Latoni David I, Geller Alan C, Semenov Yevgeniy R, Ji Zhenyu, Tsao Hensin
Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Invest Dermatol. 2025 Feb;145(2):393-399.e1. doi: 10.1016/j.jid.2024.05.032. Epub 2024 Jul 7.
The extent to which the geographic diversity of the US plays a significant role in melanoma incidence and mortality over time has not been precisely characterized. We obtained age-adjusted melanoma data for the 50 states between 2001 and 2019 from the Surveillance, Epidemiology, and End Results registry and performed hierarchical clustering (complete linkage, Euclidean space) to uncover geo-temporal trend groups over 2 decades. While there was a global increase in incidence during this time (b = +0.41, P < .0001), there were 6 distinct clusters (by absolute and Z-score) with significantly different temporal trends (analysis of covariance P < .0001). Cluster 2 states had the sharpest increase in incidence with b = +0.66, P < .0001. For mortality, the global rate decreased (b = -0.03, P = .0003) with 3 and 6 clusters by absolute and Z-scores, respectively (analysis of covariance P < .05). Cluster 1 states exhibited the smallest decline in mortality (b = -0.017, P = .008). Mortality to incidence ratios declined (b = -0.0037, P < .0001) and harbored 4 and 6 clusters by absolute and Z-score analysis, respectively (analysis of covariance P < .0001). Cluster 4 states had the lowest rate of mortality to incidence ratios decline (b = -0.003, P < .0001). These results provide an unprecedented higher dimensional view of melanoma behavior over space and time. With more refined analyses, geospatial studies can uncover local trends which can inform public health agencies to more properly allocate resources.
随着时间推移,美国地理多样性在黑色素瘤发病率和死亡率方面所起的重要作用尚未得到精确描述。我们从监测、流行病学和最终结果登记处获取了2001年至2019年期间50个州的年龄调整后黑色素瘤数据,并进行了层次聚类(完全连锁,欧几里得空间)以揭示20年间的地理时间趋势组。虽然在此期间发病率总体呈上升趋势(b = +0.41,P < .0001),但有6个不同的聚类(按绝对值和Z分数),其时间趋势存在显著差异(协方差分析P < .0001)。聚类2的州发病率增长最为急剧,b = +0.66,P < .0001。对于死亡率,总体率下降(b = -0.03,P = .0003),按绝对值和Z分数分别有3个和6个聚类(协方差分析P < .05)。聚类1的州死亡率下降幅度最小(b = -0.017,P = .008)。死亡率与发病率之比下降(b = -0.0037,P < .0001),按绝对值和Z分数分析分别有4个和6个聚类(协方差分析P < .0001)。聚类4的州死亡率与发病率之比下降率最低(b = -0.003,P < .0001)。这些结果提供了一个前所未有的关于黑色素瘤在空间和时间上行为的高维视角。通过更精细的分析,地理空间研究可以揭示局部趋势,为公共卫生机构更合理地分配资源提供依据。