Li Heidi Oi-Yee, Bailey Adrian Joseph-Michel, Grose Elysia, McDonald James Ted, Quimby Alexandra, Johnson-Obaseki Stephanie, Nessim Carolyn
12365 Faculty of Medicine, University of Ottawa, ON, Canada.
3427 Department of Economics, University of New Brunswick, NB, Canada.
J Cutan Med Surg. 2021 Jan-Feb;25(1):87-94. doi: 10.1177/1203475420960426. Epub 2020 Sep 21.
As melanoma is one of the leading cancers in average years of life lost per death from disease, screening and early diagnosis are imperative to decrease morbidity and mortality. Socioeconomic status (SES) has been shown to be associated with melanoma incidence. However, it is unclear if this association holds true in universal healthcare systems where screening, diagnostic, and treatment services are available to all patients. The objective of this systematic review was to evaluate the evidence on the association of SES and melanoma incidence in Canada. A comprehensive search of PubMed and EMBASE yielded 7 studies reporting on melanoma incidence or outcomes with respect to SES in Canada. High SES was associated with increased melanoma incidence across all studies, which encompassed all Canadian provinces, and time periods spanning from 1979 to 2012. Studies also reported an increasing incidence of melanoma over time. There were substantial discrepancies in melanoma incidence across Canadian provinces, after controlling for SES and demographic characteristics. Populations of lower SES and living within certain healthcare regions had increased risks of advanced melanoma at diagnosis. This review highlights the potential for inequities in access to care even within a universal healthcare system. Future research is needed to characterize specific risk factors within different patient groups and within the universal health system context in order to implement targeted strategies to lower melanoma incidence, morbidity, and mortality.
由于黑色素瘤是因病死亡导致平均寿命损失的主要癌症之一,筛查和早期诊断对于降低发病率和死亡率至关重要。社会经济地位(SES)已被证明与黑色素瘤发病率相关。然而,在所有患者均可获得筛查、诊断和治疗服务的全民医疗保健系统中,这种关联是否成立尚不清楚。本系统评价的目的是评估加拿大SES与黑色素瘤发病率之间关联的证据。对PubMed和EMBASE进行全面检索后,得到了7项关于加拿大SES与黑色素瘤发病率或结局的研究报告。在涵盖加拿大所有省份以及从1979年至2012年的所有时间段的所有研究中,高SES与黑色素瘤发病率增加相关。研究还报告了黑色素瘤发病率随时间的上升。在控制了SES和人口统计学特征后,加拿大各省的黑色素瘤发病率存在显著差异。SES较低且生活在某些医疗保健区域内的人群在诊断时患晚期黑色素瘤的风险增加。本评价强调了即使在全民医疗保健系统内,获得医疗服务方面也可能存在不公平现象。未来需要开展研究,以确定不同患者群体以及全民医疗保健系统背景下的具体风险因素,从而实施有针对性的策略来降低黑色素瘤的发病率、发病率和死亡率。