title: Melanoma prognosis in Europe: far from equal.
abstract: BACKGROUND
  Comprehensive, population-based analysis of melanoma survival throughout Europe is hindered by the uneven coverage and quality of European cancer registries, and by logistical and financial shortcomings. Mortality-to-incidence ratios (MIRs) have been used as a proxy for estimating survival for multiple cancers and to model melanoma prognosis, higher MIR values reflecting poorer prognosis. Updated and improved pan-European estimates of mortality and incidence rates for melanoma have become available through the International Agency for Research of Cancer project Globocan 2008, showing marked differences among European countries.
  
  
  OBJECTIVE
  To analyse MIRs for melanoma across Europe and their relationship with national health expenditures, aiming to identify countries and regions with disproportionately poor prognosis.
  
  
  METHODS
  Estimated age-standardized rates of melanoma incidence and mortality provided by Globocan 2008 were used to calculate the MIR for each European country and region. Total health expenditures per capita in European countries for 2008 were provided by the World Health Organization/Global Health Observatory. The potential correlation between MIR and total health expenditure per capita was analysed through Pearson's correlation.
  
  
  RESULTS
  Mortality-to-incidence ratios for melanoma ranged between 0·09 in Switzerland and 0·44 in Latvia. The regional average MIR was the highest in Central and Eastern Europe at 0·35; the lowest was in Western Europe, at 0·13. We found a strong inverse correlation between the individual nation's total health expenditure per capita and the calculated melanoma MIR (r = -0·76, P < 0·05).
  
  
  CONCLUSIONS
  While further improvement of melanoma registration is necessary, our findings reveal sharp disparities in the prognosis of melanoma across the Continent, correlated with significant differences in health care expenditures.
authors.affiliation: Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, 17, Marasti Blvd, Sector 1, Bucharest, Romania.
authors.forename: A M
authors.initials: AM
authors.lastname: Forsea
authors.forename: V
authors.initials: V
authors.lastname: Del Marmol
authors.forename: A
authors.initials: A
authors.lastname: Stratigos
authors.forename: A C
authors.initials: AC
authors.lastname: Geller
mesh_terms: D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008545:Melanoma / Q000191:economics / Q000401:mortality*; D011379:Prognosis; D012878:Skin Neoplasms / Q000191:economics / Q000401:mortality*