Trends and Disparities in Total-Body Skin Examination: Evaluating the National Health Interview Survey, 2000-2010

Abstract

I mprovements in melanoma mortality have not occurred across all ethnic groups. Minorities are diagnosed with melanoma at a more advanced stage and, as a result, face worse prognoses. 1 Total-body skin examination (TBSE) may help identify early skin cancers, an important predictor of survival. 2,3 Few studies have examined differences in TBSE rates among different populations, and changes in survey methodology have hindered prior efforts to analyze trends. 4 Herein, we analyze newly released nationally representative survey data to examine trends and predictors of TBSE. Methods. Data were drawn from the 2000 and 2010 National Health Interview Survey (NHIS), an annual survey of US adults. Data are publicly available; institutional review board approval was not required. The outcome variable considered was whether individuals reported receiving a TBSE within the past year. Rates and trends in TBSE were examined, and a multivariate logistic model examining predictors of TBSE was constructed. Demographic covariates included in the model were age, sex, ethnicity, marital status, region, and having an income below the poverty level. Factors potentially impacting health-seeking behavior included were a prior personal or family history of skin cancer, education level, employment status, health insurance status, and whether an individual reported delaying health care in the past year because of cost. The frequencies with which individuals reported wearing a hat and using sunscreen when in the sun for over an hour were included, as was the reported effect on one's skin after an hour of sun exposure. Self-reported health status, body mass index, physical activity, as well as smoking and alcohol use were also included. The NHIS uses a stratified multistage sample design. Estimates were weighted to construct nationally representative estimates, and multivariate logistic analysis of pooled data was conducted (Stata software, version 11.2; StataCorp LP).

Patient-reported frequency of acral surface inspection during skin examination in white and ethnic minority patients

“…Furthermore, this study was conducted at one academic center in one region of the United States, and thus these findings may not be generalizable to other patient populations. Reported rates of FBSE in this study were higher than national rates, 10 but results of this study are consistent with national data suggesting that rates of FBSE are lower in ethnic minorities. Finally, since our study was based on self-reported surveys, we chose to analyze our data using odds ratios rather than relative risk.…”

“…Recent data from the 2010 National Health Institute Survey also found rates of FBSE to be higher in non-Hispanic whites compared to ethnic minority patients (13.4–13.9% vs. 1.2–8.1%). 10 This disparity seems to correlate with the current circumstances of ethnic minority patients having more advanced melanomas at diagnosis and increased mortality. 2–3,6 Bradford et al observed ethnic minority patients to have lower 5- and 10-year ALM survival rates; however, there were no differences in survival rates between different racial groups when controlling for tumor thickness or stage.…”

Prevalence and Predictors of Recent Skin Examination in a Population-Based Twin Cohort

“…Studies have differed with regards to gender, with some finding greater likelihood and higher prevalence of screening among females (21, 22); others finding higher rates among males (23); and others still observing no differences (24). Prevalence rates for ever having physician skin examination have been uniformly low, ranging from 14 percent to 21 percent of adults in the United States (24, 25) with one study estimating that only 24 percent of individuals considered high-risk for melanoma have ever screened (25).…”

“…To date, most population-based studies of skin screening have used the National Health Information Survey (NHIS) as a primary data source (19, 22–25). While such studies have the benefits of a large sample yielding nationally representative estimates, they have not included melanoma risk factors such as nevi and childhood UV exposure.…”

Primary Care for Melanoma: Should We Be Screaming for Screening?

“…30 Dermoscopy (several synonyms) is a hand-held, noninvasive, real-time imaging technique to aid in the detection of skin cancer, including melanoma. It is available, with training, for use by primary care physicians.…”