Geographic Disparities in Stroke Clinical Trials Across the United States: A Decade of Data (2010-2020).

BACKGROUND AND OBJECTIVES Geographic disparities in stroke clinical trials may limit access to innovative treatments in high-burden regions. This study examines the distribution of completed stroke trials (2010-2020) relative to stroke mortality and hospitalization rates. METHODS Data on completed trials were obtained from ClinicalTrials.gov and stroke burden metrics from the Control and Prevention. We calculated relative study frequency (RSF) by dividing the number of stroke deaths, age-adjusted stroke death rates, and stroke hospitalizations per 100,000 Medicare beneficiaries by the number of available trials. RSF values were stratified by quartiles. RESULTS A total of 649 stroke-related clinical trials were completed across 40 states, with 10 states having no registered trials. RSF varied widely, with the lowest quartile, including Mississippi (RSF = 14.40) and Louisiana (RSF = 13.90), having high stroke hospitalizations with minimal research activity, while California (RSF = 0.09) and New York (RSF = 0.19) had greater clinical trial availability to address stroke burden. DISCUSSION Stroke trial availability is disproportionately low in high-burden regions, particularly in the Southeast and Midwest. States with high stroke mortality and hospitalization rates but low clinical trial availability may face barriers to trial access, potentially exacerbating disparities in stroke care.