title: Distance to diagnosing provider as a measure of access for patients with melanoma.
abstract: 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.
authors: 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
authors: Karyn B
authors: KB
authors: Stitzenberg
authors: Nancy E
authors: NE
authors: Thomas
authors: Kathleen
authors: K
authors: Dalton
authors: Sarah E
authors: SE
authors: Brier
authors: David W
authors: DW
authors: Ollila
authors: Marianne
authors: M
authors: Berwick
authors: Dianne
authors: D
authors: Mattingly
authors: Robert C
authors: RC
authors: Millikan
mesh_terms: 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
references: Cancer. 2003 Mar 1;97(5):1303-11
references: 12599239
references: J Am Acad Dermatol. 2000 Aug;43(2 Pt 1):211-8
references: 10906640
references: Health Place. 2005 Sep;11(3):197-204
references: 15774327
references: J Am Acad Dermatol. 1999 Jan;40(1):61-8
references: 9922013
references: BMJ. 1996 May 4;312(7039):1125-8
references: 8620127
references: Ann Surg Oncol. 2004 Mar;11(3):259-64
references: 14993020
references: J Clin Oncol. 2001 Aug 15;19(16):3622-34
references: 11504744
references: J Natl Cancer Inst. 1996 Jan 3;88(1):17-23
references: 8847720
references: J Clin Oncol. 1987 Oct;5(10):1640-5
references: 3655862
references: J Am Acad Dermatol. 1996 Apr;34(4):632-7
references: 8601653
references: Neurology. 2004 May 25;62(10):1788-93
references: 15159479
references: Cancer Causes Control. 2003 Oct;14(8):761-6
references: 14674740
references: BMJ. 1989 Jul 1;299(6690):16-8
references: 2503192
references: Br J Cancer. 2002 Sep 9;87(6):585-90
references: 12237766
references: Melanoma Res. 1998 Oct;8(5):425-9
references: 9835456
references: Am J Epidemiol. 2002 Sep 1;156(5):471-82
references: 12196317
references: Br J Cancer. 2003 Nov 3;89(9):1693-6
references: 14583771
references: J Natl Cancer Inst. 2000 Feb 2;92(3):269-71
references: 10655446
references: J Obstet Gynaecol. 1999 Mar;19(2):172-9
references: 15512264
references: J Natl Cancer Inst. 2005 Oct 19;97(20):1507-15
references: 16234564
references: J Fam Pract. 1995 Feb;40(2):143-7
references: 7852937
references: Dermatology. 2002;205(4):362-6
references: 12444332
references: J Natl Cancer Inst. 2003 Sep 17;95(18):1370-5
references: 13130112
references: Arch Fam Med. 2000 Jul;9(7):606-11
references: 10910307
references: J Med Syst. 2004 Jun;28(3):223-36
references: 15446614
references: South Med J. 2003 Jul;96(7):656-60
references: 12940314
references: Plast Reconstr Surg. 1998 Apr;101(5):1255-61
references: 9529210
references: Am J Public Health. 1996 Apr;86(4):538-43
references: 8604786
references: Ann Surg Oncol. 1994 Nov;1(6):487-94
references: 7850555
references: Cancer Pract. 1997 Nov-Dec;5(6):361-6
references: 9397704
references: Cancer. 1998 Oct 15;83(8):1664-78
references: 9781962
references: Cancer Causes Control. 2004 Nov;15(9):957-65
references: 15577298
references: J Clin Oncol. 1987 Jan;5(1):100-6
references: 3806154