Health Disparities Influence Childhood Melanoma Stage at Diagnosis and Outcome

• Published in: The Journal of pediatrics 2016-08, Vol.175, p.182-187
• Main Authors: Hamilton, Emma C., MD, Nguyen, Hoang T., PhD, Chang, Yu-Chia, MPH, Eberth, Jan M., PhD, Cormier, Janice, MD, MPH, Elting, Linda S., DrPh, Austin, Mary T., MD, MPH
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Child; Child, Preschool; European Continental Ancestry Group; Female; Follow-Up Studies; Health Services Accessibility - statistics & numerical data; health services research; Health Status Disparities; Healthcare Disparities - economics; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Hispanic Americans; Humans; Infant; Infant, Newborn; Logistic Models; Male; Melanoma - diagnosis; Melanoma - ethnology; Melanoma - mortality; Melanoma - pathology; Neoplasm Staging; pediatric melanoma; Pediatrics; Prognosis; racial disparities; Registries; Retrospective Studies; Skin Neoplasms - diagnosis; Skin Neoplasms - ethnology; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Social Class; socioeconomic status; Survival Analysis; Texas - epidemiology
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.04.068

Objective To identify health disparities in pediatric patients with melanoma that affect disease presentation and outcome. Study design 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. Results 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