Background/Objectives: Later-stage melanoma at diagnosis is associated with increased mortality. Health care access, socioeconomic status, and neighborhood-level factors likely influence stage at presentation. This study aimed to examine whether neighborhood disadvantage, as measured by the Area Deprivation Index (ADI), is associated with later-stage melanoma diagnosis.Methods: We conducted a cross-sectional analysis of a retrospective cohort of 941 patients diagnosed with melanoma at a large academic medical center between 2010 and 2019. Residential addresses were geocoded and linked to ADI and rurality data. Covariates included race, ethnicity, age, gender, and insurance status. Multivariable logistic regression models with robust standard errors clustered at the census tract level were used to assess associations with melanoma stage at diagnosis.Results: Of 941 patients (63% male, 92.8% non-Hispanic White, mean age 64 years), 432 (46%) were diagnosed with late-stage melanoma. Mean ADI was higher among late-stage cases (5.4) compared to early-stage cases (3.3) (p< 0.001), even after adjustment for covariates. Non-Hispanic White race, private insurance, older age, and urban residences were associated with earlier stage at diagnosis. Racial disparities were attenuated after adjusting for ADI, with no significant interaction between race and ADI.Conclusions: Neighborhood disadvantage is significantly associated with later-stage melanoma diagnosis and contributes to observed racial and socioeconomic disparities. These findings highlight the need for targeted educational interventions and health policy initiatives to reduce late-stage melanoma diagnoses in vulnerable populations.
背景/目的：诊断时处于晚期的黑色素瘤与死亡率升高相关。医疗可及性、社会经济状况及社区层面因素可能影响就诊时的疾病分期。本研究旨在探讨以区域剥夺指数衡量的社区劣势是否与晚期黑色素瘤诊断相关。方法：我们对2010年至2019年间在某大型学术医疗中心确诊的941例黑色素瘤患者进行回顾性队列横断面分析。通过地理编码将居住地址与区域剥夺指数及乡村性数据关联。协变量包括种族、民族、年龄、性别和保险状况。采用以人口普查区为聚类单位、具有稳健标准误的多变量逻辑回归模型评估与诊断时黑色素瘤分期的关联性。结果：在941例患者中（男性占63%，非西班牙裔白人占92.8%，平均年龄64岁），432例（46%）被诊断为晚期黑色素瘤。即使调整协变量后，晚期病例的平均区域剥夺指数（5.4）仍显著高于早期病例（3.3）（p<0.001）。非西班牙裔白人、拥有私人保险、较高年龄及城市居住与较早诊断分期相关。调整区域剥夺指数后种族差异减弱，且种族与区域剥夺指数间未发现显著交互作用。结论：社区劣势与晚期黑色素瘤诊断显著相关，并导致观察到的种族和社会经济差异。这些发现强调需要针对弱势群体实施定向教育干预和卫生政策举措，以减少晚期黑色素瘤的诊断。
Association Between Area Deprivation Index and Melanoma Stage at Presentation
肿瘤(癌症)患者之家