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Significance When treatment effects are heterogeneous, reliance on average effects from clinical trials also means relying on the distribution of baseline risk in the trial. Even when trials are representative of the then population, a drift in the risk distribution over time, especially if differential across race or SES categories, could generate disparities in outcomes when decision making on treatment choices continues to rely on the average effect from the trial. Based on our theoretical model, we illustrate that unintended phenomena involving production and use of average evidence from large clinical trials could explain up to 10.5% of the recent growth in racial disparity in diabetes incidence in the United States.

Evidence generation, decision making, and consequent growth in health disparities