Abstract 1309: Assessment of geographic and socioeconomic factors in primary brain tumor patient accrual to a natural history study
Authors: Kim Yeonju , Stockdill Macy L. , Vera Elizabeth , Miller Hope , Vo Jacqueline B. , Gilbert Mark R. , Armstrong Terri S. , Celiku Orieta 
Published: March 2024

Purpose: To better understand neuro-oncology trial access barriers in the United States (US), we assessed the role of geography, population density, and socioeconomic factors in the accrual of adult primary brain tumor patients in the Natural History Study (NHS, NCT02851706) at the National Institutes of Health (NIH).

Methods: Participant addresses were linked to zip code geography and population data from the US Census and the Neighborhood Atlas Area Deprivation Index (ADI; 1 to 100 from least to most disadvantaged). Locations with population density greater than 1000 inhabitants per square mile were considered urban. Locations were categorized based on their distance from NIH as local (&lt;50 mi), short-distance (50-200mi) and long-distance (&gt;200 mi). T-tests, chi-square tests, and multivariate logistic regression compared socioeconomic and urbanity factors.

Results: 667 NHS participants arrived from 43 states and territories, with the majority (61%) from Maryland and neighboring states, and other states contributing no more than 5% of the participants each. The home locations of the participants were disproportionately urban (60% versus 19% of all US locations, p &lt;0.001) and socioeconomically advantaged (mean ADI 26.94 versus 57.30 across all US locations, p&lt;0.001). Local participants (49%) had greater racial and ethnic diversity (73% White, 11% Black, 9% Asian, 2% other; 11% Hispanic/Latino) compared to short-distance participants (11% total; 96% White, 3% Black, 0% other; 0% Hispanic/Latino) and long-distance participants (39% total; 89% White, 3% Black, 3% Asian, 2% Other; 6% Hispanic/Latino). Local participants lived in the most socioeconomically advantaged locations (mean ADI 16.39) compared to short-distance (mean ADI 40.88, p&lt;0.001) and long-distance (mean ADI 39.69, p&lt;0.001) participants. Short-distance participants were from disproportionally non-urban areas (69%) compared to local (28%, p&lt;0.001) and long-distance (46%, p&lt;0.001) participants. Multivariate analysis also confirmed that local participants were more likely to live in more advantaged areas than short-distance (OR=0.90, p&lt;0.001) and long-distance (OR=0.93, p&lt;0.001) participants, and short-distance participants were less likely to live in urban areas compared to local (OR=0.19, p&lt;0.001) and long-distance (OR=0.44, p=0.008) participants.

Conclusion: The trial enrolled patients across the US, albeit with most participants arriving from neighboring states and socioeconomically advantaged, urban areas. Greater rural patient participation from nearby areas reflects the positive impact of NIH subsidies in reducing the financial challenges linked to participating in clinical trials. Current trends indicate that continued and targeted efforts to enable participation from local disadvantaged communities can ameliorate access to neuro-oncology clinical care and research.

Citation Format: Yeonju Kim, Macy L. Stockdill, Elizabeth Vera, Hope Miller, Jacqueline B. Vo, Mark R. Gilbert, Terri S. Armstrong, Orieta Celiku. Assessment of geographic and socioeconomic factors in primary brain tumor patient accrual to a natural history study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1309.