Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
PLoS One. 2024 Jul 5;19(7):e0305915. doi: 10.1371/journal.pone.0305915. eCollection 2024.
Aim of the study was to characterise the association between screening, prevalence and mortality of skin cancer in Germany considering the spatial distribution. The study included the total set of outpatient data of all statutory health insured people and cause-of-death statistics in Germany between 2011-2015 on county level. To identify regions with high/low screening, prevalence and mortality rates, probability maps were calculated. Scenarios were developed based on the research questions. These were used to identify regions that share both high/low rates of screening, prevalence and mortality. Regression analyses were used to characterise these regions, taking into account sociodemographic characteristics. Significant regional variations in prevalence, screening and mortality in Germany were identified. Depending on the scenario, influences of sociodemographic conditions become apparent. For example, a lower income (p = 0.006) and poorer accessibility of the closest dermatologist (p = 0.03) predicted a lower prevalence of and fewer screenings for skin cancer. In regions with low screening and high mortality, significant (p = 0.03) associations with the educational status of the population were also found. The study identified the first spatial associations between screening, prevalence and mortality of skin cancer in Germany. The results indicate that regional population-related characteristics (e.g., sociodemographic characteristics) play an important role in explaining the associations and should be given more weight in further studies. However, further studies, particularly on the spatial variation of skin cancer mortality, are still necessary.
本研究旨在探讨德国皮肤癌筛查、患病率和死亡率之间的关联，并考虑其空间分布。研究纳入了 2011 年至 2015 年期间德国所有法定健康保险人群的全部门诊数据和县级死因统计数据。为了确定具有高/低筛查率、患病率和死亡率的地区，计算了概率图。根据研究问题制定了方案。这些方案用于识别具有高/低筛查率、患病率和死亡率的共享地区。回归分析用于描述这些地区，同时考虑社会人口统计学特征。研究结果显示，德国在皮肤癌的患病率、筛查率和死亡率方面存在显著的区域差异。根据不同的方案，社会人口统计学条件的影响变得明显。例如，较低的收入（p = 0.006）和最近皮肤科医生可及性较差（p = 0.03）预示着皮肤癌的患病率较低，筛查率也较低。在筛查率低、死亡率高的地区，人口受教育程度也与这些地区存在显著关联（p = 0.03）。本研究首次在德国发现了皮肤癌筛查、患病率和死亡率之间的空间关联。结果表明，与区域人口相关的特征（如社会人口统计学特征）在解释这些关联方面发挥着重要作用，在进一步的研究中应给予更多重视。然而，仍需要进一步的研究，特别是关于皮肤癌死亡率的空间变化。
