Representation Of Minority Groups Research Articles

Diversity of Participants in Williams Syndrome Intervention Studies.

This study describes participant diversity in Williams syndrome (WS) intervention studies. A literature search was conducted to identify prospective treatment studies including participants with WS. Data was extracted on the reporting of and information provided on age, sex, cognitive ability, socioeconomic status, race, and ethnicity. Eleven eligible articles were identified. Reporting rates of demographic factors varied considerably, with the highest rates for age and sex (100%) and the lowest reporting rates for race (18%) and ethnicity (9%). Combining demographic data from the two studies that reported on race and/or ethnicity (n = 33), 88% of participants were White. The combined participant mean age was 20.9 years. There is a low frequency of reporting on several demographic factors including socioeconomic status, race, and ethnicity in WS intervention studies. There is a need for increased representation of racial and ethnic minority groups, older participants, and more cognitively impaired patients in WS research.

In-hospital outcomes of PCI in patients who have ESRD vs non-ESRD patients, a retrospective study involving a National Inpatient Sample (NIS) database

BackgroundCardiovascular disease is the leading cause of death for patients with end-stage renal disease (ESRD). ESRD is known to affect a large portion of the American population. Previous data for patients undergoing percutaneous coronary intervention (PCI) in the setting of ESRD for Acute Coronary Syndrome (ACS) and non-ACS etiologies have shown to have an increase in in-hospital mortality, and prolonged hospitalization among other complications. MethodsThe national inpatient sample (NIS) was used to identify patients who underwent PCI between the years 2016–2019. Patients were then grouped into those with ESRD on renal replacement therapy (RRT). Logistic regression models were employed to assess the primary outcome of in-hospital mortality, while linear regression models were utilized to evaluate secondary outcomes, including hospitalization cost and length of stay. ResultsA total of 21,366 unweighted observations were initially included, consisting of 50 % ESRD patients and 50 % randomly selected patients without ESRD who underwent PCI. These observations were weighted to represent a national estimate of 106,830 patients. The mean age of the study population was 65 years, and 63 % of the patients were male. The ESRD group had a greater representation of minority groups compared to the control group. The in-hospital mortality rate was significantly higher in the ESRD group compared to the control group, with an odds ratio of 1.803 (95 % CI: 1.502 to 2.164; p-value of 0.0002). Additionally, the ESRD group had significantly higher healthcare costs and longer length of stay, with a mean difference of $47,618 (95 % CI: $42,701 to $52,534, p-value <0.0001) and 2.933 days (95 % CI, 2.729 to 3.138 days, p-value <0.0001), respectively. ConclusionIn-hospital mortality, cost, and length of stay for patients undergoing PCI were found to be significantly greater in the ESRD group.

Who Tells Your Story? Analyzing a Century of Utah History

Who Tells Your Story? Analyzing a Century of Utah History

A plain language summary of daratumumab plus lenalidomide/bortezomib/dexamethasone in transplant-eligible Black patients with newly diagnosed multiple myeloma in the GRIFFIN study.

This is a summary of a publication about Black participants of the GRIFFIN clinical study that was published in Blood Cancer Journal in April 2022. The GRIFFIN clinical study looked at the treatment combination of daratumumab plus a standard therapy for multiple myeloma (called RVd therapy, which stands for lenalidomide, bortezomib, and dexamethasone) in adult patients who had not been treated before for multiple myeloma and so were considered to have newly diagnosed multiply myeloma. Multiple myeloma is a blood cancer of plasma cells. Based on the participants' age, medical history, and indicators of good general health, the participants in the GRIFFIN study were also eligible to receive autologous stem cell transplant as part of their therapy. This summary describes results for the Black participants of the GRIFFIN clinical study who received daratumumab plus RVd therapy (called D-RVd) to see if D-RVd therapy is better than RVd therapy at reducing the amount of multiple myeloma cancer cells in a patient's body. Due to racial disparities leading to historically low representation of minority groups in clinical studies, optimal treatments are not defined for Black patients with newly diagnosed multiple myeloma. Since previously published results from the overall population in the GRIFFIN study indicated that D-RVd therapy was better than RVd therapy, the researchers wanted to determine if this was also the case among Black participants. Out of 207 participants in the GRIFFIN study, 15% (32 participants) were Black and 78% (161 participants) were White. In both Black and White participants, D-RVd therapy reduced the amount of myeloma cancer cells more than RVd therapy. Additionally, D-RVd and RVd therapy had similar safety results for Black and White participants. This analysis of GRIFFIN by race shows that Black people benefit from the daratumumab-containing D-RVd therapy as much as White people. Additionally, D-RVd therapy had similar safety results to RVd therapy for both Black and White people. Clinical Trial Registration: NCT02874742 (ClinicalTrials.gov).

