Urban-rural differences in survival from cutaneous melanoma in Queensland.
OBJECTIVE
To assess how much of the urban-rural disparity in melanoma survival in Queensland is due to later diagnosis.


METHODS
Data were obtained from the population-based Queensland Cancer Registry. We used incident cases for the six years 1996 to 2001 with follow-up to the end of 2002, so that all patients were followed for at least 12 months with a median follow-up time of 41 months. Cox regression models were used to compare urban versus rural case-fatality rates, after adjusting for thickness, level, subsite, age and sex.


RESULTS
The adjusted case-fatality rate was 20% higher in rural versus urban areas (hazard ratio 1.20, 95% CI 1.02-1.43).


CONCLUSIONS
There is some characteristic of living in an urban area, other than earlier diagnosis, that improves melanoma survival. In the first instance, differences in access to services and variation in management practices deserve investigation and exclusion.
Coory
Michael
M
School of Population Health, Faculty of Health Sciences, University of Queensland, Herston Road, Herston, Queensland 4006. m.coory@sph.uq.edu.au
Smithers
Mark
M
Aitken
Joanne
J
Baade
Peter
P
Ring
Ian
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011793:Queensland; D012424:Rural Population; D012878:Skin Neoplasms; D017741:Survivors; D014505:Urban Population