Melanoma prognosis in the United States: Identifying barriers for improved care

Publication date: Available online 17 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Zachary H. Hopkins, Christopher Moreno, Ryan Carlisle, Aaron M. Secrest

Abstract

Background

Despite improvements in melanoma mortality, disparities in melanoma survival persist. We evaluated possible sociodemographic and healthcare-based predictors of differences in U.S. melanoma survival using the melanoma mortality-to-incidence ratio (MIR).

Methods

State-based MIRs were calculated using United States Cancer Statistics data from 1999-2014. Pearson correlations and linear regressions were employed 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 (NCIDCCs), healthcare spending per capita, average household income, racial/ethnic makeup of the population, percentage of uninsured, and percentage with a bachelor's degree.

Results

Mean overall MIR was 0.15±0.04; only Alaska was an outlier (0.24). No state MIRs significantly increased over time; MIR decreased for most states. Multivariable analysis revealed that states with more active physicians (p=0.02) and a higher percentage non-Hispanic whites (p=0.004) had higher MIRs (poorer survival). Significant Pearson correlations were seen between MIR and melanoma incidence (r=-0.72, p<0.001), melanoma mortality (r=0.38, p<0.001), dermatologist density (r=0.32, p<0.001), and NCIDCC count (r=-0.12, p=0.001).

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 melanoma survival disparities.

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