Examining the pathways linking lower socioeconomic status and advanced melanoma

Abstract

Low socioeconomic status (SES) is associated with more advanced melanoma at diagnosis and decreased survival. Exploring the pathways linking lower SES and thicker melanoma will help guide public and professional strategies to reduce deaths. The authors surveyed 566 newly diagnosed patients at Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System, and University of Michigan. SES was assessed by education level (high school/general education degree or less [HS], associate/technical school degree, or ≥college graduate). All data was obtained by self-report among patients within three months of their diagnosis. HS-educated individuals were significantly more likely than college graduates to believe that melanoma was not very serious (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.79-4.71) and were less likely to know the asymmetry, borders (irregular), color (variegated), and diameter (>6 mm) (ABCD) melanoma rule or the difference between melanoma and ordinary skin growths (OR, 0.34 [95% CI, 0.23-0.52] and 0.26 [95% CI, 0.16-0.41] respectively). Physicians were less likely to have ever told HS-educated versus college-educated individuals they were at risk for skin cancer (OR, 0.46; 95% CI, 0.31-0.71) or instructed them on how to examine their skin for signs of melanoma (OR, 0.40; 95% CI, 0.25-0.63). HS-educated individuals were less likely to have received a physician skin examination within the year before diagnosis (OR, 0.54; 95% CI, 0.37-0.80). Decreased melanoma risk perception and knowledge among low-SES individuals and decreased physician communication regarding skin examinations of these individuals may be key components of the consistently observed socioeconomic gradient in mortality. The current findings suggest the need to raise melanoma awareness among lower-SES patients and to increase physician awareness of socioeconomic disparities in clinical communication and care.