Number of Interventional Clinical Trials Registered per Million Population per Country Worldwide

BackgroundHistorically, Sweden and Denmark have excelled in clinical trial publications per million population, but many trials have remained unpublished. Enforceable policies for trial registration before launch, made global and national clinical research assessments possible. The World Health Organisation (WHO) hosts the International Clinical Trials Registry Platform (ICTRP) for interventional clinical trials, with data from 1999. ObjectiveTo find out if the retrospective or prospective trial registration activities per million population per country during the 2009 to 2022 period have improved after establishing the number of interventional clinical trials registered per million population per country during the 1999 to 2022 period. MethodsWe used the WHO ICTRP to extract the numbers of registered interventional clinical trials. We entered data in Microsoft Excel to analyse two separate periods, 1999 to 2022 and 2009 to 2022. The second period aimed at filtering out the pickup of the registration requirements. To obtain the trial registration activity by country, we divided the number of interventional clinical trials registered by the countrys population in millions. Information on population numbers originated from the World Bank, the Central Intelligence Agency World Factbook, and The National Institute of Statistics and Economic Studies (of France) as of 2022. We collected data as of 03-01-2024. ResultsIn February 2023, there were 943.113 interventional clinical trials on the ICTRP. After excluding 32.309 trials with unknown country of origin, 910.804 trials from 229 countries and territories were analysed. For countries or territories with populations over 1 million, the top five in interventional clinical trial registrations per million during 1999-2022 were Denmark, Estonia, Belgium, The Netherlands, and Latvia. For 2009-2022, they were Denmark, Estonia, Belgium, The Netherlands, and New Zealand. The top five overall, irrespective of population, for both periods were Pitcairn, The Vatican, Tokelau, Niue, and Denmark. ConclusionsSince 1999, there has been worldwide growth in interventional trial registrations, especially among top-contributing countries. The global average stands at approximately 115 registered trials per million people from 1999 to 2022, highlighting the need for continued efforts to improve trial registration and production. Smaller Western countries lead in interventional clinical trials per million population.