title: Association of socioeconomic status with Breslow thickness and disease-free and overall survival in stage I-II primary cutaneous melanoma.
abstract: OBJECTIVE
  To investigate the influence of socioeconomic status (SES) on Breslow thickness, disease-free survival, and overall survival in patients with stage I-II primary cutaneous melanoma (PCM).
  
  
  METHODS
  The study consists of all consecutive patients who were diagnosed as having PCM and were treated and followed up at our hospital between November 1, 1998, and July 31, 2009. Pathologic and sociodemographic characteristics of the patients were obtained. We categorized SES into 3 levels: low (manual employees and skilled/unskilled workers, including farmers, with primary education level), middle (nonmanual employees and clerks with middle education level), and high (professionals, executives, administrators, and entrepreneurs with tertiary education).
  
  
  RESULTS
  A total of 1443 consecutive patients were evaluated. In a multivariate logistic regression analysis, sex (female vs male: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.08-1.75), SES (high vs middle: OR, 1.27; 95% CI, 0.96-1.69; high vs low: OR, 1.73; 95% CI, 1.26-2.38), age (<60 vs ≥60 years: OR, 1.35; 95% CI, 1.03-1.78), and family context (single vs living with relatives: OR, 1.37; 95% CI, 0.97-1.94) were the strongest correlates of Breslow thickness. Compared with high SES, the risk of melanoma-related death, adjusted for age and sex, was 7 times higher (hazard ratio, 7.44; 95% CI, 3.27-16.93) and almost 2 times higher (hazard ratio, 1.88; 95% CI, 1.04-3.39) in patients with low SES living alone or living with relatives, respectively.
  
  
  CONCLUSIONS
  In patients with PCM, low SES is associated with thicker melanoma and a poorer clinical outcome.
authors.affiliation: Unit of Medical Oncology, Ospedali Riuniti Bergamo, Largo Barozzi 1, Bergamo, Italy. mariomandala@tin.it
authors.forename: Mario
authors.initials: M
authors.lastname: Mandalà
authors.forename: Gian Lorenzo
authors.initials: GL
authors.lastname: Imberti
authors.forename: Dario
authors.initials: D
authors.lastname: Piazzalunga
authors.forename: Maurizio
authors.initials: M
authors.lastname: Belfiglio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucisano
authors.forename: Roberto
authors.initials: R
authors.lastname: Labianca
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Marchesi
authors.forename: Barbara
authors.initials: B
authors.lastname: Merelli
authors.forename: Silvana
authors.initials: S
authors.lastname: Robone
authors.forename: Paola
authors.initials: P
authors.lastname: Poletti
authors.forename: Laura
authors.initials: L
authors.lastname: Milesi
authors.forename: Carlo
authors.initials: C
authors.lastname: Tondini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology*; D012923:Social Class; D015996:Survival Rate