Outcomes/Effectiveness Research

Individuals who reside in areas with higher median household income have better rates of melanoma survival

A new study confirms findings of other studies that link living in a lower socioeconomic status (SES) area to poorer survival from melanoma, a very aggressive skin cancer. Researchers found that older Medicare-insured patients who lived in areas with an average median household income of $30,000 or less per year were more likely to die within 5 years of melanoma diagnosis than those residing in more affluent areas, even after adjusting for other factors.

University of Texas researchers analyzed data from a population-based cancer registry covering 14 percent of the U.S. population to identify 23,068 elderly patients diagnosed with melanoma between 1988 and 1999. Patients who lived in the lower-income areas had lower 5-year survival rates than those living in more affluent areas (88.5 vs. 91.1 percent). Similarly, higher income was associated with a 12 percent lower risk of dying from melanoma, after adjusting for sociodemographics, cancer stage at diagnosis, cancer thickness, and other factors.

Ethnicity also seemed to play a role in melanoma survival. For whites and all other ethnic groups, 5-year survival rates increased as income increased. However, the effect was greater for other racial groups (77.6 to 90.1 percent) than for whites (89 to 91.9 percent). Older age, male sex, and being unmarried were also associated with greater risk of dying from melanoma. Nodular melanoma was more frequent in persons residing in low SES areas and was associated with a higher risk of dying. In addition, advanced stage at diagnosis and thicker lesions were associated with residing in lower SES areas and with a higher risk of dying. The researchers call for more studies to determine whether low SES leads to later diagnosis, worse tumor characteristics (for example, ulceration), or poorer early detection and surgery of melanoma. Their study was supported in part by the Agency for Healthcare Research and quality (HS11618).

See "Socioeconomic status and survival in older patients with melanoma," by Carlos A. Reyes-Ortiz, M.D., Ph.D., James S. Goodwin, M.D., Jean L. Freeman, Ph.D., and Yong-Fang Kuo, Ph.D., in the November 2006 Journal of the American Geriatric Society 54, pp. 1758-1764.

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