Diversity, equity, and inclusion in gastroenterology and hepatology: A survey of where we stand.

In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. We developed and administered a 33-item electronic cross-sectional survey to members of five national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. Of the 1219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n=431 [35.4%]), in professional leadership (n=340 [27.9%]), and among practicing GI and hepatology professionals (n=324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n=545 [44.7%]), medical student opportunities (n=520 [42.7%]), and program and professional society leadership roles for underrepresented racial and ethnic minority groups (n=473 [38.8%]). Our survey explored imperative and timely perspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.

Diversity, equity, and inclusion in gastroenterology and hepatology: a survey of where we stand

In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. We developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. Of the 1219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n= 431 [35.4%]), in professional leadership (n= 340 [27.9%]), and among practicing GI and hepatology professionals (n= 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n= 545 [44.7%]), medical student opportunities (n= 520 [42.7%]), and program and professional society leadership roles for underrepresented racialand ethnic minority groups (n= 473 [38.8%]). Our survey explored imperative and timelyperspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.

Diversity, Equity, and Inclusion in Gastroenterology and Hepatology: A Survey of Where We Stand

In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. We developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. Of the 1219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n= 431 [35.4%]), in professional leadership (n= 340 [27.9%]), and among practicing GI and hepatology professionals (n= 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n= 545 [44.7%]), medical student opportunities (n= 520 [42.7%]), and program and professional society leadership roles for underrepresented racialand ethnic minority groups (n= 473 [38.8%]). Our survey explored imperative and timelyperspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.

Representation of Race and Ethnicity in Randomized Clinical Trials of Diabetic Macular Edema and Retinal Vein Occlusion Compared to 2010 US Census Data

Diverse enrollment and adequate representation of racial and ethnic minority groups in randomized clinical trials (RCTs) are valuable to ensure external validity and applicability of results. To compare the distribution of race and ethnicity in RCTs of diabetic macular edema (DME) and macular edema from retinal vein occlusion (RVO) to that of US Census data. This was a cross-sectional retrospective analysis comparing racial and ethnic demographic characteristics of US-based RCTs of DME and RVO between 2004 and 2020 with 2010 US Census data. PubMed and ClinicalTrials.gov were searched to screen for completed phase 3 RCTs with published results. Of 169 trials screened, 146 were excluded because they were incomplete, did not report race and ethnicity, or were not based in the US, and 23 trials were included (15 DME and 8 RVO). The number and percentage of American Indian or Alaska Native, Asian, Black, Hispanic, Native Hawaiian or Other Pacific Islander, and White participants was recorded in each RCT. The demographic distribution and proportion was compared to the reported distribution and proportion in the 2010 US Census using the χ2 test. Overrepresentation, underrepresentation, or representation commensurate with 2010 US Census data in the racial and ethnic populations of RCTs of retinal vascular disease. In 23 included RCTs of DME and RVO, there were a total of 38 participants (0.4%) who identified as American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander (groups combined owing to small numbers), 415 Asian participants (4.4%), 904 Black participants (9.6%), 954 Hispanic participants (10.1%), and 7613 White participants (80.4%). By comparison, the 2010 US Census data indicated that 1.1% of the US population self-reported as American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander (groups combined for comparison in this study), 4.8% self-reported as Asian, 12.6% as Black or African American, 16.3% as Hispanic, and 63.7% as White. American Indian or Alaska Native and Hawaiian or Other Pacific Islander participants were underrepresented in 2 trials, neither overrepresented nor underrepresented in 20, and not overrepresented in any of the included trials. Asian participants were underrepresented in 10 trials, overrepresented in 4, and neither overrepresented nor underrepresented in 8. Black participants were underrepresented in 9 trials, overrepresented in 2, and neither overrepresented nor underrepresented in 11. Hispanic participants were underrepresented in 15 trials, overrepresented in 2, and neither overrepresented nor underrepresented in 5. White participants were underrepresented in 2 trials, overrepresented in 14, and neither overrepresented nor underrepresented in 7. The χ2 values comparing RCT demographic distribution to US 2010 Census data were significantly different in 22 of 23 included RCTs. The findings in this study indicated a discrepancy between racial and ethnic demographic data in RCTs of DME and RVO and the US population according to the 2010 Census. White study participants were most frequently overrepresented, and Hispanic study participants were most frequently underrepresented. These findings support the need for more efforts to recruit underrepresented racial and ethnic minorities to improve external validity in trial findings.

