title: Health Disparities Influence Childhood Melanoma Stage at Diagnosis and Outcome.
abstract: To identify health disparities in pediatric patients with melanoma that affect disease presentation and outcome.
  
  
  
  This was a retrospective cohort study of all persons aged ≤18 years diagnosed with melanoma and enrolled in the Texas Cancer Registry between 1995 and 2009. Socioeconomic status (SES) and driving distance to the nearest pediatric cancer treatment center were calculated for each patient. Logistic regression was used to determine factors associated with advanced-stage disease. Life table methods and Cox regression were used to estimate survival probability and hazard ratios.
  
  
  
  A total of 185 adolescents (age >10 years) and 50 young children (age ≤10 years) were identified. Hispanics (n = 27; 12%) were 3 times more likely than non-Hispanic whites (n = 177; 75%) to present with advanced disease (OR, 3.8; 95% CI, 1.7-8.8). Young children were twice as likely as adolescents to present with advanced disease (OR, 2.2; 95% CI, 1.1-4.3). Distance to treatment center and SES did not affect stage of disease at presentation. Hispanics and those in the lowest SES quartile had a significantly higher mortality risk (hazard ratios, 3.0 [95% CI, 1.2-7.8] and 4.3 [95% CI, 1.4-13.9], respectively). In the adjusted survival model, only advanced disease was predictive of mortality (P < .001).
  
  
  
  Hispanics and young children with melanoma are more likely to present with advanced disease, and advanced disease is the single most important predictor of survival. Heightened awareness among physicians is needed to facilitate early detection of melanoma within these groups.
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Emma C
authors.initials: EC
authors.lastname: Hamilton
authors.affiliation: Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Hoang T
authors.initials: HT
authors.lastname: Nguyen
authors.affiliation: Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Yu-Chia
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC; Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Eberth
authors.affiliation: Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Janice
authors.initials: J
authors.lastname: Cormier
authors.affiliation: Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Pediatric Patient Care, Children's Cancer Hospital, The University of Texas M.D. Anderson Cancer Center, Houston, TX. Electronic address: Mary.T.Austin@uth.tmc.edu.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Austin
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000473:pathology*; D012923:Social Class; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology; D044465:White People
keywords: health services research; pediatric melanoma; racial disparities; socioeconomic status