Differences in melanoma outcomes among Hispanic Medicare enrollees

Panta Rouhani, Kristopher Arheart, Robert Kirsner

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 languageEnglish
Pages (from-to)768-776
Number of pages9
JournalJournal of the American Academy of Dermatology
Volume62
Issue number5
DOIs
StatePublished - May 1 2010

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Medicare
Hispanic Americans
Melanoma
Fee-for-Service Plans
Health Maintenance Organizations
Delivery of Health Care
Odds Ratio
Confidence Intervals
Survival
Logistic Models
Delayed Diagnosis
Ethnic Groups
Epidemiology
Databases
Population
Neoplasms

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 journalArticle

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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.",
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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.

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