University of Florida Health Cancer Center, University of Florida, 1600 SW Archer Road, D2-3, Gainesville, FL, 32610, USA.
Billings Clinic, 2800 Tenth Avenue North, Billings, MT, 59107, USA.
J Racial Ethn Health Disparities. 2022 Dec;9(6):2291-2299. doi: 10.1007/s40615-021-01166-6. Epub 2021 Oct 14.
Black patients are diagnosed with melanoma at a later stage, as compared with their white counterparts. It is unknown if Medicaid expansion might ameliorate this disparity.
Using data from the 2016 National Cancer Database, we conducted a retrospective cohort study. The primary objective was to evaluate whether being diagnosed with melanoma at a Medicaid Expansion State (MES) and black race are associated with a late diagnosis of melanoma. Main exposure: Being diagnosed in a MES. Secondary exposure: Race. Main outcome: Odds of Stage IV vs Stages 0-III at diagnosis. Univariate, multivariate logistic regression, and propensity score analyses were conducted to evaluate the potential associations. Sub-group analysis was conducted according to age < 65 or ≥ 65 years.
A total of 216,604 patients were included, 40-90 years of age, [Formula: see text] 64 years [SD 12.47]. In univariate analysis, patients diagnosed in MES were 15% less likely (95% CI, 0.81-0.88) to be diagnosed with Stage IV melanoma. Black race (vs white) had 3.04 increased odds (95% CI, 2.56-3.60) of late diagnosis. In multivariate analysis, adjusting for socio-economic confounders, patients < 65 years of age were 13% less likely (95% CI, 0.82-0.92) to be diagnosed with Stage IV melanoma. By propensity score analysis, the strength of the associations remained. Black race (vs white) was associated with higher odds (95% CI, 1.91-3.08) of being diagnosed with Stage IV disease. For black patients < 65 years, being diagnosed in a state without Medicaid expansion had 2.55 higher odds (95% CI, 1.93-3.38) of being diagnosed with Stage IV melanoma, which decreased to 2.11 odds (95% CI, 1.34-3.33) in MES. The interaction between race and MES was statistically significant (P = 0.008).
This study suggests that patients are less likely to be diagnosed with Stage IV melanoma in MES. This beneficial effect is more pronounced among Black minorities.
与白人患者相比，黑种人患者的黑色素瘤确诊时间更晚。尚不清楚医疗补助扩展计划是否可以改善这一差距。
本研究使用了 2016 年国家癌症数据库的数据，开展了一项回顾性队列研究。主要目的是评估在医疗补助扩大州（MES）诊断黑色素瘤和黑种人种族是否与黑色素瘤的晚期诊断相关。主要暴露因素：在 MES 中诊断。次要暴露因素：种族。主要结局：诊断时 IV 期与 0-III 期的比值。进行单变量、多变量逻辑回归和倾向评分分析，以评估潜在关联。根据年龄<65 岁或≥65 岁进行亚组分析。
共纳入 216604 名 40-90 岁的患者[公式：见正文]64 岁[标准差 12.47]。在单变量分析中，MES 中诊断的患者 IV 期黑色素瘤的诊断可能性降低 15%（95%CI，0.81-0.88）。与白人相比，黑种人（vs 白人）的晚期诊断风险增加了 3.04 倍（95%CI，2.56-3.60）。在多变量分析中，调整了社会经济混杂因素后，年龄<65 岁的患者 IV 期黑色素瘤的诊断可能性降低了 13%（95%CI，0.82-0.92）。通过倾向评分分析，关联的强度仍然存在。与白人相比，黑种人（vs 白人）的 IV 期疾病诊断风险更高（95%CI，1.91-3.08）。对于年龄<65 岁的黑人患者，在没有医疗补助扩展计划的州诊断，IV 期黑色素瘤的诊断可能性增加了 2.55 倍（95%CI，1.93-3.38），在 MES 中，这一几率降至 2.11 倍（95%CI，1.34-3.33）。种族和 MES 之间的交互作用具有统计学意义（P=0.008）。
本研究表明，在 MES 中，患者 IV 期黑色素瘤的诊断可能性较低。这一有益效果在黑人群体中更为明显。
