title: The role of spatially-derived access-to-care characteristics in melanoma prevention and control in Los Angeles county.
abstract: Among 10,068 incident cases of invasive melanoma, we examined the effects of patient characteristics and access-to-care on the risk of advanced melanoma. Access-to-care was defined in terms of census tract-level sociodemographics, health insurance, cost of dermatological services and appointment wait-times, clinic density and travel distance. Public health insurance and education level were the strongest predictors of advanced melanomas but were modified by race/ethnicity and poverty: Hispanic whites and high-poverty neighborhoods were worse off than non-Hispanic whites and low-poverty neighborhoods. Targeting high-risk, underserved Hispanics and high-poverty neighborhoods (easily identified from existing data) for early melanoma detection may be a cost-efficient strategy to reduce melanoma mortality.
authors.affiliation: Spatial Sciences Institute, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, United States. Electronic address: aagustin@usc.edu.
authors.forename: Loraine A
authors.initials: LA
authors.lastname: Escobedo
authors.affiliation: Keck School of Medicine, University of Southern California, United States.
authors.forename: Ashley
authors.initials: A
authors.lastname: Crew
authors.affiliation: Keck School of Medicine, University of Southern California, United States.
authors.forename: Ariana
authors.initials: A
authors.lastname: Eginli
authors.affiliation: Keck School of Medicine, University of Southern California, United States.
authors.forename: David
authors.initials: D
authors.lastname: Peng
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Cousineau
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States.
authors.forename: Myles
authors.initials: M
authors.lastname: Cockburn
mesh_terms: D019352:Censuses; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D015141:Los Angeles; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000517:prevention & control*; D011203:Poverty; D044469:Racial Groups; D012111:Residence Characteristics; D012307:Risk Factors; D062206:Spatial Analysis; D044465:White People / Q000706:statistics & numerical data
keywords: Cancer surveillance data; Health care accessibility; High-risk population; Melanoma; Minority groups