WOMEN's POLITICAL REPRESENTATION: THEORETICAL AND HISTORICAL ASPECTS

The article raises theoretical questions about the importance of women's representation in national parliaments in the context of a strategy to achieve gender parity in politics. Based on the theory of representation by H. Pitkin, the authors reflect on the role of women’s representation in legislative bodies in the promotion of women-oriented politics, and draw attention to the cross-national features of women's advancement in politics. The historical outline of the evolution of women's representation in parliaments focuses on such countries as Great Britain, the USSR, Ireland, the USA, the United Arab Emirates, etc. The authors draw attention to the concept of a "women-friendly state", formulated in the Scandinavian countries, and extrapolate it to theoretical reflections on the importance of women's representation in the parliaments of other countries. The authors demonstrate the difference between descriptive and substantive types of representation using the representation of women as an example and analyze the theory of "critical mass" that is traditionally used by researchers when talking about the representation of minority groups in politics.

Interventions to increase racial and ethnic minority accrual into cancer clinical trials: A systematic review.

Racial and ethnic minorities (REMs) continue to be underrepresented in clinical trials despite the 1993 National Institutes of Health's Revitalization Act mandating the representation of women and underrepresented minority groups in clinical trials. Although Blacks represent 15% and Hispanics 13% of the cancer population, their clinical trial enrollment rates are disproportionately low at 4% to 6% and 3% to 6%, respectively. A systematic review exploring interventions aimed at improving cancer clinical trial (CCT) enrollment for REMs was conducted. A systematic search of PubMed, Cochrane CENTRAL, and Ovid PsycINFO was conducted for English-language studies since 1993. Inclusion criteria included peer-reviewed, US-based studies with interventions aimed to recruit underrepresented minority adult patients into cancer clinical trials. REM groups were defined as Black, Hispanic, Asian, American Indian, and Native Hawaiian/other Pacific Islander. The systematic search identified 3123 studies, of which nine met inclusion criteria. Interventions included patient navigation/coaching (n= 4), a clinical trial educational video (n= 2), institutional research infrastructure changes (n= 1), a relationship building and social marketing recruitment model (n= 1), and cultural competency training for providers (n= 1). A statistically significant improvement in accrual was shown in three of the patient navigation interventions, one of the clinical trial educational videos and an institutional research infrastructure change. This systematic review illustrates several potential mechanisms by which to increase CCT recruitment for patients of REM backgrounds in various clinical settings. More randomized controlled trials are needed to further explore the benefits of these interventions for REMs.

