Distance to diagnosing provider as a measure of access for patients with melanoma.
OBJECTIVE
To examine the effect of travel distance and other sociodemographic factors on access to a diagnosing provider for patients with melanoma.


METHODS
Analysis was performed of all incident cases of melanoma in 2000 from 42 North Carolina counties.


METHODS
Academic research.


METHODS
Patients and providers from 42 North Carolina counties were geocoded to street address.


METHODS
Associations between Breslow thickness and clinical and sociodemographic factors (age, sex, poverty rate, rurality, provider supply, and distance to diagnosing provider) were examined.


RESULTS
Of 643 eligible cases, 4.4% were excluded because of missing data. The median Breslow thickness was 0.6 mm (range, 0.1-20.0 mm). The median distance to diagnosing provider was 8 miles (range, 0-386 miles). For each 1-mile increase in distance, Breslow thickness increased by 0.6% (P =.003). For each 1% increase in poverty rate, Breslow thickness increased by 1% (P =.04). Breslow thickness was 19% greater for patients aged 51 to 80 years than for those aged 0 to 50 years (P =.02) and was 109% greater for patients older than 80 years than for those aged 0 to 50 years (P < .001). Sex, rurality, and supply of dermatologists were not associated with Breslow thickness.


CONCLUSIONS
For patients with melanoma, distance to the diagnosing provider is a meaningful measure of access that captures different information than community-level measures of rurality, provider supply, and socioeconomic status. Future work should be targeted at identifying factors that may affect distance to diagnosing provider and serve as barriers to melanoma care.
Stitzenberg
Karyn B
KB
Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, 3010 Old Clinic Bldg, CB 7213, Chapel Hill, NC 27599-7213, USA. karyn_stitzenberg@unc.edu
Thomas
Nancy E
NE
Dalton
Kathleen
K
Brier
Sarah E
SE
Ollila
David W
DW
Berwick
Marianne
M
Mattingly
Dianne
D
Millikan
Robert C
RC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D009367:Neoplasm Staging; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012959:Socioeconomic Factors
Cancer. 2003 Mar 1;97(5):1303-11
12599239
J Am Acad Dermatol. 2000 Aug;43(2 Pt 1):211-8
10906640
Health Place. 2005 Sep;11(3):197-204
15774327
J Am Acad Dermatol. 1999 Jan;40(1):61-8
9922013
BMJ. 1996 May 4;312(7039):1125-8
8620127
Ann Surg Oncol. 2004 Mar;11(3):259-64
14993020
J Clin Oncol. 2001 Aug 15;19(16):3622-34
11504744
J Natl Cancer Inst. 1996 Jan 3;88(1):17-23
8847720
J Clin Oncol. 1987 Oct;5(10):1640-5
3655862
J Am Acad Dermatol. 1996 Apr;34(4):632-7
8601653
Neurology. 2004 May 25;62(10):1788-93
15159479
Cancer Causes Control. 2003 Oct;14(8):761-6
14674740
BMJ. 1989 Jul 1;299(6690):16-8
2503192
Br J Cancer. 2002 Sep 9;87(6):585-90
12237766
Melanoma Res. 1998 Oct;8(5):425-9
9835456
Am J Epidemiol. 2002 Sep 1;156(5):471-82
12196317
Br J Cancer. 2003 Nov 3;89(9):1693-6
14583771
J Natl Cancer Inst. 2000 Feb 2;92(3):269-71
10655446
J Obstet Gynaecol. 1999 Mar;19(2):172-9
15512264
J Natl Cancer Inst. 2005 Oct 19;97(20):1507-15
16234564
J Fam Pract. 1995 Feb;40(2):143-7
7852937
Dermatology. 2002;205(4):362-6
12444332
J Natl Cancer Inst. 2003 Sep 17;95(18):1370-5
13130112
Arch Fam Med. 2000 Jul;9(7):606-11
10910307
J Med Syst. 2004 Jun;28(3):223-36
15446614
South Med J. 2003 Jul;96(7):656-60
12940314
Plast Reconstr Surg. 1998 Apr;101(5):1255-61
9529210
Am J Public Health. 1996 Apr;86(4):538-43
8604786
Ann Surg Oncol. 1994 Nov;1(6):487-94
7850555
Cancer Pract. 1997 Nov-Dec;5(6):361-6
9397704
Cancer. 1998 Oct 15;83(8):1664-78
9781962
Cancer Causes Control. 2004 Nov;15(9):957-65
15577298
J Clin Oncol. 1987 Jan;5(1):100-6
3806154