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Melanoma prognosis in the United States: Identifying barriers for improved care - 12/04/19

Doi : 10.1016/j.jaad.2019.01.003 
Zachary H. Hopkins, MD a, Christopher Moreno, BS b, Ryan Carlisle, BS c, Aaron M. Secrest, MD, PhD d, e,
a Department of Internal Medicine, University of Utah, Salt Lake City, Utah 
c School of Medicine, University of Utah, Salt Lake City, Utah 
d Department of Dermatology, University of Utah, Salt Lake City, Utah 
e Department of Population Health Sciences, University of Utah, Salt Lake City, Utah 
b College of Medicine, Texas A&M University, Temple, Texas 

Correspondence to: Aaron M. Secrest, MD, PhD, Departments of Dermatology and Population Health Sciences, University of Utah, 30 N 1900 E, 4A330, Salt Lake City, UT 84132.Departments of Dermatology and Population Health SciencesUniversity of Utah30 N 1900 E4A330Salt Lake CityUT84132

Abstract

Background

Despite improvements in melanoma mortality, disparities in melanoma survival persist. We evaluated possible sociodemographic and health care–based predictors of differences in melanoma survival in the United States by using the melanoma mortality-to-incidence ratio (MIR).

Methods

State-based MIRs were calculated by using US cancer statistics data from 1999 to 2014. Pearson correlations and linear regressions were used to determine associations between MIR and dermatologist density, primary care provider density, number of physicians by state, number of National Cancer Institute–designated cancer centers, health care spending per capita, average household income, racial/ethnic makeup of the population, percentage of uninsured individuals, and percentage with a bachelor's degree.

Results

The mean overall MIR was 0.15 ± 0.04; only Alaska was an outlier (0.24). No state MIRs increased significantly over time; MIR decreased for most states. Multivariable analysis revealed that states with more active physicians (P = .02) and a higher percentage non-Hispanic whites (P = .004) had higher MIRs (poorer survival). Significant Pearson correlations were seen between MIR and melanoma incidence (r = –0.72, P < .001), melanoma mortality (r = 0.38, P < .001), dermatologist density (r = 0.32, P < .001), and National Cancer Institute–designated cancer center count (r = –0.12, P = .001).

Conclusions

Melanoma survival is improved in higher-incidence areas and areas with higher dermatologist density. These findings highlight areas of poorer melanoma survival and the need for local studies evaluating disparities in melanoma survival.

Le texte complet de cet article est disponible en PDF.

Key words : barriers to care, dermatology, disparities, epidemiology, health care access, melanoma, mortality-to-incidence ratio, prognosis

Abbreviations used : MIR, NCIDCC, SD


Plan


 Funding sources: Dr Secrest was supported by research grants from the American Skin Association, National Eczema Association, and National Psoriasis Foundation. No specific funding was secured for this project.
 Disclosure: Dr Secrest is on the advisory board of VisualDx. Dr Hopkins, Mr Moreno, and Mr Carlisle have no conflicts of interest to disclose.
 Drs Secrest and Hopkins had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
 Reprints not available from the authors.


© 2019  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 80 - N° 5

P. 1256-1262 - mai 2019 Retour au numéro
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