Differences in melanoma outcomes among Hispanic Medicare enrollees
Accepted 17 November 2009. published online 10 March 2010.
Background
Hispanics are given the diagnosis of melanoma at later stages and have reduced survival.
Objective
We sought to evaluate the effect of Hispanic ethnicity and different health care delivery systems (fee-for-service [FFS] and health maintenance organizations) on melanoma stage at diagnosis and survival.
Methods
We studied a retrospective cohort of 40,633 patients, with at least 3 years of follow-up, who were given the diagnosis of incident melanoma from 1991 to 2002 and were 65 years or older using data from the Surveillance, Epidemiology, and End Results–Medicare linked database. The analytic sample consisted of 39,962 non-Hispanic whites (NHW) and 671 Hispanics. Logistic regression models examined the roles of the health care delivery system and race/ethnicity in stage at diagnosis and survival.
Results
For FFS patients, Hispanics were more likely to be given a diagnosis at an advanced stage (distant vs earlier stages [odds ratio {OR} = 2.07; 95% confidence interval {CI} = 1.36-3.16]; regional vs earlier stages [OR = 2.31; 95% CI = 1.75-3.03]) compared with NHW. Among Hispanic patients, those enrolled in health maintenance organizations were less likely to be given a diagnosis at later stage (regional vs earlier stages [OR = 0.50; 95% CI = 0.31-0.81]) than FFS patients; however, the earlier stage at diagnosis did not improve survival. For patients with a previous cancer before their melanoma diagnoses, NHW enrolled in health maintenance organizations from 1991 to 2002 were given a diagnosis at earlier stages compared with NHW FFS patients (OR = 0.72; 95% CI = 0.52-0.99); this was not found among Hispanics.
Limitations
These results reflect findings in a Medicare-aged population and it is not clear if they are generalizable to younger patients.
Conclusions
Differences in melanoma outcomes among different ethnic groups are, in part, dependent on the health care setting in which patients are enrolled.
aDepartment of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
bDepartment of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida
cSylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
Reprint requests: Robert S. Kirsner, MD, PhD, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10 Ave, RMSB, Room 2023-A, Miami, FL 33136.
ABSTRACT