of interventional ovarian cancer clinical trials in the United States.

U.S.-based ovarian cancer clinical trials (2008-2021) identified from the Aggregate Analysis of ClinicalTrials.gov database were aggregated by county and year. Trial availability was defined as ≥1 open interventional trial in a given county-year. County-level availability was linked to the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and to ovarian cancer cases (diagnosed between 2008 and 2021) from the Surveillance, Epidemiology, and End Results Program. Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between high social vulnerability (SVI ≥90th percentile) and trial availability, adjusting for patient-level factors.

Among 70,486 ovarian cancer patients, 82% resided in counties with available trials during their year of diagnosis. Trial availability increased over time but was concentrated in higher-income, non-rural counties. In multivariable analysis, residence in highly socially vulnerable counties was associated with significantly lower odds of trial availability (OR 0.28, 95% CI 0.21-0.37).

County-level social vulnerability is associated with lower ovarian cancer clinical trial availability. These findings highlight structural inequities in clinical trial infrastructure and support that strategies to expand trial access in socially vulnerable communities are needed.