Lack of Cardiovascular Trial Diversity Is an International Issue: Dr Shrilla Banerjee Gives UK Perspective

Shrilla Banerjee, MD, FRCP, consultant cardiologist, Surrey and Sussex Healthcare NHS Trust, describes the social determinants of health (SDOH) that she sees contributing to cardiovascular health disparities in the United Kingdom and what politicians and clinical trialists can do to help mitigate these issues.

Transcript

What are some SDOH that further contribute to cardiovascular health disparities, and what strategies might mitigate their impact on health outcomes?

There are some changes that need to be implemented by politicians. We need to advocate for our patients and lobby politicians to improve living conditions, minimum wage, and the expectation of access to food for school children. It's something that doesn't strike me on a regular basis, because it's not something I'm exposed to, but we have children in schools in the UK who don't eat a proper meal apart from when they go to school.

So, in fact, if we gave [food] access to all school children, it wouldn't be a huge cost but it would improve the quality of life and the lived experience of children from minority populations and from more deprived populations—it's not only minority populations. And it would improve their health care and then their well-being as they go into adulthood, because if you have poor health care nutrition in childhood, it often leads to poor health outcomes as an adult as well.

So there's lots of things we can think about on an institutional level, but on a personal level, obviously addressing your own bias. We need to make sure that our patients who have more economic challenges are encouraged to enroll in clinical trials and be supportive in that way as well.

We perhaps need to make a quota in research. We're suggesting that now for women. Women are often 20% or 30% of clinical trial participants when they're 50%, 52% of the population. So why isn't it 50/50? Certain conditions impact women at a later age, so if there's an age cutoff, you can understand that there may be less women in the age group being randomized. But actually it's not difficult to find more mixed populations, and I think we need to encourage that. If you encourage trialists to enroll more people of color, then I think we'll get more relevant data.