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.

Etiologies of Melanoma Development and Prevention Measures: A Review of the Current Evidence

“…Areas with a higher density of dermatologists are correlated with the earlier diagnosis of melanoma [ 128 , 129 , 130 ]. One spatial analysis study found that a low density of clinics corresponded to a 30% increase in the risk for thick lesions [ 128 ].…”

“…Areas with a higher density of dermatologists are correlated with the earlier diagnosis of melanoma [ 128 , 129 , 130 ]. One spatial analysis study found that a low density of clinics corresponded to a 30% increase in the risk for thick lesions [ 128 ]. The distance to dermatologist clinics increased the risk of thick tumors for White Hispanic individuals and poorer communities, which highlights the issue of a lack of accessibility to treatment due to racial and socioeconomic disparities [ 128 ].…”

“…One spatial analysis study found that a low density of clinics corresponded to a 30% increase in the risk for thick lesions [ 128 ]. The distance to dermatologist clinics increased the risk of thick tumors for White Hispanic individuals and poorer communities, which highlights the issue of a lack of accessibility to treatment due to racial and socioeconomic disparities [ 128 ]. Another study found that having access to 0.001-1 dermatologists per 100,000 people reduced melanoma mortality by 35%, and having access to 1.001-2 dermatologists per 100,000 people reduced melanoma mortality by 53% [ 129 ].…”

“…Studies found that expanded public insurance coverage under the Affordable Care Act's Medicaid program has been correlated with a decrease in late-stage cancer diagnosis through increased access to medical professionals and increased affordability of care [126,127]. Though this is encouraging, other studies have found publicly insured patients to have, on average, thicker melanoma than privately insured patients, likely because public insurance is not universally accepted and can lead to less timely care [128].…”

Liver cancer mapping based on actual medical treatment choices

“…area-based measures of poverty, education, racial/ethnic composition and acculturation) (McKernan et al, 2015), potential access (i.e. health insurance coverage, wait time and affordability of services) and spatial access (travel distance and neighborhood-level density of physicians) (Escobedo et al, 2017). In China, the real condition is more complex.…”