Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 768-776 |
| Number of pages | 9 |
| Journal | Journal of the American Academy of Dermatology |
| Volume | 62 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2010 |
Fingerprint
Keywords
- cancer detection
- dermatoepidemiology
- epidemiology
- ethnic disparities
- health outcomes
- health services
- melanoma
- survival
ASJC Scopus subject areas
- Dermatology
Cite this
Differences in melanoma outcomes among Hispanic Medicare enrollees. / Rouhani, Panta; Arheart, Kristopher; Kirsner, Robert.
In: Journal of the American Academy of Dermatology, Vol. 62, No. 5, 01.05.2010, p. 768-776.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Differences in melanoma outcomes among Hispanic Medicare enrollees
AU - Rouhani, Panta
AU - Arheart, Kristopher
AU - Kirsner, Robert
PY - 2010/5/1
Y1 - 2010/5/1
N2 - 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.
AB - 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.
KW - cancer detection
KW - dermatoepidemiology
KW - epidemiology
KW - ethnic disparities
KW - health outcomes
KW - health services
KW - melanoma
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=77950595853&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77950595853&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2009.11.594
DO - 10.1016/j.jaad.2009.11.594
M3 - Article
C2 - 20219264
AN - SCOPUS:77950595853
VL - 62
SP - 768
EP - 776
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
SN - 0190-9622
IS - 5
ER -