There are geographic disparities in access to clinical trial sites for neovascular age-related macular degeneration (nAMD) in the US. While proximity to urban centers is beneficial for efficiency and retention of subjects, the study identifies populations with a high travel burden to sites, which may contribute to under-representation.
In recent decades, the expanding pipeline of clinical trials has offered new therapies to improve visual outcomes in nAMD. Understanding accessibility to clinical trials is imperative to address the disease burden of nAMD for all populations in the United States. There were 42 trials involving nAMD across 829 unique clinical trial sites in the US. In multivariable regression, driving distance greater than 60 miles was significantly associated with rural location and Midwest and South versus Northeast. Lower odds of driving greater than 60 miles were associated with census tracts with a higher percentage of African Americans, Hispanics, and Asians, as compared to Whites, and a lower percentage of the population less than 200% of the federal poverty level. Time traveled greater than 60 minutes had similar predictors in regression modelling.