社会脆弱性阻碍临床试验参与胃肠道癌症手术患者
Shruthi R Perati1, Sana M Mohayya2, Henry A Pitt1,2,3
1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
社区的社会脆弱性和在社区医院接受手术显著减少了胃肠道癌症临床试验的招生. 这些因素不成比例地影响弱势群体的参与.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 健康的社会决定因素
背景情况:
- 临床试验对于促进癌症治疗至关重要,但在参与者多样性方面面临挑战.
- 在临床试验中,弱势群体往往代表性不足,这限制了研究结果的概括性.
研究的目的:
- 调查社区社会脆弱性对接受胃肠道 (GI) 癌症手术的患者临床试验参与的影响.
- 确定影响试验招生的社会脆弱性和医院环境的特定领域.
主要方法:
- 使用了Vizient临床数据库 (CDB),涵盖了美国大型医院网络.
- 分析了399,446名胃肠癌手术患者 (2018年7月至2023年6月) 的数据.
- 使用Vizient脆弱性指数 (VVI) 来评估人口普查区层面的社会脆弱性.
主要成果:
- 只有1.9%的患者参加了临床试验.
- 社会脆弱的患者,特别是那些经济和教育处境不利的患者,参与试验的几率较低 (OR 0.71).
- 社区医院的手术显著减少了试验招生 (OR 0.38),对社会脆弱的患者产生了复合效应.
结论:
- 女性性别,黑人种族,医疗补助保险和更高的社会脆弱性与消化道癌临床试验入学率降低有关.
- 社区医院环境是招募试验的最强抑制因素,特别是与社会脆弱性相结合时.
- 解决健康和医院差异的社会决定因素对于公平的临床试验参与至关重要.
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