Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10 Ave, RMSB, Room 2023-A, Miami, FL 33136, USA.
J Am Acad Dermatol. 2010 May;62(5):768-76. doi: 10.1016/j.jaad.2009.11.594. Epub 2010 Mar 9.
Hispanics are given the diagnosis of melanoma at later stages and have reduced survival.
We sought to evaluate the effect of Hispanic ethnicity and different health care delivery systems (fee-for-service [FFS] and health maintenance organizations) on melanoma stage at diagnosis and survival.
We studied a retrospective cohort of 40,633 patients, with at least 3 years of follow-up, who were given the diagnosis of incident melanoma from 1991 to 2002 and were 65 years or older using data from the Surveillance, Epidemiology, and End Results-Medicare linked database. The analytic sample consisted of 39,962 non-Hispanic whites (NHW) and 671 Hispanics. Logistic regression models examined the roles of the health care delivery system and race/ethnicity in stage at diagnosis and survival.
For FFS patients, Hispanics were more likely to be given a diagnosis at an advanced stage (distant vs earlier stages [odds ratio {OR} = 2.07; 95% confidence interval CI = 1.36-3.16]; regional vs earlier stages [OR = 2.31; 95% CI = 1.75-3.03]) compared with NHW. Among Hispanic patients, those enrolled in health maintenance organizations were less likely to be given a diagnosis at later stage (regional vs earlier stages [OR = 0.50; 95% CI = 0.31-0.81]) than FFS patients; however, the earlier stage at diagnosis did not improve survival. For patients with a previous cancer before their melanoma diagnoses, NHW enrolled in health maintenance organizations from 1991 to 2002 were given a diagnosis at earlier stages compared with NHW FFS patients (OR = 0.72; 95% CI = 0.52-0.99); this was not found among Hispanics.
These results reflect findings in a Medicare-aged population and it is not clear if they are generalizable to younger patients.
Differences in melanoma outcomes among different ethnic groups are, in part, dependent on the health care setting in which patients are enrolled.
西班牙裔人群被诊断出黑色素瘤的阶段更晚，且存活率更低。
我们旨在评估西班牙裔人群的种族和不同医疗服务体系（按服务项目付费制（FFS）和健康维护组织（HMO））对黑色素瘤诊断时的分期和生存的影响。
我们研究了 1991 年至 2002 年期间从监测、流行病学和最终结果-医疗保险数据库中获得至少 3 年随访的年龄在 65 岁及以上的 40633 名患者，该队列中患者被诊断为患有黑色素瘤。分析样本包括 39962 名非西班牙裔白人（NHW）和 671 名西班牙裔。逻辑回归模型用于检验医疗服务体系和种族/民族在诊断时的分期和生存中的作用。
对于 FFS 患者，与 NHW 相比，西班牙裔更有可能被诊断为晚期（远处与早期分期相比[优势比（OR）=2.07；95%置信区间（CI）=1.36-3.16]；区域与早期分期相比[OR=2.31；95%CI=1.75-3.03]）。在西班牙裔患者中，与 FFS 患者相比，参加 HMO 的患者被诊断为晚期的可能性较低（区域与早期分期相比[OR=0.50；95%CI=0.31-0.81]）；然而，早期诊断并不能提高生存率。对于在黑色素瘤诊断之前患有其他癌症的患者，1991 年至 2002 年期间，参加 HMO 的 NHW 患者与参加 FFS 的 NHW 患者相比，被诊断为早期分期（OR=0.72；95%CI=0.52-0.99）；而西班牙裔患者则没有这种情况。
这些结果反映了医疗保险人群中的发现，尚不清楚这些结果是否适用于更年轻的患者。
不同种族群体的黑色素瘤结果差异部分取决于患者所在的医疗服务环境。
