title: Socioeconomic status and survival in older patients with melanoma.
abstract: OBJECTIVE
  To determine the association between socioeconomic status (SES) and survival in older patients with melanoma.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Surveillance, Epidemiology and End Results (SEER): a population-based cancer registry covering 14% of the U.S. population.
  
  
  METHODS
  Twenty-three thousand sixty-eight patients aged 65 and older with melanoma between 1988 and 1999.
  
  
  METHODS
  Outcome was melanoma-specific survival. Main independent variable was SES (measured as census tract median household income) taken from the SEER-Medicare linked data.
  
  
  RESULTS
  Subjects residing in lower-income areas (< or =30,000 dollars/y) had lower 5-year survival rates (88.5% vs 91.1%, P < .001) than subjects residing in higher-income areas (>30,000 dollars/y). In Cox proportional hazard models, higher income was associated with lower risk of death from melanoma (hazard ratio = 0.88, 95% confidence interval = 0.79-0.98, P = .02) after adjusting for sociodemographics, stage at diagnosis, thickness, histology, anatomic site, and comorbidity index. There was an interaction effect between SES and ethnicity and survival from melanoma. For whites and nonwhites (all other ethnic groups), 5-year survival rates increased as income increased, although the effect was greater for nonwhites (77.6% to 90.1%, 1st to 5th quintiles, P = .01) than for whites (89.0% to 91.9%, 1st to 5th quintiles, P < .001).
  
  
  CONCLUSIONS
  Older subjects covered by Medicare residing in lower-SES areas had poorer melanoma survival than those residing in higher-SES areas. Further research is needed to determine whether low SES is associated with late-stage disease biology and poorer early detection of melanoma.
authors.affiliation: Sealy Center on Aging, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA. careyeso@utmb.edu
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Reyes-Ortiz
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
authors.forename: Jean L
authors.initials: JL
authors.lastname: Freeman
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000191:economics / Q000401:mortality*; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D012878:Skin Neoplasms / Q000191:economics / Q000401:mortality*; D012923:Social Class; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology