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. 1996 Apr;86(4):538–544. doi: 10.2105/ajph.86.4.538

Cutaneous melanoma mortality among the socioeconomically disadvantaged in Massachusetts.

A C Geller 1, D R Miller 1, R A Lew 1, R W Clapp 1, M B Wenneker 1, H K Koh 1
PMCID: PMC1380556  PMID: 8604786

Abstract

OBJECTIVES: To identify groups for melanoma prevention and early detection programs, this study explored the hypothesis that survival with cutaneous melanoma is disproportionately lower for persons of lower socioeconomic status. METHODS: Massachusetts Cancer Registry and Registry of Vital Records and Statistics data (1982 through 1987) on 3288 incident cases and 1023 deaths from cutaneous melanoma were analyzed. Mortality/incidence ratios were calculated and compared, predictors of late stage disease were examined with logistic regression analysis, and a proportional hazards regression analysis that used death registration as the outcome measure for incident cases was performed. RESULTS: Lower socioeconomic status was associated with a higher mortality/incidence ratio after adjustment for age and sex. For education, the mortality/incidence ratio was 0.37 in the lower group vs 0.25 in the higher group (rate ratio = 1.48, 95% confidence interval [CI] = 1.08, 2.03). Late stage disease was independently associated with lower income (rate ratio for lowest vs highest tertile = 1.64, 95% CI = 1.20, 2.25), and melanoma mortality among case patients was associated with lower education (rate ratio = 1.52, 95% CI = 1.09, 213). CONCLUSIONS: Melanoma patients of lower socioeconomic status may be more likely to die from their melanoma than patients of higher socioeconomic status. Low- SES communities may be appropriate intervention targets.

