Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
College of Medicine, Texas A&M University, Temple, Texas.
J Am Acad Dermatol. 2019 May;80(5):1256-1262. doi: 10.1016/j.jaad.2019.01.003. Epub 2019 Jan 17.
Despite improvements in melanoma mortality, disparities in melanoma survival persist. We evaluated possible sociodemographic and health care-based predictors of differences in melanoma survival in the United States by using the melanoma mortality-to-incidence ratio (MIR).
State-based MIRs were calculated by using US cancer statistics data from 1999 to 2014. Pearson correlations and linear regressions were used 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, health care spending per capita, average household income, racial/ethnic makeup of the population, percentage of uninsured individuals, and percentage with a bachelor's degree.
The mean overall MIR was 0.15 ± 0.04; only Alaska was an outlier (0.24). No state MIRs increased significantly over time; MIR decreased for most states. Multivariable analysis revealed that states with more active physicians (P = .02) and a higher percentage non-Hispanic whites (P = .004) had higher MIRs (poorer survival). Significant Pearson correlations were seen between MIR and melanoma incidence (r = -0.72, P < .001), melanoma mortality (r = 0.38, P < .001), dermatologist density (r = 0.32, P < .001), and National Cancer Institute-designated cancer center count (r = -0.12, P = .001).
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 disparities in melanoma survival.
尽管黑色素瘤死亡率有所提高，但黑色素瘤存活率仍存在差异。我们通过使用黑色素瘤死亡率与发病率比（MIR）来评估美国黑色素瘤存活率差异的可能社会人口统计学和医疗保健预测因素。
根据 1999 年至 2014 年的美国癌症统计数据，计算了基于州的 MIR。使用皮尔逊相关和线性回归来确定 MIR 与皮肤科医生密度、初级保健提供者密度、州内医生人数、国立癌症研究所指定癌症中心数量、人均医疗保健支出、平均家庭收入、人口种族/族裔构成、未参保人数百分比和拥有学士学位的百分比之间的关联。
总体平均 MIR 为 0.15±0.04；只有阿拉斯加是个例外（0.24）。没有州的 MIR 随时间显著增加；大多数州的 MIR 下降。多变量分析显示，医生活动更活跃的州（P=0.02）和非西班牙裔白人比例较高的州（P=0.004）的 MIR 更高（生存率更差）。MIR 与黑色素瘤发病率（r=-0.72，P<0.001）、黑色素瘤死亡率（r=0.38，P<0.001）、皮肤科医生密度（r=0.32，P<0.001）和国立癌症研究所指定癌症中心数量（r=-0.12，P=0.001）之间存在显著的皮尔逊相关。
黑色素瘤发病率较高的地区和皮肤科医生密度较高的地区，黑色素瘤生存率得到改善。这些发现突出了黑色素瘤生存率较差的地区，并需要进行当地研究，以评估黑色素瘤生存率的差异。
