Improving Representation in Clinical Trials and Research Building Research Equity for Women and Underrepresented Groups (2022) / Chapter Skim
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Appendix A: Quantifying the Potential Health and Economic Impacts of Increased Trial Diversity
Appendix A: Quantifying the Potential Health and Economic Impacts of Increased Trial Diversity
Pages 169-190
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From page 169... ...
We then consider a counterfactual scenario in which disparities in disease impact on mortality, disability, and workforce participation are eliminated. Future Elderly Model The Future Elderly Model is a dynamic microsimulation of health risk factors, chronic illnesses, disability, and health-related economic outcomes for the U.S.
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From page 170... ...
Throughout, non-Hispanic white males serve as the reference group due to their historical inclusion and representation in clinical trials. Non-Hispanic Black males, Hispanic males, non-Hispanic white females, non-Hispanic Black females, and Hispanic females all potentially benefit from narrowing the differential impact of disease on the outcomes of interest.
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From page 171... ...
Adjusted relative risks for the key parameters of interest (the underrepresented group and disease interaction term) are shown in A-2.
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From page 172... ...
Initial prevalence of disease varies across groups, with the highest rates of diabetes among non-Hispanic Black males, Hispanic males, and Hispanic females. Heart disease at baseline is highest among non-Hispanic white females and non-Hispanic Black males.
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From page 173... ...
0.98] Hispanic females 1.11 [1.02, 1.10 [1.06, 0.88 1.15 [1.07, 1.18 [1.15, 0.86 1.11 [1.03, 1.14 [1.11, 0.95 1.21]
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From page 174... ...
TABLE A-3 Baseline Characteristics at Simulation Start 174 Non-Hispanic Non-Hispanic White Non-Hispanic Non-Hispanic Black Hispanic Hispanic White Males Females Black Males Females Males Females Weighted N 2,879,983 2,920,961 509,836 576,820 648,817 633,641 Age 52 52 52 52 52 52 BMI 29.3 30.6 30.7 33.3 29.9 30.7 Current smoker 25% 16% 23% 19% 21% 24% Diabetes 14% 11% 23% 13% 26% 29% Heart disease 8% 15% 10% 6% 3% 7% Hypertension 39% 33% 57% 55% 38% 38% Any disability 18% 20% 15% 17% 11% 20% Working for pay 81% 79% 72% 66% 89% 65%
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From page 175... ...
Lifetime risk for developing these chronic illnesses is high for the 51–52-yearold cohort in the FEM, as seen in Table A-7, Table A-8, and Table A-9. Diabetes risk ranges from 47 percent for non-Hispanic white females to 77 percent for Hispanic females.
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From page 176... ...
13.3] TABLE A-5 Life Years, Disability-free Life Years, and Remaining Work Years for Heart Disease Scenario Baseline Conterfactual Delta Baseline Conterfactual Delta Baseline Counterfactual Delta Hispanic females 36.3 [36.3, 37.7 [37.3, 1.0 [0.9, 23.2 [23.1, 24.5 [24.4, 1.4 [1.4, 8.3 [8.3, 8.6 [8.6, 8.6]
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From page 177... ...
14.0] TABLE A-6 Life Years, Disability-free Life Years, and Remaining Work Years for Hypertension Scenario Baseline Conterfactual Delta Baseline Conterfactual Delta Baseline Counterfactual Delta Hispanic females 35.9 [35.6, 36.9 [36.6, 1.0 [0.9, 23.6 [23.5, 25.2 [25.1, 1.6 [1.5, 8.4 [8.4, 8.6 [8.6, 8.6]
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From page 178... ...
(discounted) LE DFLY Aggregate WY Hispanic females 633,641 77% 0.29 [0.27, 0.50 [0.48, 0.28 [0.27, $20.9 [$19.7, $36.6 [$34.8, $6.7 [$6.4, 0.30]
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From page 179... ...
Wage impacts total $42.2 billion. Valuing the Potential Gains for the Future Elderly Population Finally, expanding beyond the narrow birth cohort considered above, we assessed the potential for innovation by looking at the U.S.
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From page 180... ...
(discounted) LE DFLY Aggregate WY Hispanic females 633,641 70% 0.30 [0.29, 0.51 [0.50, 0.12 [0.12, $20.3 [$19.4, $34.0 [$33.1, $2.7 [$2.7, 0.32]
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From page 181... ...
(discounted) LE DFLY Aggregate WY Hispanic females 633,641 86% 0.28 [0.26, 0.66 [0.64, 0.15 [0.14, $23.1 [$21.6, $54.3 [$52.5, $4.0 [$3.8, 0.30]
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From page 182... ...
$.8 [0.7, 0.9] 0.23 [0.20, 0.37 [0.35, Heart disease 161,500,000 64% 0.25]
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From page 183... ...
Similarly, Table A-12 shows the transition models for key outcomes in the heart disease analysis. Here, the key parameter of interest, "underrepresented and has heart disease," is associated with a 0.9 percentage point increase in 2-year mortality, a 5.6 percentage point increase in reporting disability, and a 3.8 percentage point reduction in working for pay.
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From page 184... ...
* -0.012 spline 75–84 Hispanic females # 0.01 0.002 -0.004 age spline 75–84 Black males # age -0.016 -0.041*
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From page 185... ...
* 0.003 spline over 85 Black females # age -0.012 -0.016 0.004 spline over 85 Hispanic females # -0.013 0.008 0.06 age spline over 85 Constant -4.232*
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From page 186... ...
-0.011 spline 75–84 Hispanic females # 0.009 0 -0.006 age spline 75–84 Black males # age -0.02 -0.048*
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From page 187... ...
p<0.05. TABLE A-13 Hypertension Mortality Margins Disability Margins Work Margins b b b b b b Main Lag of hypertension 0.183*
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From page 188... ...
* r2_p 0.156 0.085 0.231 N 191014 191014 178786 178786 166815 166815 NOTE: Asterisks represent statistical significance.
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From page 189... ...
Wash ington, DC: The National Academies Press. RAND HRS (Health and Retirement Study)
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