A Systematic Review of Literature on the Representation of Racial and Ethnic Minority Groups in Clinical Nutrition Interventions

The racial and ethnic disparities in diet-related chronic diseases are major concerns. This systematic review examines the extent to which diet-induced changes in health outcomes, such as cardiometabolic, inflammation, cancer, bone health, and kidney function outcomes, etc., have been reported and discussed by race or ethnicity in randomized trials with 2 or more diet arms that recruited both minority and non-Hispanic White groups. Databases (i.e., PubMed, Cochrane Library, and Web of Science) were searched up to August 2021. Thirty-four studies that discussed effects of defined dietary interventions on health outcomes by racial or ethnic minority group compared with non-Hispanic Whites were included in the systematic review (PROSPERO registration number: CRD42021229256). Acute trials and those with 1 diet arm that accounted for race or ethnicity in their analyses and studies that focused on a single racial or ethnic group were discussed separately. Most studies were conducted in Black compared with White adults testing effects of energy restriction, macronutrient modification, sodium reduction, or variations of the Dietary Approaches to Stop Hypertension (DASH) diet on cardiometabolic outcomes. There was limited focus on other minority groups. Evidence suggests greater blood pressure reduction for Black adults compared with Whites particularly with DASH (or similar) diets. Overall, there was limited consideration for group-specific eating patterns and diet acceptability. Overall risk of bias was low. With emerging precision nutrition initiatives that aim to optimize metabolic responses in population subgroups through tailored approaches, it is imperative to ensure adequate representation of racial and ethnic subgroups for addressing health disparities. Factors that help explain variability in responses such as socioecological context should be included and adequately powered. Given the racial and ethnic disparities in chronic diseases, studying the adoption, maintenance, and effectiveness of dietary interventions on health outcomes among different groups is critical for developing approaches that can mitigate diet-related health disparities.

Racial disparities in the small business loan market

ABSTRACT We investigate patterns of racial bias in small business loans denial rates in the US across different credit risk scores. Using data constructed from the 1998 Survey of Small Business Finances and Kauffman Firm Survey, we find disparities in loan approval ratings between Black and White entrepreneurs in intermediate risk categories, but not for the best and worst categories. We explain these findings with a simple and generalizable statistical discrimination model where banks hold prior beliefs of repayment probability based on the applicant’s group and observe noisy signals of creditworthiness. Our model predicts that differences in loan denial rates across groups are more pronounced at middle range values and disappear at very high and very low credit scores. Identifying the likely cause of differential treatment in the market is an important first step in improving representation of minority groups as entrepreneurs. Our findings contribute to this critical effort by delineating the nature of racial bias in the credit market and informing remediation policies.

Diversity, Equity, and Inclusion in Gastroenterology and Hepatology: A Survey of Where We Stand.

In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. We developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. Of the 1,219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n = 431 [35.4%]), in professional leadership (n = 340 [27.9%]), and among practicing GI and hepatology professionals (n = 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n = 545 [44.7%]), medical student opportunities (n = 520 [42.7%]), and program and professional society leadership roles for underrepresented racial and ethnic minority groups (n = 473 [38.8%]). Our survey explored imperative and timely perspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.

Gender Discrimination in South Korea: Exploring the Role of Leadership, Gender, and Family Cultures

Increasing gender equity and representation of minority groups has long been recognized as a core condition of achieving social equity. This is especially because gender inequality, manifested through adverse treatment such as discrimination, imposes large costs on employees, employers, and societies. In this context, it is not surprising that organizations large and small have been engaged in diversity management efforts as a way to increase organizational equity. However, diversity itself may not always lead to equitable outcomes, especially if it is not accompanied with changes to organizational cultures, norms, and leadership. The focus of this paper is on the determinants gender discrimination. Using a unique panel dataset of managers from South Korea, we examine whether and how workgroup gender context, leadership, supervisory behaviors, and family supportive cultures predictor gender discrimination. The findings shed light on the importance of gender representation at different levels of the organization, and cultural change as ways to mitigate gender based discrimination.

HPR17 Racial and Ethnic Disparities in Multiple Myeloma: Moving Towards Inclusion or at a Standstill?

