Impact of Socioeconomic Status and Sociodemographic Factors on Melanoma Presentation Among Ethnic Minorities

Abstract

Minority melanoma patients have worse survival. In this study, we evaluated the impact of socioeconomic and demographic factors on minority melanoma patients presenting to two different New York City hospitals (one public and one private) managed by the same multidisciplinary team. Sociodemographic and clinicopathologic characteristics were retrieved for melanoma patients presenting to Bellevue Hospital Center (BHC), a public hospital, and the New York University Cancer Institute (NYUCI), a private cancer center. Socioeconomic data was obtained from the United States Census Bureau database. The Kruskal-Wallis and chi-square tests were used to evaluate the associations between race/ethnicity and continuous and categorical variables (e.g. income, stage at presentation), respectively. Minorities comprised 2% (27/1296) of melanoma patients at the NYUCI compared to 42% (50/119) at BHC. Those presenting to the NYUCI were more likely to have a higher median household income (p=0.05), a higher educational level (p=0.04), and an earlier stage at presentation (p=0.02) than those at BHC. NYUCI patients were predominantly covered by commercial insurance (70%), whereas Medicaid (62%) was common among BHC patients. Only 19% of Hispanic patients at BHC chose English as their preferred language. Our data demonstrate that language and health care system factors affect melanoma presentation in minorities.

Patients' Preferences for Biopsy Result Notification in an Era of Electronic Messaging Methods

“…In the United States, 30% have a college degree or higher 36 compared with 81.9% in our study, likely because UCSF and Duke are located in metropolitan areas with a higher percentage of college-educated adults than the national metropolitan average 37 and because previous work 38 has found that highly educated patients have better access to health care and that patients with melanoma at a universityaffiliated teaching hospital were generally more well educated and had higher socioeconomic status than patients with melanoma at a nearby public hospital. 39 Duke participants indicated that the online portal option was their second most preferred method; this finding correlates with these patients' longer duration of exposure to and 41 Because the rapidity of receiving results is paramount to patients in our and other studies, 2,5,6,[12][13][14] and the stated need for interactive discussion of results is secondary, it is possible that notification of biopsy results by online portal will overtake telephone and clinic visit as the method preferred by patients for biopsy notification in the future. Accessing complex results via online portals may increase patient stress because of misinterpretation in the absence of counseling from a physician.…”

Impact of Socioeconomic Status and Ethnicity on Melanoma Presentation and Recurrence in Caucasian Patients

“…Several studies have subsequently shown that health insurance coverage is a significant determinant of melanoma stage at diagnosis in the US [12,32]. Nonetheless, the majority of NYU patients are commercially insured; therefore, health care access is less likely to be an intermediary in the correlation between SES and melanoma presentation in this patient cohort.…”

“…Patient demographics and primary tumor pathologic characteristics were obtained for each patient at the time of enrollment, as previously described [12]. Sociodemographic data included patient date of birth, gender, race, ethnicity, personal and family history of melanoma, personal and family history of BRCA -associated cancers (e.g.…”

“…While high SES is linked to melanoma incidence [5,6,7], low SES independently predicts poor outcome in the general melanoma population [5,11,12]. However, prior studies examining the impact of SES on melanoma survival have often been limited by the confounding effects of race, as race is correlated with both SES and survival [13].…”

Disparities in the Presentation and Management of Cutaneous Melanoma That Required Admission

“…This disproportion is mainly attributed to the substantially higher risk of melanoma in this racial group [2]; however, emerging evidence suggests that non-White racial groups are more likely to experience unfavorable prognoses despite their lower incidence [27]. Large-scale studies on the population of the United States generally, and of California, New York, Connecticut, and Florida specifically, identified socioeconomic and racial disparities in association with melanoma [7, 8, 12, 27-36]. Most of these studies used cancer registry records and the Surveillance, Epidemiology, and End Results (SEER) database.…”