# A public equity index for trial sites and sponsors, tied to funding

Source: https://onco.cc/ideas/idea-tr1-site-equity-index/  
OnCo record `idea-tr1-site-equity-index` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Rank hospitals and companies each year on how well their trial participants match the people with the disease in their area, and use the ranking when deciding who gets public research money and trial contracts.

## Summary

An independent body computes, for each site and sponsor, participation-to-prevalence ratios by race, ethnicity, age, sex and rurality across their oncology trials, publishes the index annually, and public funders and cooperative groups weight site selection and grant scoring by it. Sponsors use it in site selection.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Public ranking with funding consequences will raise representativeness at low-ranked sites more than internal reporting does, by making equity a competitive metric.
- Rationale: Public quality rankings changed hospital behaviour in surgery and infection control; trial equity currently has no comparable visible metric.
- Proposed test: Publish the index for two years; compare change in representativeness between sites in the bottom quartile and those above.
- Maturity: speculative
- Actor: policy

## Sources

- Bottleneck evidence (Trials do not represent the people who get cancer): Loree et al., Disparity of race reporting and representation in trials leading to cancer drug approvals (JAMA Oncology 2019): https://doi.org/10.1001/jamaoncol.2019.1870

## Connected records

- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)
- key papers: [Disparity of Race Reporting and Representation in Clinical Trials Leading to Cancer Drug Approvals From 2008 to 2018](https://onco.cc/key-papers/paper-loree-jama-oncol/)

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