Racial disparities are marked in multiple myeloma (MM), where incidence is higher among Black and Hispanic individuals than White persons. Adequate representation of minority groups in oncology trials is critical to improve data and ameliorate outcomes; however, little is known about the progress toward this goal in MM. We explored regulatory and health technology assessment (HTA) agency guidance and patterns of reporting and representation in trials to understand the state of inclusion in clinical development in MM.

AACR Cancer Disparities Progress Report 2022.

AACR Cancer Disparities Progress Report 2022.

A Descriptive Analysis of Integrated Plastic Surgery Residency Program Directors in the United States.

The role sex plays in surgical leadership positions is heavily discussed in the literature; however, there is an absence of research looking at plastic surgery program director (PD) demographics and the differences between male and female PDs. A cross sectional study of publicly available online resources of all integrated plastic surgery residency programs was performed. Demographic and academic data of integrated plastic surgery PDs was analyzed focusing on the differences in PDs based on sex. Eighty-two integrated plastic surgery residencies were analyzed. Fifteen PDs (18.3%) were female. Fifty-six (68%) PDs completed general surgery residencies, whereas 24 (29%) completed an integrated plastics residency. All female PDs were fellowship trained, whereas only 46 (68%) male PDs pursued additional training after residency ( P = 0.02). Research output among male PDs was greater with 49.9 publications and a higher average H-index, at 13.3, compared with women with an average of 27.5 publications ( P = 0.008) and an H-index of 8.7 ( P = 0.02). When comparing male to female PDs, there was no difference between age at PD appointment ( P = 0.15), or in the amount of time between completion of plastic surgery training to PD appointment ( P = 0.29). Male PDs were older (52.2) compared with female PDs (46.5) ( P = 0.02). Male PDs served longer terms (4.98 years) than female PDs (2.87 years) ( P = 0.003). The majority of integrated plastic surgery PDs are men with a Doctor of Medicine degree who completed a general surgery residency and a plastic surgery fellowship. Most PDs also completed fellowship in a plastic subspecialty. Male PDs had higher research output, which may be attributed to their older age on average. Although women make up only 18.3% of plastic surgery PDs, this percentage is similar to the 17.2% of active female plastic surgeons in the United States. As more women train in plastic surgery, it is possible that the percentage of women serving academic leadership roles will increase. By gaining a better understanding of the demographics and diversity in plastic surgery residency program leadership, efforts can be made to increase the representation of minority groups in academic leadership roles.

2. A Descriptive Analysis of Integrated Plastic Surgery Program Directors

Background: The role gender plays in surgical leadership positions is heavily discussed in the literature, however there is an absence of research looking at plastic surgery program director (PD) demographics and the differences between male and female PDs. Methods: A cross sectional study of publicly available online resources of all integrated plastic surgery residency programs was performed. Demographic and academic data of integrated plastic surgery PDs was analyzed focusing on the differences in PDs based on gender. Results: 82 integrated plastic surgery residencies were analyzed. 15 PDs (18.3%) were female. 56 (68%) PDs completed general surgery residencies, while 24 (29%) completed an integrated plastics residency. All female PDs were fellowship trained while only 46 (68%) male PDs pursued additional training after residency (p=0.02). Research output amongst male PDs was greater with 49.9 publications and a higher average H-index, at 13.3, compared to women with an average of 27.5 publications (p=0.008) and an H-index of 8.7(p=0.02). When comparing male to female PDs, there was no difference between age at PD appointment (p=0.15), or in the amount of time between completion of plastic surgery training to PD appointment (p=0.29). Male PDs were older (52.2) compared to female PDs (46.5) (p=0.02). Male PDs served longer terms (4.98 years) than females (2.87 years) (p=0.003). Conclusion: The majority of integrated plastic surgery PDs are male with an M.D. who completed a general surgery residency and a plastic surgery fellowship. Most PDs also completed fellowship in a plastic subspecialty. Male PDs had higher research output, which may be attributed to their older age on average. Although females make up only 18.3 % of plastic surgery PDs, this percentage is similar to the 17.2% of active female plastic surgeons in the U.S. As more women train in plastic surgery, it is possible that the percentage of females serving academic leadership roles, will increase. By gaining a better understanding of the demographics and diversity in plastic surgery residency program leadership, efforts can be made to increase the representation of minority groups in academic leadership roles.

