Flynn Michael Seth, Gayed Matthew, Lebhar Jamie, Jacobs Jennifer, Bailey-Burke Christian, Tissera Kristin, Liu Beiyu, Green Cynthia, Pavlis Michelle B, Mosca Paul J
Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina, USA.
Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA.
J Rural Health. 2025 Mar;41(2):e12881. doi: 10.1111/jrh.12881. Epub 2024 Oct 3.
To assess rural-urban and health professional shortage area (HPSA)-related influences on the characteristics of melanoma in North Carolina.
We conducted a single-center retrospective cohort study of patients living in North Carolina with an available pathology report for invasive cutaneous melanoma seen in the Duke University Health System from 01/01/2014 to 12/31/2020. Multivariable logistic regression models were employed to compare patient and tumor characteristics between rural versus urban county residence as well between melanoma thicknesses dichotomized into thin (≤1.0 mm) and thicker (>1.0 mm) tumors.
The cohort included 807 patients, and rural patients accounted for 177 (21.9%) of invasive cutaneous melanomas. Rural patients had significantly higher odds of having thicker tumors than urban patients (odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.17-2.71; P = .008). Rural patients were significantly more likely to be female (OR = 1.59, 95% CI: 1.10-2.28; P = .013) and located in a population-based (OR = 2.66, 95% CI: 1.84-3.84; P<.001) or geographic-based (OR = 8.21, 95% CI: 3.33-20.22; P<.001) HPSA. Living in a medium- or high-shortage population-based HPSA was associated with higher odds of thicker tumors (OR = 2.65, 95% CI: 1.85-3.80; P<.001).
Patients living in rural North Carolina counties were more likely than those in urban counties to be diagnosed with melanomas >1.0 mm in thickness, a clinically significant difference with important prognostic implications. Interventions at the county- and state-level to address this disparity may include improving access to skin cancer screening and teledermatology programs, increasing partnerships with primary care providers, and targeting interventions to counties with health professional shortages.
评估北卡罗来纳州城乡差异及卫生专业人员短缺地区（HPSA）对黑色素瘤特征的影响。
我们进行了一项单中心回顾性队列研究，研究对象为居住在北卡罗来纳州且有2014年1月1日至2020年12月31日期间在杜克大学卫生系统确诊的侵袭性皮肤黑色素瘤病理报告的患者。采用多变量逻辑回归模型比较农村与城市县居民之间以及黑色素瘤厚度分为薄型（≤1.0毫米）和厚型（>1.0毫米）肿瘤患者的特征。
该队列包括807名患者，农村患者占侵袭性皮肤黑色素瘤患者的177例（21.9%）。农村患者肿瘤厚度大于城市患者的几率显著更高（优势比[OR]=1.78，95%置信区间[CI]：1.17 - 2.71；P = 0.008）。农村患者女性比例显著更高（OR = 1.59，95%CI：1.10 - 2.28；P = 0.013），且更有可能位于基于人群的（OR = 2.66，95%CI：1.84 - 3.84；P<0.001）或基于地理的（OR = 8.21，95%CI：3.33 - 20.22；P<0.001）卫生专业人员短缺地区。居住在基于人群的中度或高度短缺的卫生专业人员短缺地区与肿瘤厚度更大的几率更高相关（OR = 2.65，95%CI：1.85 - 3.80；P<0.001）。
居住在北卡罗来纳州农村县的患者比城市县的患者更有可能被诊断出黑色素瘤厚度>毫米，这是一个具有重要预后意义的临床显著差异。在县和州层面解决这一差异的干预措施可能包括改善皮肤癌筛查和远程皮肤病学项目的可及性，增加与初级保健提供者的合作，并针对卫生专业人员短缺的县进行干预。
