Trends in melanoma mortality among non-Hispanic whites by educational attainment

Thursday January 19, 2012

Study finds that recent declines in melanoma mortality in the US are largely confined to more educated groups

Objective:
To evaluate overall trends in melanoma mortality rates among non-Hispanic whites by educational level

Design:
Descriptive study

Setting:
Death certificate records from 26 states, representing approximately 45% of the US population as reported by the National Center for Health Statistics, with recorded educational level information and population data from the US Bureau of Census Current Population Survey

Patients:
Recorded deaths from malignant melanoma in non-Hispanic whites reported from 1993 through 2007

Main Outcome Measure:
Age-standardized mortality rates for melanoma were evaluated by educational attainment (a marker of socioeconomic status) among non-Hispanic whites (aged 25-64 years) from 1993 through 2007. Rate ratios assessed the time trend in age-adjusted death rates by sex and educational level. Mortality differentials in educational level were measured using the regression-based Relative Index of Inequality. All statistical tests were 2-sided.

Results:
Melanoma mortality declined significantly between 1993-1997 and 2003-2007 in men (RR [rate ratio], 0.916; 95% CI, 0.878-0.954; P < .001) and women (RR, 0.907; 95% CI, 0.857-0.957; P < .001). However, these declines occurred only among the most educated persons ( 13 years of education irrespective of sex), and nonsignificant increases were found among the least-educated individuals, specifically men (P = .17). As a result, the Relative Index of Inequality by education in melanoma mortality in 2003-2007 relative to 1993-1997 (baseline) widened by 51.7% in men and by 35.7% in women.

Conclusions:
Recent declines in melanoma mortality rates among non-Hispanic whites in the United States mainly reflect declines among the most-educated individuals. The widening disparities in melanoma mortality rates by education calls for early detection strategies to effectively target high-risk, less-educated, non-Hispanic white individuals.

Source:

Cokkinides VE, Geller AC, Jemal A. Arch Dermatol. Published online January 16, 2012. doi:10.1001/archdermatol.2011.2779
http://archderm.ama-assn.org/cgi/content/short/archdermatol.2011.2779