Does Where You Live Affect Melanoma Risk?

01/28/2019
Maps

States with a higher incidence of melanoma and higher density of dermatologists had better survival rates, according to the findings of a recent study. Conversely, states with lower melanoma incidence had higher mortality rates.1 

“This study is a bird’s eye view of melanoma survival in United States,” said Zachary Hopkins, MD, first author of the study and resident in Internal Medicine at University of Utah Health in Salt Lake City. “We are interested in finding disparities in state health care systems to target specific states to improve care for people.”2
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In the study, Hopkins and his colleagues calculated state-based mortality-to-incidence ratios (MIR) using the United States Cancer Statistics data from 1999 to 2014. They assessed associations between MIR and dermatologist density, primary care provider density, number of physicians by state, number of National Cancer Institute-designated Cancer Centers (NCIDCCs), healthcare spending per capita, average household income, racial/ethnic makeup of a population, percentage of uninsured, and percentage with bachelor’s degree.

The overall mean MIR was 0.15±0.04. Alaska was the only outlier with a MIR of 0.24. There were no significant increases in MIRS overtime, and most states had decreases in MIR.  

States with the highest incidence of melanoma were found to have better survival rates, such as Oregon, Washington, Utah, Minnesota, Vermont, and New Hampshire. However, states with lower incidence of melanoma, such as Texas, Louisiana, Alabama, Indiana, Illinois, and Nevada, had lower survival rates. Alaska was the only state where survival worsened significantly during the study period. 

Other analyses showed that states with more active physicians and a higher percentage of non-Hispanic whites had poorer survival. In addition, significant Pearson correlations were seen between MIR and melanoma incidence, melanoma mortality, dermatologist density, and NCIDCC count.

“These findings highlight areas of poorer melanoma survival and the need for local studies evaluating melanoma survival disparities,” Hopkins et al concluded.1 

“The analysis is telling us that 2 people with similar melanomas could have very different outcomes based on where they live and the care they receive,” said senior study author Aaron Secrest, MD, PhD, assistant professor in the departments of dermatology and population Health sciences at University of Utah Health. “We can use this information to improve care to help more people survive.”2

References

1. Hopkins ZH, Moreno C, Carlisle R, Secrest AM. Melanoma prognosis in the United States: Identifying barriers for improved care [published online January 16, 2018]. J Am Acad Dermatol. https://doi.org/10.1016/j.jaad.2019.01.003

2. States with fewer melanoma diagnoses have higher death rates [press release]. Salt Lake City, NJ: University of Utah Health; January 17, 2019. https://healthcare.utah.edu/publicaffairs/news/2019/01/melanoma-hopkins.php. Accessed January 28, 2019.