Abstract A119: Unveiling disparities in clinical trial participation: Exploring socioeconomic barriers and access to insurance among diverse ethnic groups
Authors: Jubran Ritta , Lapidot Yelena , Bader Tzvia , Gaziel Avital 
Published: December 2023

Introduction: Diversity in clinical trials (CTs) is crucial for enhancing the ability to generalize research findings and promote equal health services for underserved populations. Researchers and companies seeking approval for late-stage CTs are now asked by the US Food and Drug Administration (FDA) to provide a diversity plan to ensure inclusivity among CT participants. To design such a plan, it is important to study the barriers leading to underrepresentation in CTs. While CTs interventions are mostly covered by trial sponsors, insurance coverage is still required for participation. We studied the impact of insurance coverage, as a potential  factor impacting participation in CTs among underserved communities, while considering other key parameters such as age, sex, cancer type and disease status. Methods: Leal is an AI-based platform that matches cancer patients (pts) to CTs based on a self reported medical profile. The profile includes parameters essential for CT matching including disease status, stage, biomarker/mutational status, treatment history, comorbidities and demographics. This study included a multi-ethnic cohort of 4,525 pts who signed up to the platform in 2023. We analyzed potential barriers for CT enrollment among various ethnic groups. We implemented the non-parametric Pearson's Χ², the Welch's t-test and the Games-Howell pairwise comparisons tests, at significance level of 0.05. Results: Insurance coverage was significantly linked to ethnicity. Non-white pts comprised 37% of uninsured pts, which was markedly higher compared to their representation in the insured group (24%, p&lt;0.0001). Medicaid had the most diverse subscriber base (33%) compared to other insurance providers (p&lt;0.0001), independently from disease status and cancer type. In addition, when considering participation in CTs, 78% of non-white pts were willing to travel up to 50 miles, while a larger percentage of white pts (64%) were open to traveling between 100 and 200 miles (p&lt;0.0001). Conclusions: We found a strong association between socioeconomic status and potential barriers for CTs participation including insurance coverage and willingness to travel. The higher proportion of uninsured non-whites highlights the disparity in access to insurance of underserved populations. This may stem from both financial constraints or limited education and community resources. Medicaid had the most diverse subscriber base, which is aligned with its aim to provide coverage to pts with low income. To increase diversity in CTs, financial support programs for uninsured patients should be considered. In addition, CT sites should consider incorporating insurance programs for pts with disadvantaged backgrounds. Our study also revealed reduced willingness among non-whites to travel long distances to trial sites. To ensuring representative outcomes across diverse populations, regardless of location or socioeconomic status, requires addressing accessibility limitations through financial support, localized trial sites, and community-targeted recruitment strategies.

Citation Format: Ritta Jubran, Yelena Lapidot, Tzvia Bader, Avital Gaziel. Unveiling disparities in clinical trial participation: Exploring socioeconomic barriers and access to insurance among diverse ethnic groups [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A119.