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Selected References

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  1. Auvinen A. Social class and colon cancer survival in Finland. Cancer. 1992 Jul 15;70(2):402–409. doi: 10.1002/1097-0142(19920715)70:2<402::aid-cncr2820700206>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  2. Bassett M. T., Krieger N. Social class and black-white differences in breast cancer survival. Am J Public Health. 1986 Dec;76(12):1400–1403. doi: 10.2105/ajph.76.12.1400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Berg J. W., Ross R., Latourette H. B. Economic status and survival of cancer patients. Cancer. 1977 Feb;39(2):467–477. doi: 10.1002/1097-0142(197702)39:2<467::aid-cncr2820390215>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  4. Bonett A., Roder D., Esterman A. Epidemiological features of melanoma in South Australia: implications for cancer control. Med J Aust. 1989 Nov 6;151(9):502-4, 506-9. [PubMed] [Google Scholar]
  5. Brenner H., Mielck A., Klein R., Ziegler H. The role of socioeconomic factors in the survival of patients with colorectal cancer in Saarland/Germany. J Clin Epidemiol. 1991;44(8):807–815. doi: 10.1016/0895-4356(91)90133-t. [DOI] [PubMed] [Google Scholar]
  6. Cooke K. R., Skegg D. C., Fraser J. Socio-economic status, indoor and outdoor work, and malignant melanoma. Int J Cancer. 1984 Jul 15;34(1):57–62. doi: 10.1002/ijc.2910340110. [DOI] [PubMed] [Google Scholar]
  7. Dayal H. H., Polissar L., Dahlberg S. Race, socioeconomic status, and other prognostic factors for survival from prostate cancer. J Natl Cancer Inst. 1985 May;74(5):1001–1006. [PubMed] [Google Scholar]
  8. Farley T. A., Flannery J. T. Late-stage diagnosis of breast cancer in women of lower socioeconomic status: public health implications. Am J Public Health. 1989 Nov;79(11):1508–1512. doi: 10.2105/ajph.79.11.1508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Freeman H. P. Cancer in the economically disadvantaged. Cancer. 1989 Jul 1;64(1 Suppl):324–345. doi: 10.1002/1097-0142(19890701)64:1+<324::aid-cncr2820641334>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  10. Freeman H. P., Wasfie T. J. Cancer of the breast in poor black women. Cancer. 1989 Jun 15;63(12):2562–2569. doi: 10.1002/1097-0142(19890615)63:12<2562::aid-cncr2820631234>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  11. Gallagher R. P., Elwood J. M., Threlfall W. J., Spinelli J. J., Fincham S., Hill G. B. Socioeconomic status, sunlight exposure, and risk of malignant melanoma: the Western Canada Melanoma Study. J Natl Cancer Inst. 1987 Oct;79(4):647–652. [PubMed] [Google Scholar]
  12. Graham S., Marshall J., Haughey B., Stoll H., Zielezny M., Brasure J., West D. An inquiry into the epidemiology of melanoma. Am J Epidemiol. 1985 Oct;122(4):606–619. doi: 10.1093/oxfordjournals.aje.a114140. [DOI] [PubMed] [Google Scholar]
  13. Karjalainen S., Pukkala E. Social class as a prognostic factor in breast cancer survival. Cancer. 1990 Aug 15;66(4):819–826. doi: 10.1002/1097-0142(19900815)66:4<819::aid-cncr2820660437>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  14. Kirkpatrick C. S., Lee J. A., White E. Melanoma risk by age and socio-economic status. Int J Cancer. 1990 Jul 15;46(1):1–4. doi: 10.1002/ijc.2910460102. [DOI] [PubMed] [Google Scholar]
  15. Koh H. K., Caruso A., Gage I., Geller A. C., Prout M. N., White H., O'Connor K., Balash E. M., Blumental G., Rex I. H., Jr Evaluation of melanoma/skin cancer screening in Massachusetts. Preliminary results. Cancer. 1990 Jan 15;65(2):375–379. doi: 10.1002/1097-0142(19900115)65:2<375::aid-cncr2820650233>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  16. Koh H. K. Cutaneous melanoma. N Engl J Med. 1991 Jul 18;325(3):171–182. doi: 10.1056/NEJM199107183250306. [DOI] [PubMed] [Google Scholar]
  17. Koh H. K., Lew R. A., Prout M. N. Screening for melanoma/skin cancer: theoretic and practical considerations. J Am Acad Dermatol. 1989 Feb;20(2 Pt 1):159–172. doi: 10.1016/s0190-9622(89)70017-7. [DOI] [PubMed] [Google Scholar]
  18. Lee J. A., Strickland D. Malignant melanoma: social status and outdoor work. Br J Cancer. 1980 May;41(5):757–763. doi: 10.1038/bjc.1980.138. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lee P. Y., Silverman M. K., Rigel D. S., Vossaert K. A., Kopf A. W., Bart R. S., Garfinkel L., Levenstein M. J. Level of education and the risk of malignant melanoma. J Am Acad Dermatol. 1992 Jan;26(1):59–63. doi: 10.1016/0190-9622(92)70007-3. [DOI] [PubMed] [Google Scholar]
  20. Liberatos P., Link B. G., Kelsey J. L. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121. doi: 10.1093/oxfordjournals.epirev.a036030. [DOI] [PubMed] [Google Scholar]
  21. Linden G. The influence of social class in the survival of cancer patients. Am J Public Health Nations Health. 1969 Feb;59(2):267–274. doi: 10.2105/ajph.59.2.267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Lipworth L., Abelin T., Connelly R. R. Socio-economic factors in the prognosis of cancer patients. J Chronic Dis. 1970 Aug;23(2):105–115. doi: 10.1016/0021-9681(70)90069-x. [DOI] [PubMed] [Google Scholar]
  23. MacKie R. M., Hole D. Audit of public education campaign to encourage earlier detection of malignant melanoma. BMJ. 1992 Apr 18;304(6833):1012–1015. doi: 10.1136/bmj.304.6833.1012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Pearce N. E., Howard J. K. Occupation, social class and male cancer mortality in New Zealand, 1974-78. Int J Epidemiol. 1986 Dec;15(4):456–462. doi: 10.1093/ije/15.4.456. [DOI] [PubMed] [Google Scholar]
  25. Rampen F. H., van Huystee B. E., Kiemeney L. A. Melanoma/skin cancer screening clinics: experiences in The Netherlands. J Am Acad Dermatol. 1991 Nov;25(5 Pt 1):776–777. doi: 10.1016/s0190-9622(08)80968-1. [DOI] [PubMed] [Google Scholar]
  26. Savage D., Lindenbaum J., Van Ryzin J., Struening E., Garrett T. J. Race, poverty, and survival in multiple myeloma. Cancer. 1984 Dec 15;54(12):3085–3094. doi: 10.1002/1097-0142(19841215)54:12<3085::aid-cncr2820541246>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  27. Shaw H. M., McGovern V. J., Milton G. W., Farago G. A. Cutaneous malignant melanoma: occupational and prognosis. Med J Aust. 1981 Jan 10;1(1):37–38. [PubMed] [Google Scholar]
  28. Vågerö D., Persson G. Risks, survival and trends of malignant melanoma among white and blue collar workers in Sweden. Soc Sci Med. 1984;19(4):475–478. doi: 10.1016/0277-9536(84)90207-7. [DOI] [PubMed] [Google Scholar]
  29. Williams R. R., Horm J. W. Association of cancer sites with tobacco and alcohol consumption and socioeconomic status of patients: interview study from the Third National Cancer Survey. J Natl Cancer Inst. 1977 Mar;58(3):525–547. doi: 10.1093/jnci/58.3.525. [DOI] [PubMed] [Google Scholar]

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