Utilizing ZIP code-based choropleth maps as a visual tool to analyze Native Hawaiian and Pacific Islander (NHPI) recruitment patterns in Alzheimer's disease clinical trials in Hawai‘i: A retrospective study

ObjectiveQuantify recruitment of Native Hawaiian and Pacific Islander (NHPI) participants from 22 Alzheimer's disease (AD) clinical trials over 5 years and utilize choropleth maps as a visual tool to identify where in the Hawaiian community recruited participants are located in order to better inform future recruitment efforts and improve equity and population diversity for future AD clinical trials.MethodsA retrospective chart review was conducted at a dual-site origin clinical trial center in Hawai'i. Inclusion criteria were a diagnosis of mild cognitive impairment and participation in one or more AD clinical trials conducted between 2020 and 2024. Demographic information of clinical trial participants was collected via chart review and included self-identified race/ethnicity, age, residence, and number of clinical trials the patient has participated in. Clinical trial participants were categorized by ZIP codes established by the US Census Bureau. Differences across race/ethnicity groups were assessed using either Pearson's Chi-squared test or Fisher's exact test.ResultsA total of 244 patients participated across the state of Hawai'i in 22 AD clinical trials between 2020 and 2024. Of this total, 169 (69%) patients provided their race/ethnicity, and 75 (31%) did not provide their race/ethnicity. White patients had the highest percentage of participation (44%), followed by Asian patients (34%) and NHPI patients (15%). The population distribution visualized in this study's choropleth maps suggests that NHPI were under-recruited from the west side of O'ahu.ConclusionsOur retrospective study applied choropleth maps to visualize the recruitment data and patterns of AD clinical trials. By utilizing choropleth maps to analyze recruitment areas, the NHPI community and other underrepresented populations may benefit from targeted, culturally informed recruitment strategies.