Valentin Virginia L, Sanderson Wayne, Westneat Susan, Durbin Eric
From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Department of Epidemiology, the University of Kentucky College of Public Health, and the Kentucky Cancer Registry, University of Kentucky, Lexington.
South Med J. 2018 Nov;111(11):649-653. doi: 10.14423/SMJ.0000000000000888.
The purpose of this study was to assess for any associations between individual and social factors and late-stage melanoma in Kentucky from 1995 to 2013.
The study combines three datasets: individual-level data from the Kentucky Cancer Registry, census tract-level data from the US Census, and county-level physician licensure data from the Kentucky Department for Public Health. The study population is described by all cases, early stage, and late stage. Logistic regression was used to evaluate the unadjusted associations between each covariate and early-stage and late-stage disease groups. All of the significant variables were assessed for interaction effect, and the significant interaction terms were used in the final model. Multiple logistic regression provided the final model of late-stage disease.
In this study population, a dramatic increase in melanoma incidence is seen from 1995 to 2013 with a threefold increase in the number of cases per year. Of the 10,109 cases reported, 13.6% have late-stage disease, with a mean age for all cases at 56.9 years and the majority being men. Late-stage cases are more commonly uninsured or insured with Medicaid or Medicare compared with cases with early-stage lesions. Having a spouse or partner is clearly protective from being diagnosed as having late-stage melanoma, whereas being uninsured or having Medicaid increases the odds of late-stage melanoma.
The incidence of melanoma is increasing dramatically. With no screening recommendation for the general population from the US Preventive Task Force, clinicians should focus on those at increased risk of late-stage melanoma: unmarried men who are uninsured or receiving Medicaid.
本研究旨在评估1995年至2013年肯塔基州个人因素和社会因素与晚期黑色素瘤之间的任何关联。
该研究合并了三个数据集：肯塔基州癌症登记处的个人层面数据、美国人口普查的普查区层面数据以及肯塔基州公共卫生部的县级医生执照数据。研究人群按所有病例、早期病例和晚期病例进行描述。采用逻辑回归评估每个协变量与早期和晚期疾病组之间的未调整关联。对所有显著变量进行交互作用评估，并将显著的交互项纳入最终模型。多元逻辑回归提供了晚期疾病的最终模型。
在本研究人群中，1995年至2013年黑色素瘤发病率急剧上升，每年病例数增加了两倍。在报告的10109例病例中，13.6%为晚期疾病，所有病例的平均年龄为56.9岁，大多数为男性。与早期病变病例相比，晚期病例更常见未参保或参保了医疗补助或医疗保险。有配偶或伴侣显然可降低被诊断为晚期黑色素瘤的风险，而未参保或参保医疗补助则会增加患晚期黑色素瘤的几率。
黑色素瘤发病率正在急剧上升。由于美国预防任务组未对普通人群提出筛查建议，临床医生应关注晚期黑色素瘤风险增加的人群：未参保或领取医疗补助的未婚男性。
