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Health Disparities Influence Childhood Melanoma Stage at Diagnosis and Outcome.
Hamilton, Emma C; Nguyen, Hoang T; Chang, Yu-Chia; Eberth, Jan M; Cormier, Janice; Elting, Linda S; Austin, Mary T.
Afiliação
  • Hamilton EC; Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
  • Nguyen HT; Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
  • Chang YC; Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
  • Eberth JM; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC; Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.
  • Cormier J; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
  • Elting LS; Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
  • Austin MT; Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Pediatric Patient Care, Children's Cancer Hospital, The Un
J Pediatr ; 175: 182-7, 2016 08.
Article em En | MEDLINE | ID: mdl-27233520
OBJECTIVE: To identify health disparities in pediatric patients with melanoma that affect disease presentation and outcome. STUDY DESIGN: This was a retrospective cohort study of all persons aged ≤18 years diagnosed with melanoma and enrolled in the Texas Cancer Registry between 1995 and 2009. Socioeconomic status (SES) and driving distance to the nearest pediatric cancer treatment center were calculated for each patient. Logistic regression was used to determine factors associated with advanced-stage disease. Life table methods and Cox regression were used to estimate survival probability and hazard ratios. RESULTS: A total of 185 adolescents (age >10 years) and 50 young children (age ≤10 years) were identified. Hispanics (n = 27; 12%) were 3 times more likely than non-Hispanic whites (n = 177; 75%) to present with advanced disease (OR, 3.8; 95% CI, 1.7-8.8). Young children were twice as likely as adolescents to present with advanced disease (OR, 2.2; 95% CI, 1.1-4.3). Distance to treatment center and SES did not affect stage of disease at presentation. Hispanics and those in the lowest SES quartile had a significantly higher mortality risk (hazard ratios, 3.0 [95% CI, 1.2-7.8] and 4.3 [95% CI, 1.4-13.9], respectively). In the adjusted survival model, only advanced disease was predictive of mortality (P < .001). CONCLUSION: Hispanics and young children with melanoma are more likely to present with advanced disease, and advanced disease is the single most important predictor of survival. Heightened awareness among physicians is needed to facilitate early detection of melanoma within these groups.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Cutâneas / Disparidades nos Níveis de Saúde / Disparidades em Assistência à Saúde / Melanoma Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Aspecto: Determinantes_sociais_saude / Equity_inequality / Patient_preference Limite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Newborn País/Região como assunto: America do norte Idioma: En Revista: J Pediatr Ano de publicação: 2016 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Cutâneas / Disparidades nos Níveis de Saúde / Disparidades em Assistência à Saúde / Melanoma Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Aspecto: Determinantes_sociais_saude / Equity_inequality / Patient_preference Limite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Newborn País/Região como assunto: America do norte Idioma: En Revista: J Pediatr Ano de publicação: 2016 Tipo de documento: Article País de publicação: Estados Unidos