Disparities in Melanoma Outcomes Found Between Urban and Rural Populations

Mata EM, Trinidad N, Blue E, Lobl M, Clarey D, Zheng C, Wysong A. Disparities in melanoma outcomes in urban versus rural settings: An analysis from the Nebraska cancer registry 2001-2016. J Am Acad Dermatol. 2023 Mar 21:S0190-9622(23)00450-4. doi: 10.1016/j.jaad.2023.02.057. Epub ahead of print. PMID: 36948296.

Male patients with melanoma living in rural areas were found to have a greater odds of death from melanoma when compared to their urban counterparts after controlling for gender, age, race, stage of disease, and site (OR 2.13 ;95% CI 1.93-2.36, P ≤ .0001).

Clinical Pearls

• This study looked at the difference in outcomes of rural and urban patients with melanoma in the state of Nebraska from the years 2001-2016

• 9,688 patients with melanoma were included in this study with the most affected sites being the trunk and limb area and the head and neck area for both rural and urban populations

• Male patients with melanoma living in rural areas were found to have a greater odds of death from melanoma when compared to their urban counterparts after controlling for gender, age, race, stage of disease, and site (OR 2.13 ;95% CI 1.93-2.36, P ≤ .0001)

Discussion:

This study by Mata et al. published in the Journal of American Academy of Dermatology sought to investigate how melanoma affects rural and urban populations differently. Melanoma causes the majority of deaths due to skin cancer and has been shown to have an increasing incidence in the United States.

Using data from the Nebraska Cancer Registry from 2001-2016, the authors gathered demographic and clinical information including each patients location (rural vs urban) for all patient’s diagnosed with melanoma during this time period. Additionally, mortality data was obtained via death certificates from the Department of Health and Human Services. Univariate and multivariate logistic regression models were then used to determine the odds ratio of death relating to each variable included.

Following data collection, 9,688 patients living in Nebraska were found to be diagnosed with melanoma. Of these, 38% lived in rural areas while 62% lived in urban areas. Of note, the authors did mention that near one-third of Nebraska’s population lives in rural areas. Additionally, the areas most commonly affected were the trunk and limb (most common) and the head and neck (second most common). Finally, male patients living in rural areas were found to have a higher odds of death from melanoma when compared to their urban counterparts (OR 2.13 ;95% CI 1.93-2.36, P ≤ .0001).