Gaps in clinical trial diversity remain despite efforts to raise awareness and encourage participation

While minority patients report higher levels of trust in their health care providers, according to a new study from the Ohio State University College of Medicine.

A study published in Journal of General Internal Medicine, looked at the relationship between race and ethnicity and clinical trial invitation, participation, and knowledge. It also examined the sources of influence on clinical trial participation.

“The diversity of clinical trials is critical to the development of safe, effective treatments and interventions health equity” said Daniel Walker, associate professor of family and community medicine and member of the Center for the Advancement of Team Science, Analytics and Systems Thinking at the Health Services and Implementation Research Institute.

“Recent efforts to increase awareness of clinical trials and reduce racial and ethnic disparities participation has not yet budged as the non-Hispanic white population continues to be the highest participant in clinical trials. This study seeks to understand why.”

According to the US Census Bureau, racial and ethnic minorities make up 40% of the US population. In contrast, the US Food and Drug Administration reports that 75% of the 32,000 patients who participated in clinical trials of 53 new drugs in 2020 were non-Hispanic white.

To examine this discrepancy, researchers examined results from the Health Care National Trends Survey (HINTS), which was conducted from February to June 2020. HINTS collected data from US adults on health care use, use of health information technology, and demographics. A total of 3,865 adults over the age of 18 took part in it. Survey respondents reported race and ethnicity as non-Hispanic white, non-Hispanic black, Hispanic, and other non-Hispanic.

The researchers analyzed the data and found:

• Non-Hispanic black participants had higher odds of being invited to a clinical trial, but no differences in odds of participation were observed by race or ethnicity.
• All survey participants, regardless of race and ethnic originsaid their personal medical workers were the most trusted source of information about clinical trials, followed by public health organizations and public health agencies.
• Hispanic, non-Hispanic black, and other non-Hispanic participants were less likely than non-Hispanic white participants to say they would be strongly influenced by their physician’s encouragement to participate.
• Non-Hispanic black participants were less likely than non-Hispanic white participants to say that family encouragement would significantly influence their decision to participate in a clinical trial.

“Our findings suggest that mistrust of the health care system may play a greater role than trust in individual health care providers when it comes to influencing racial and ethnic minority patient participation in clinical trials” said Dr. Joshua J. Joseph, associate professor of internal medicine at The Ohio State College of Medicine and endocrinologist at The Ohio State University Wexner Medical Center.

The paper recommends that future efforts to improve the diversity of clinical trials should extend beyond health systems to build trust directly within communities. Researchers in academia, government, and industry should use community organizations’ established relationships with racial and ethnic populations to develop community-informed, engaged, and community-based research approaches to increase diversity.