title: Cutaneous melanoma mortality among the socioeconomically disadvantaged in Massachusetts.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Geller
authors.forename: D R
authors.initials: DR
authors.lastname: Miller
authors.forename: R A
authors.initials: RA
authors.lastname: Lew
authors.forename: R W
authors.initials: RW
authors.lastname: Clapp
authors.forename: M B
authors.initials: MB
authors.lastname: Wenneker
authors.forename: H K
authors.initials: HK
authors.lastname: Koh
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008545:Melanoma / Q000401:mortality*; D008875:Middle Aged; D011159:Population Surveillance; D011203:Poverty; D016016:Proportional Hazards Models; D012042:Registries; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000401:mortality*; D012959:Socioeconomic Factors; D015996:Survival Rate