Abstract Details

Title Disparities in Stroke Clinical Trial Enrollment by Geographic Social Vulnerability

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-001

Objective To quantify disparities in stroke clinical trial enrollment by geographic social vulnerability within South Carolina (SC).

Background Geographic marginalization may limit the access of vulnerable populations to practice-changing treatments available through clinical trials, even in regions with a high stroke burden.

Design/Methods

Patient demographic data (zip code, race/ethnicity, sex) were obtained from the participating institute’s trial database for 5 multicenter clinical trials assessing interventions for the prevention/treatment of acute ischemic stroke. Using the CDC/ATSDR SVI database, each SC county was assigned a level on the social vulnerability index (SVI) among “high,” “medium-high,” “low-medium,” and “low.” The yearly numbers of hospital discharges for stroke patients from each county were extracted from the SC Revenue and Fiscal Affairs Office database – we then compared the proportion of trial participants enrolled at each SVI level (among all trial participants) to the proportion of hospitalized patients from the respective counties (among all counties), calculated as the enrollment-hospitalization ratio (EHR).

Results Among 79 trial participants, only 6 (7.59%) were enrolled from high-SVI counties. Fifty-four participants (68.35%) originated from low-SVI counties, 11 (13.92%) from low-medium-SVI counties, and 8 (10.13%) from medium-high-SVI counties. The proportion of Black participants remained consistent within the high-SVI (n=2; 33.3%) and low-SVI (n=17; 31.5%) groups, as did the proportion of women (n=3; 50.0% in high-SVI counties vs. n=26; 48.1% in low-SVI counties). No Hispanic patients were enrolled from any county. Comparing enrollment with hospitalization, patients from low-SVI counties were over-enrolled across all years (EHR: 1.48 in 2016-2017, 1.44 in 2018-2019, 1.95 in 2020-2021; 1.31 in 2022-2024). Patients from high-SVI counties were initially over-enrolled compared with hospitalization (EHR: 2.87 in 2016-2017), however, this decreased sharply in 2018-2019 (EHR: 0.64) and 2020-2021 (EHR: 0.0), and increased again in 2022-2024 (EHR: 1.40).

Conclusions Recruitment from regions with high social vulnerability lags behind in stroke clinical trials.

Authors/Disclosures
Mahnoor Islam, MD, MBBS (Medical University of South Carolina) PRESENTER	Dr. Islam has nothing to disclose.
Alexander Vorobyev, MD (Medical University of South Carolina)	Dr. Vorobyev has nothing to disclose.
Todd LeMatty, MHA	Mr. LeMatty has nothing to disclose.
Caitlan LeMatty	Miss LeMatty has nothing to disclose.
Christine Holmstedt, DO	The institution of Dr. Holmstedt has received research support from NIH. The institution of Dr. Holmstedt has received research support from Patient-Centered Outcomes Research Institute.

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