Association between state Medicaid policies and accrual of Black participants to cancer clinical trials.

1501 Background: Black individuals remain underrepresented in U.S. cancer clinical trials, partly due to financial barriers to participation. While coverage of the routine costs of trial participation has long been mandatory for Medicare and the commercially insured, only 16 states have enacted similar mandates for Medicaid enrollees. Given the disproportionate representation of Black individuals in state Medicaid programs, we hypothesized that such mandates may have led to improved accrual of Black participants to cancer clinical trials. Methods: We conducted a retrospective, quasi-experimental study using de-identified data from the ECOG-ACRIN Cancer Research Group to evaluate changes in the accrual of Black participants to cancer clinical trials associated with state-mandated Medicaid coverage of routine trial costs. The study population included non-elderly adults enrolled in therapeutic clinical trials for breast, colorectal, lung, or prostate cancer from 2000-2019. We employed a difference-in-differences approach with event-study specification to compare outcomes in states that mandated Medicaid coverage of routine trial costs relative to states that did not, before and after mandates were enacted. Outcomes included the proportion of trial participants who had Medicaid insurance (vs. non-Medicaid) and the proportion who were Black (vs. non-Black). Models adjusted for age, sex, cancer type, cancer stage, study phase, and study site (community vs. academic). Results: Among 24,321 trial participants (mean age 52.0 [SD 8.2] years, 82.8% female), 7.2% had Medicaid coverage and 10.5% were Black. Compared to states without Medicaid coverage mandates, states with mandates had a statistically significant increase in the proportion of Black trial participants in the first year following the mandate (+6.4 percentage points [95%CI 1.8% to 11.0%]) but not in subsequent years. There was no association between state mandates and the proportion of trial participants enrolled in Medicaid (effects ranged from -0.7 percentage points [95%CI -4.6% to 3.3%] in the first year after mandates to -3.9% [95%CI -8.6% to 0.8%] in the third year). Conclusions: State-mandated Medicaid coverage of the routine costs of trial participation was associated with a short-term increase in the proportion of Black trial participants. These findings suggest that Medicaid policies have the potential to improve representation of racial minority groups in cancer clinical trials, and support recent federal legislation mandating state Medicaid programs to cover trial participation costs as of January 2022. Our study was limited by use of data from only one large cancer research group, focus on only four common cancers, and limited power to analyze the policy impact for other racial and ethnic minority groups. Additional work is needed to replicate these findings in larger cohorts of trial participants.

Descriptive over-representation, cliental accountability, and minority politics: the case of the Druze in Israel

ABSTRACT This article explores the relationship between descriptive representation, patrimonial voting, turnout, and voting patterns in small ethnic groups. It argues that the combination between patrimonial voting and descriptive representation marginalizes the importance of substantive representation, leading to a decline in turnout, but simultaneously to cliental loyalty networks among voters that shape voting preferences. It utilizes the case of the Druze in Israel and analyzes their voting patterns in order to establish the argument that the mechanism that leads to party preferences among minority voters, namely, clientalistic accountability, is the same mechanism that renders descriptive over-representation devoid of substantive impact on state policies directed towards the minority. Our aim is to enrich the literature on the affinity between minority descriptive representation, patrimonial voting, clientalist accountability, and political efficacy. We demonstrate that Druze candidates in Zionist parties, especially those close to decision-making circles by being part of the governmental coalition, establish a broad network of supporters based on family ties, personally benefiting voters by integrating them or their relatives into high-income jobs, making their cliental preferences rational. This creates the gap between mere descriptive representation of minority groups and the substantial representation of their communal interests in “patronage democracy.”