Estimating the potential survival gains by eliminating socioeconomic and sex inequalities in stage at diagnosis of melanoma.
BACKGROUND
Although inequalities in cancer survival are thought to reflect inequalities in stage at diagnosis, little evidence exists about the size of potential survival gains from eliminating inequalities in stage at diagnosis.


METHODS
We used data on patients diagnosed with malignant melanoma in the East of England (2006-2010) to estimate the number of deaths that could be postponed by completely eliminating socioeconomic and sex differences in stage at diagnosis after fitting a flexible parametric excess mortality model.


RESULTS
Stage was a strong predictor of survival. There were pronounced socioeconomic and sex inequalities in the proportion of patients diagnosed at stages III-IV (12 and 8% for least deprived men and women and 25 and 18% for most deprived men and women, respectively). For an annual cohort of 1025 incident cases in the East of England, eliminating sex and deprivation differences in stage at diagnosis would postpone approximately 24 deaths to beyond 5 years from diagnosis. Using appropriate weighting, the equivalent estimate for England would be around 215 deaths, representing 11% of all deaths observed within 5 years from diagnosis in this population.


CONCLUSIONS
Reducing socioeconomic and sex inequalities in stage at diagnosis would result in substantial reductions in deaths within 5 years of a melanoma diagnosis.
Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.
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MJ
Rutherford
Statistical Information Team, Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK.
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Ironmonger
Statistical Information Team, Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK.
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Ormiston-Smith
Cambridge Centre for Health Services Research, Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Abel
1] Cambridge Centre for Health Services Research, Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK [2] National Cancer Registration Service, Public Health England, Eastern Office, Cambridge CB22 3AD, UK.
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Greenberg
1] Cambridge Centre for Health Services Research, Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK [2] Health Behaviour Research Centre, Department of Epedimiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Lyratzopoulos
1] Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK [2] Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm SE-171 77, Sweden.
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Lambert
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality; D009367:Neoplasm Staging; D012737:Sex Factors; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate