Socioeconomic status as a predictor of melanoma survival in a series of 1083 cases from Brazil: just a marker of health services accessibility?

Melanoma survival is determined by disease-related and patient-related factors; there is a growing body of evidence that other issues may play a role in this disease. In this study, the role of socioeconomic factors in the evolution of melanoma was evaluated. This was a retrospective study with incident cases of melanoma treated in an oncology center in Rio de Janeiro, Brazil, during the period of 1997-2004. The socioeconomic variable of choice was education (9 years or more vs. 8 years or less of school attendance). In this period, there were 1083 patients with primary melanoma of the skin, 58.1% with low school attendance. No difference was found in relation to the year of diagnosis with respect to overall survival. Five-year survival for the entire group was 67.0%. Men had worse survival [hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.54-2.35]; a protective effect was found for whites (HR 0.64, 95% CI 0.49-0.84), higher educational level (HR 0.55, 95% CI 0.44-0.69), and upper limb lesions (HR 0.61, 95% CI 0.38-0.98). A higher risk of death was observed for patients with nodular melanoma (HR 1.96, 95% CI 1.49-2.58), acrolentiginous melanoma (HR 2.68, 95% CI 2.09-3.44), lesions in the soles and palms (HR 1.78, 95% CI 1.22-2.6), and increasing age (HR 1.02 for each year, 95% CI 1.01-1.02). In the multivariate analysis, after controlling for stage, age, sex, ethnicity, and clinical type, education remained a protective factor both for overall survival (HR 0.76, 95% CI 0.61-0.94) and for relapse-free survival (HR 0.76, 95% CI 0.61-0.94). In conclusion, socioeconomic status as measured by educational level represented an important factor related to melanoma clinical evolution in the cohort studied.