Neighborhood Disadvantage and Recruitment and Retention of Participants in STRIDE , a Multi‐Center Clinical Trial of Community‐Living Older Persons

ABSTRACT Background Socioeconomically disadvantaged neighborhoods disproportionately include minority and poor populations that are often underrepresented in clinical trials. Our objective was to determine whether recruitment and retention of participants differ based on neighborhood disadvantage. Methods In a multi‐center clinical trial that included 86 primary care practices within 10 US health care systems in 9 states, outreach to 140,850 patients led to enrollment of 5451 persons, 70 or older, at high risk for serious fall injuries. Multiple indicators of recruitment and retention were evaluated. Neighborhood disadvantage was defined as the highest quintile of scores on the state area deprivation index. Results Patients who lived in a disadvantaged neighborhood were less likely to return a screening postcard (risk ratio RR 95% CI: 0.88 0.85–0.91) than their non‐disadvantaged counterparts, but they were more likely to have a positive screen (RR 95% CI: 1.05 1.00–1.09, p = 0.047). The likelihood of study enrollment (RR 95% CI: 0.79 0.70–0.90) was substantially lower among patients living in a disadvantaged neighborhood. Among enrolled participants, a significantly higher percentage of those living in a disadvantaged neighborhood, relative to their non‐disadvantaged counterparts, were Black (10.6 vs. 4.8), had a high school education or less (36.7 vs. 21.6), and were less affluent (21.8 vs. 13.8). After study enrollment, participants who lived in a disadvantaged neighborhood had a higher likelihood of death (adjusted RR 95% CI: 2.64 1.76–3.98) and refused interviews (adjusted RR 95% CI: 2.15 1.20–3.85), but not study withdrawal (adjusted RR 95% CI: 0.94 0.63–1.39) or loss to follow‐up (adjusted RR 95% CI: 1.18 0.84–1.65). Conclusion In this large multi‐center clinical trial of older persons, living in a socioeconomically disadvantaged neighborhood was associated with diminished yields in both recruitment and retention. Assessing neighborhood disadvantage and implementing targeted strategies may improve recruitment and retention of diverse populations of older persons in clinical trials.