Association of Indoor Tanning Regulations With Health and Economic Outcomes in North America and Europe

Abstract

he incidence of skin cancer in fair-skinned populations is high and increasing globally [1][2][3] such that total health care spending on its treatment is among the highest of all cancers in countries such as the United States, Denmark, and Australia. [4][5][6] The most common skin cancers are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) (collectively known as keratinocyte carcinomas). Melanoma is less common overall but is the most frequently diagnosed cancer in young adults 7 and is more serious, with 59 782 deaths from melanoma annually worldwide. 8 Exposure to UV radiation is the predominant cause of keratinocyte carcinomas and melanoma, 9 thus, these cancers are largely preventable by reducing personal exposure to UV radiation by sun protection 10 or avoidance of indoor tanning. 11 Indoor tanning devices (eg, sunbeds, tanning beds, and sunlamps) can emit high to extreme levels of UV radiation, 12 and in 2009. the International Agency for Research on Cancer (IARC) classified indoor tanning devices as carcinogenic to humans. 9 More than 20 countries have now legislated against indoor tanning for persons younger than 18 years (or even younger), whereas Australia has banned all commercial indoor tanning and Brazil has banned private and commercial indoor tanning. 13 Other countries have introduced various restrictions, such as preventing indoor tanning by UV-sensitive people, banning unsupervised access, licensing indoor tan-IMPORTANCE UV radiation emissions from indoor tanning devices are carcinogenic. Regulatory actions may be associated with reduced exposure of UV radiation at a population level.OBJECTIVE To estimate the long-term health and economic consequences of banning indoor tanning devices or prohibiting their use by minors only in North America and Europe compared with ongoing current levels of use. DESIGN, SETTING, AND PARTICIPANTSThis economic analysis modeled data for individuals 12 to 35 years old in North America and Europe, who commonly engage in indoor tanning. A Markov cohort model was used with outcomes projected during the cohort's remaining life-years. Models were populated by extracting data from high-quality systematic reviews and meta-analyses, epidemiologic reports, and cancer registrations.MAIN OUTCOMES AND MEASURES Main outcomes were numbers of melanomas and deaths from melanoma, numbers of keratinocyte carcinomas, life-years, and health care and productivity costs. Extensive sensitivity analyses were performed to assess the stability of results. RESULTSIn an estimated population of 110 932 523 in the United States and Canada and 141 970 492 in Europe, for the next generation of youths and young adults during their remaining lifespans, regulatory actions that ban indoor tanning devices could be expected to gain 423 000 life-years, avert 240 000 melanomas (−8.2%), and avert 7.3 million keratinocyte carcinomas (−7.8%) in North America and gain 460 000 life-years, avert 204 000 melanomas (−4.9%), and avert 2.4 million keratinocyte carcinomas (−4.4%) in Europe compare...

Epidemiology of Melanoma

“…Indoor tanning rates among US high school students declined from 15.6% in 2009 to 7.3% in 2015, although white, non-Hispanic young women continue to have the highest rates of usage [ 25 ]. A JAMA Dermatology economic analysis from 2020 concluded that banning indoor tanning among those under 35 could avert 448,000 cases of melanomas [ 26 ].…”

Association Between State Indoor Tanning Legislation and Google Search Trends Data in the United States From 2006 to 2019: Time-Series Analysis

“…The increase in indoor tanning restrictions may explain reductions in the number of indoor tanning providers, consumer spending on indoor tanning [5], and past-year indoor tanning among girls (24.1% in 2009 and 9.5% in 2015) and boys (5.7% in 2009 and 3.3% in 2015) attending high school and young adults aged 18-34 years (14% in 2007 and 4% in 2018) in the United States in recent years [3,6]. More stringent regulations have been associated with greater reductions in indoor tanning behavior and have been estimated to have a greater impact on melanoma incidence, mortality, and cost [7][8][9][10].…”

Sunbed Use among 11- to 17-Year-Olds and Estimated Number of Commercial Sunbeds in England with Implications for a ‘Buy-Back’ Scheme

“…In a large study in France, parents with a lower understanding of sun safety measures and less stringent protection behaviours had children engaging in fewer sun protection practices than children of parents who did practise sun protection [ 24 ]. Legislation banning commercial sunbeds sends a clear message from the government that they are protecting citizens’ health, and moreover it is highly likely to be an investment that will save healthcare costs in the longer-term [ 14 , 16 ].…”

“…Published point estimates for 15- to 19-year-old use in England from before the 2010 ban on sunbeds for under 18-year-olds [ 2 ] were projected to 2020 based on this two-yearly proportional decrease. Comparing the English projected estimate with <20-year-old European prevalence for 2020, extrapolated using the same trend from the 2012 and 2014 estimates, indicated that the ban further reduced sunbed use in adolescents by 39 percentage points [ 14 , 16 ].…”