Cokkinides Vilma E, Geller Alan C, Jemal Ahmedin
Surveillance Research Program, American Cancer Society, Atlanta, GA 30303, USA.
Arch Dermatol. 2012 May;148(5):587-91. doi: 10.1001/archdermatol.2011.2779.
To evaluate overall trends in melanoma mortality rates among non-Hispanic whites by educational level.
Descriptive study.
Death certificate records from 26 states, representing approximately 45% of the US population as reported by the National Center for Health Statistics, with recorded educational level information and population data from the US Bureau of Census Current Population Survey.
Recorded deaths from malignant melanoma in non-Hispanic whites reported from 1993 through 2007.
Age-standardized mortality rates for melanoma were evaluated by educational attainment (a marker of socioeconomic status) among non- Hispanic whites (aged 25-64 years) from 1993 through 2007. Rate ratios assessed the time trend in age-adjusted death rates by sex and educational level. Mortality differentials in educational level were measured using the regression-based Relative Index of Inequality. All statistical tests were 2-sided.
Melanoma mortality declined significantly between 1993-1997 and 2003-2007 in men (RR [rate ratio], 0.916; 95% CI, 0.878-0.954; P.001) and women (RR, 0.907; 95% CI, 0.857-0.957; P.001). However, these declines occurred only among the most educated persons (≥13 years of education irrespective of sex), and nonsignificant increases were found among the least-educated individuals, specifically men (P=.17). As a result, the Relative Index of Inequality by education in melanoma mortality in 2003-2007 relative to 1993-1997 (baseline) widened by 51.7% in men and by 35.7% in women.
Recent declines in melanoma mortality rates among non-Hispanic whites in the United States mainly reflect declines among the most-educated individuals. The widening disparities in melanoma mortality rates by education calls for early detection strategies to effectively target high-risk, less-educated, non-Hispanic white individuals.
按教育程度评估非西班牙裔白人中黑色素瘤死亡率的总体趋势。
描述性研究。
来自26个州的死亡证明记录，据美国国家卫生统计中心报告，这些州约占美国人口的45%，并包含美国人口普查局当前人口调查的教育程度记录信息和人口数据。
1993年至2007年报告的非西班牙裔白人中恶性黑色素瘤的记录死亡病例。
1993年至2007年，按教育程度（社会经济地位的一个指标）评估25至64岁非西班牙裔白人中黑色素瘤的年龄标准化死亡率。率比评估了按性别和教育程度调整的死亡率的时间趋势。使用基于回归的不平等相对指数测量教育程度方面的死亡率差异。所有统计检验均为双侧检验。
1993 - 1997年至2003 - 2007年期间，男性（率比[RR]，0.916；95%置信区间[CI]，0.878 - 0.954；P <.001）和女性（RR，0.907；95% CI，0.857 - 0.957；P <.001）的黑色素瘤死亡率显著下降。然而，这些下降仅发生在受教育程度最高的人群中（无论性别，教育年限≥13年），而在受教育程度最低的人群中，尤其是男性，发现死亡率有不显著的上升（P = 0.17）。因此，2003 - 2007年相对于1993 - 1997年（基线），按教育程度划分的黑色素瘤死亡率不平等相对指数在男性中扩大了51.7%，在女性中扩大了35.7%。
美国非西班牙裔白人中黑色素瘤死亡率近期的下降主要反映了受教育程度最高人群中的下降情况。黑色素瘤死亡率按教育程度的差距不断扩大，这就需要早期检测策略，以有效针对高风险、受教育程度较低的非西班牙裔白人个体。
