title: Predictors of neighborhood risk for late-stage melanoma: addressing disparities through spatial analysis and area-based measures.
abstract: Minority populations have disproportionately more advanced stage melanoma and worse survival. To clarify the impact of race and ethnicity on late-stage melanoma diagnosis, we performed spatial analysis of geocoded melanoma cases diagnosed in Florida, 1999-2008, to identify geographic clusters of higher-than-expected incidence of late-stage melanoma and developed predictive models for melanoma cases in high-risk neighborhoods accounting for area-based poverty, race/ethnicity, patient insurance status, age, and gender. In the adjusted model, Hispanic ethnicity and census tract-level poverty are the strongest predictors for clustering of late-stage melanoma. Hispanic whites were 43% more likely to live in neighborhoods with excessive late-stage melanoma (P<0.001) compared with non-Hispanic whites (NHW). For every 1% increase in population living in poverty, there is a 2% increase in late-stage melanoma clustering (P<0.001). Census tract-level poverty predicted late-stage melanoma similarly among NHW and Hispanic whites. The impact of insurance coverage varied among populations; the most consistent trend was that Medicaid coverage is associated with higher odds for late-stage melanoma. The finding that Hispanics are most likely to reside in high-risk neighborhoods, independent of poverty and insurance status, underscores the importance of addressing, and overcoming community-level barriers to melanoma care.
authors: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: shu@med.miami.edu.
authors: Shasa
authors: S
authors: Hu
authors: Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors: Recinda
authors: R
authors: Sherman
authors: Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors: Kristopher
authors: K
authors: Arheart
authors: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors: Robert S
authors: RS
authors: Kirsner
mesh_terms: D000368:Aged; D005006:Ethnicity; D005260:Female; D005431:Florida; D005843:Geography; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D006278:Medicare; D008545:Melanoma / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology*; D008875:Middle Aged; D008913:Minority Groups; D016017:Odds Ratio; D011203:Poverty; D012111:Residence Characteristics; D012306:Risk; D018426:SEER Program; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology*; D012923:Social Class; D014481:United States; D044465:White People