Paper
A country portfolio can look middling on rate and still hold a vast stock of unresolved years. Debt makes that backlog visible.
Which country-linked CT.gov portfolios carry the deepest unresolved overdue years once the two-year results deadline is converted into debt rather than counts? We analysed 249,507 eligible older closed interventional studies from the March 29, 2026 full-registry snapshot and exploded named-country links. We summed unresolved years beyond the two-year mark across country-linked portfolios with at least 500 linked studies, then compared that debt with missing-results stock and mean unresolved age. The United States carried the largest country-linked overdue-debt stock at 491,364 unresolved years, followed by Canada at 90,480, France at 89,004, and Germany at 77,270. Germany carried the heaviest large-country mean unresolved age at 9.4 years, while the United States remained singular on debt stock because of scale. The geography of chronic silence looks different from rate tables alone, combining very large North American and European portfolios with substantial unresolved stock. Country-linked overdue debt counts country-linked studies rather than assigning each multinational record to one national portfolio.