Paper
U.S. presence is not a cosmetic bucket split. It changes the sponsor-class story in a large and durable way.
How different do sponsor-class reporting gaps look once older CT.gov studies are collapsed into any-U.S., no-U.S., and no-country buckets instead of a longer geography table? We analysed 249,507 eligible older closed interventional studies from the March 29, 2026 full-registry snapshot and grouped them by U.S. presence using recorded country locations. The project compares two-year no-results rates, ghost-protocol rates, visible shares, and sponsor-class contrasts across any-U.S., no-U.S., and no-country portfolios. Any-U.S. studies showed a 52.1 percent no-results rate, versus 88.7 percent for no-U.S. studies and 80.9 percent for studies with no named country. Within no-U.S. studies, OTHER reached 94.9 percent no results and industry 70.9 percent, while any-U.S. industry fell to 45.5 percent and any-U.S. NIH to 52.3 percent. U.S. presence therefore behaves like a divider across sponsor classes, and the ex-U.S. backlog is much quieter than the any-U.S. registry surface. U.S.-presence buckets reflect recorded study locations rather than verified enrollment shares, sponsor domicile, or legal obligations.