Disparities in melanoma incidence and mortality in rural versus urban Michigan

Abstract

Introduction: We sought to identifying the possible existence of disparities between rural and urban residents of Michigan for the incidence by stage of disease and disease-specific mortality for cutaneous melanoma (CM). Methods: Incidence rates for stage of disease and disease-specific mortality of cutaneous melanoma were calculated and controlled for gender, age, and area of residence from January 1, 2014, to December 31, 2018, from data collected form the Michigan Department of Health and Human Services and the Centers for Disease Control and Prevention.Results: The incidence rates for CM were significantly higher in rural Michigan counties, from 2014-2018, for all patients, both age groups, both genders and all stages. Melanoma-specific mortality rates were also significantly higher for all patients, both age groups and both genders in rural Michigan counties. Using logistic regression analysis, while controlling for age and gender, rural Michigan counties continued to have a higher melanoma-specific morality rate during our study period (OR = 1.491; 95% CI, 1.27-1.74; p = <.001). Conclusion:We found significant disparities in the incidence rates and disease specific mortality for cutaneous melanoma in rural compared to urban Michigan from 2014-2018.

Incidence Rates and Outcomes of Nodular and Superficial Spreading Melanoma along the Rural-Urban Continuum in Kentucky and Their Relationship to Provider Care Access

“…Several prior studies have reached similar findings concerning cause-specific mortality and rurality, without identifying access to care as a potential cause. Shellenberger et al 9 found both higher incidence and cause-specific mortality rates in rural versus urban Michigan counties. These findings were not correlated with differences in the number of practicing dermatologists per county or likely associated with differences in stage at presentation because even localized stage presentation differed significantly between rural and urban locations; the authors hypothesized that an inability to use race and/or insurance status as a covariate may have contributed to the observed patterns.…”

“…Henley et al 8 found higher incidence rates for melanoma in nonmetropolitan rural counties across the United States and higher cause-specific death rates in nonmetropolitan versus metropolitan counties overall. Shellenberger et al 9 found both incidence rates and cause-specific mortality rates for cutaneous melanoma to be significantly greater in rural Michigan counties. Alternatively, Haluza et al 10 found significantly higher melanoma incidence and cause-specific mortality rates in urban districts in Austria, yet somewhat conflicting patterns with respect to altitude.…”

The influence of rurality on melanoma diagnosis in Indiana: A retrospective cohort study

“…Research has shown that rurality is associated with higher age‐adjusted melanoma incidence rate and melanoma‐specific mortality rates, particularly in men. 1 , 2 , 3 Twenty‐two percent of Indiana residents live in counties with rural designations, and it is estimated that 2180 cases of melanoma will be diagnosed in Indiana in 2023. 4 , 5 To establish equitable care, it is imperative to identify and address associations between rurality and melanoma disease progression.…”

Rural Melanoma Patients Have Less Surgery and Higher Melanoma-Specific Mortality

“…12 When looking at patients with CM specifically, rural populations often have greater age-adjusted incidence rates 13 and melanoma-specific mortality rates. 14 Patients living in rural areas are more likely to experience delays in receiving a biopsy and have biopsies performed by primary care physicians, 15 when studies have shown that dermatologists detect CM at thinner depths and earlier stages. 16,17 In addition, patients with melanoma detected by a dermatologist are less likely to experience delays in surgery compared to a non-dermatologist provider 18 ; however, rural regions have decreased densities of dermatologists.…”

“…18 Additionally, those studies that did investigate rurality are in smaller, regional cohorts, or did not account for treatment receipt. 14 However, there is a gap in the literature on how geography directly impacts CM treatment receipt and survival. Therefore, we aimed to assess the association between rurality and receipt of recommended surgery and melanoma cause-specific mortality in a national cohort.…”